To assess the impact of maintenance nifedipine therapy on pregnancy duration in women with preterm placenta previa bleeding.
PPADAL was a randomized, double-blind, placebo-controlled trial conducted ...between 05/2008 and 05/2012 in five French hospitals. The trial included 109 women, aged ≥ 18 years, with at least one episode of placenta previa bleeding, intact membranes and no other pregnancy complication, at gestational age 24 to 34 weeks and after 48 hours of complete acute tocolysis. Women were randomly allocated to receive either 20 mg of slow-release nifedipine three times daily (n = 54) or placebo (n = 55) until 36 + 6 weeks of gestation. The primary outcome for the trial was length of pregnancy measured in days after enrolment. Main secondary outcomes were rates of recurrent bleeding, cesarean delivery due to hemorrhage, blood transfusion, maternal side effects, gestational age at delivery and adverse perinatal outcomes (perinatal death, chronic lung disease, neonatal sepsis, intraventricular hemorrhage > grade 2, perventricular leukomalacia > grade 1, or necrotizing enterocolitis). Analysis was by intention to treat.
Mean (SD) prolongation of pregnancy was not different between the nifedipine (n = 54) and the placebo (n = 55) group; 42.5 days ± 23.8 versus 44.2 days ± 24.5, p = 0.70. Cesarean due to hemorrhage performed before 37 weeks occurred more frequently in the nifedipine group in comparison with the placebo group (RR, 1.66; 95% confidence interval, 1.05-2.72). Adverse perinatal outcomes were comparable between groups; 3.8% for nifedipine versus 5.5% for placebo (relative risk, 0.52; 95% confidence interval 0.10-2.61). No maternal mortality or perinatal death occurred.
Maintenance oral nifedipine neither prolongs duration of pregnancy nor improves maternal or perinatal outcomes.
ClinicalTrials.gov NCT00620724.
To evaluate the status of congenital diaphragmatic hernia (CDH) management in France and to assess predictors of adverse outcomes.
We reviewed the first-year outcome of all cases of CDH reported to ...the French National Register in 2011.
A total of 158 cases were included. Of these, 83% (131) were prenatally diagnosed, with a mortality rate of 39% (44 of 112) for live born infants with a known outcome at hospital discharge. Mortality increased to 47% (60 of 128) including those with termination of pregnancy and fetal loss. This contrasts with the 7% (2 of 27) mortality rate of the patients diagnosed postnatally (P = .002). Mortality worsened with 1 prenatal marker of CDH severity (OR 3.38 1.30-8.83 P = .013) and worsened further with 2 markers (OR 20.64 5.29-80.62 P < .001). Classic postnatal risk factors of mortality such as side of hernia (nonleft P = .001), prematurity (P < .001), low birth weight (P = .002), and size of the defect (P < .001) were confirmed. Of the 141 live births (114 prenatal and 27 postnatal diagnosis) with known outcomes, 93 (67%) survived to hospital discharge, 68 (60%) with a prenatal diagnosis and 25 (93%) with a postnatal diagnosis. The median time to hospital discharge was 34 days (IQR, 19.25-62). Of these survivors, 71 (76%) were followed up for 1 year.
Despite advances in management of CDH, mortality was high and associated with prenatal risk factors. Postnatally, severe persