Publications by authors named "Thubert T"
Background: Preeclampsia (PE) contributes to maternal and fetal mortality and morbidity. Supplementation with L-arginine, the precursor of nitric oxide, has not proven effective, possibly due to extensive arginine catabolism in the splanchnic bed. Citrulline is converted by the kidney to L-arginine.
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- This study investigated the incidence and risk factors for complete uterine rupture among women attempting vaginal birth after cesarean delivery (VBAC) over a 16-year period in France.
- Out of 48,124 patients with a prior cesarean section, 65.8% attempted a VBAC, with a uterine rupture rate of 0.63%.
- Key findings indicated that prior vaginal delivery decreased the risk of uterine rupture, while labor induction increased it; additionally, specific factors during spontaneous labor, like a low Bishop score and an arrest of cervical dilation, also heightened the risk.
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- Laparoscopy surgery introduces challenges like fatigue that can impact surgeons' performance, necessitating a study to understand fatigue's effects on surgical precision and safety.
- This research involves 29 surgical residents and focuses on how general fatigue affects their performance during training exercises, evaluating criteria such as movement quality, muscle activation, and perceived workload.
- The study is ethically approved and aims to publish its findings in scientific journals and present them at international conferences to enhance future research.
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- This study investigates the effectiveness of uterine artery embolization (UAE) with gelatin foam to manage delayed bleeding caused by vascularized retained products of conception (vRPOC) after abortion or miscarriage during a 5-year period at 11 French hospitals.
- Out of 224 patients evaluated, 94.2% experienced clinical success, although 7.3% showed persistent vRPOC at imaging follow-ups, with some minor and major complications reported.
- The results suggest that while UAE with gelatin foam is generally safe and effective, certain factors like having a hypertrophic uterine artery and using gelatin foam torpedoes may increase the risk of persistent bleeding issues.
Objective: To propose guidelines for the management of complications of prosthetic mid-urethral tape surgery for stress urinary incontinence in women.
Methods: These guidelines are based on an exhaustive literature review on retropubic and trans-obturator mid-urethral tape complications. The expert panel rated the level of evidence of each study, summarized literature for the treatment of each complication, and proposed guidelines.
Background: The French Health Authority (Haute Autorité de santé) and French scientific societies (Collège national des gynécologues et obstétriciens français) recommend the use of midurethral slings as the surgical treatment of choice for stress incontinence due to urethral hypermobility and failure of hygienic diet and pelvic rehabilitation. Within a year of implantation, almost 90% of patients no longer experience stress urinary incontinence. Despite their recognized efficacy, retropubic and/or trans-obturator midurethral sling can expose patients to potentially severe infectious complications.
View Article and Find Full Text PDFBackground: Recent recommendations from the French High Authority of Health on pelvic organ prolapse (POP) management underline the value of a pelvic examination.
Objectives: The aim of this paper was to analyze the literature and identify the best evidence available regarding pelvic examination for women presenting prolapse-associated symptoms in terms of diagnosis and predictability of treatment success.
Search Strategy: The databases were queried similarly using Medical Subject Headings (MeSH) and non-MeSH terms broadly related to pelvic examination and POP management.
Objective: To evaluate the health status and recovery of women after mid-urethral sling (MUS) revision in response to complications.
Design: Cross-sectional study using a questionnaire sent to women from a registry.
Setting: Twenty-two French surgical centres.
Article Synopsis
- The French National Authority for Health reviewed literature on complications from pelvic organ prolapse (POP) surgery using synthetic mesh, which are rare but can severely impact women's quality of life, leading to multidisciplinary clinical practice recommendations with graded levels of evidence.
- Patients must be adequately informed about the risks of POP surgery, with specific guidelines suggesting against certain practices like vaginal packing and requiring alternative surgical techniques in complex cases.
- For bladder injuries during surgery, recommended practices include suturing and monitoring ureter permeability, with potential use of a prosthetic mesh post-repair for better outcomes.
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- Surgical residents in France currently lack a standardized framework for assessing their autonomy in the operating room, which is crucial for their confidence and future independent practice.
- The study reviewed 231 publications and identified 21 that met specific criteria, revealing a variety of autonomy assessment tools, with the Zwisch Scale being the most commonly used among them.
- The research highlights the need for better-defined measures of surgical autonomy, as well as understanding the various factors that influence it, to enhance training and teaching methods in the surgical field.
Background: Midurethral slings are the gold standard for treating stress urinary incontinence, but their complications may raise concerns. Complications may differ by the approach used to place them.
Objective: This study aimed to compare serious complications and reoperations for recurrence after midurethral sling procedures when using the retropubic vs the transobturator route for female stress urinary incontinence.
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- The study aimed to evaluate different treatment options for women diagnosed with interstitial pregnancy (IP) by analyzing outcomes from various therapeutic methods between January 2008 and December 2019.
- Three treatments were assessed: surgical treatment (ST), in situ methotrexate combined with systemic methotrexate (IS-MTX), and systemic methotrexate alone (IM-MTX). Success rates differed significantly, with ST showing a 100% success rate, while IS-MTX and IM-MTX had 70.6% and 31% success rates, respectively.
- The findings suggest that ST and IS-MTX are effective for IP, while IM-MTX is less effective. Emergency surgery is recommended
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- Anti-D immunoglobulin injections are mainly given to prevent alloimmunization during pregnancy, particularly before 12 weeks of gestation, but their effectiveness at this stage is less clear compared to later injections.
- A study conducted at Nantes University Hospital in 2018 analyzed the costs of three different alloimmunization prevention strategies in France, the UK, and the Netherlands, focusing on women treated before 12 weeks.
- Findings showed that the average cost of prevention in France was significantly higher (around €117.8 per episode) compared to potential savings of about 60% if UK or Dutch guidelines were followed, indicating a need for practice modifications to reduce costs.
Background: Central sensitization is frequently associated with chronic pelvic pain and requires specific management. The pain is described as hypersensitivity to an innocuous stimulus that is both widespread and persistent. However, no study has evaluated if central sensitization can be measured objectively with neurophysiological tests in the pelvic and perineal area to prove this concept in women with chronic pelvic pain.
View Article and Find Full Text PDFManagement of women with abnormal uterine bleeding: Clinical practice guidelines of the French National College of Gynaecologists and Obstetricians (CNGOF).
Eur J Obstet Gynecol Reprod Biol
September 2023
Objective: To provide French guidelines for the management of women with abnormal uterine bleeding (AUB).
Design: A consensus committee of 26 experts was formed. A formal conflict-of-interest policy was developed at the beginning of the process and enforced throughout.
[Pelvic exam in gynecology and obstetrics: Guidelines for clinical practice].
Gynecol Obstet Fertil Senol
June 2023
Article Synopsis
- The objective of the guidelines is to standardize the pelvic clinical exam for gynecology and obstetrics, ensuring practices are evidence-based.
- A committee of 45 experts, including patient representatives, developed these guidelines independently, focusing on high-quality recommendations using the GRADE® system.
- They formulated 40 questions into a PICO format, yielding 27 recommendations, with differing levels of agreement, while highlighting the need for more research in areas lacking evidence.
Article Synopsis
- - The study aimed to evaluate how maternal isolation during the post-birth period (especially during COVID-19 lockdown) affected postpartum depression (PPD) rates in 265 new mothers, finding that isolation led to higher PPD symptoms shortly after childbirth but not at later time points.
- - Results showed that during lockdown, 31% of mothers reported higher PPD symptoms on day 3 compared to 17.8% for those outside lockdown, with notable psychological impacts on partners, indicating that isolation may exacerbate emotional distress.
- - Factors that increased PPD risk included prior psychological abuse, stressful life events, and negative birth experiences, while having more than one child appeared to offer some protection against PPD symptoms.
Introduction: Postpartum ovarian vein thrombosis (POVT) is a rare but serious postpartum complication that can be life-threatening due to its embolic and septic risks. The clinical and paraclinical diagnosis is difficult because of the non-specific signs and the absence of a gold standard for imaging. There is no consensus in the literature on the treatment and follow-up of these patients.
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- The study aimed to determine if ropivacaine infiltration after an episiotomy reduces postpartum pain compared to a placebo.
- Conducted in two French maternity units, 272 women participated, receiving either ropivacaine or placebo before episiotomy repair, with follow-ups at various intervals.
- Results showed no significant difference in perineal pain rates or other secondary outcomes between the two groups, indicating that ropivacaine infiltration did not offer any added benefit over placebo.
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- A vaginal delivery simulation program was implemented for obstetric and gynecology residents to improve skills and reduce maternal-fetal mortality during twin pregnancies.
- The program included theoretical and practical components, followed by an evaluation based on the Kirkpatrick model to measure effectiveness.
- Residents reported increased confidence and technical skills after the simulation, with unanimous agreement on the realism and importance of the training session for their education.
Objective: To analyze outcomes and postoperative complications in patients undergoing robot-assisted isthmocele repair.
Method: This retrospective cohort study included 33 patients who had robot-assisted laparoscopic surgical management of an isthmocele between September 2013 and August 2020 in two French university hospitals. All charts were reviewed to identify patient characteristics, preoperative and postoperative anatomical findings, complications, and postoperative fertility and symptoms.
Local injection of methotrexate ultrasound guided-transvaginal.
J Gynecol Obstet Hum Reprod
September 2022
Article Synopsis
- * Traditional treatments often involved invasive surgeries, but advancements in imaging now allow for earlier diagnosis and conservative management to help preserve the patient's fertility.
- * The article focuses on a technique for delivering Methotrexate via vaginal injection under ultrasound guidance, which has shown promising results for treating non-tubal ectopic pregnancies.
Background: Miscarriage is a frequent problem that requires dilation and curettage in 30% of cases. This routine surgery may lead to intrauterine adhesions and severe infertility. Hyaluronic acid gel is known to reduce intrauterine adhesions after hysteroscopic surgery.
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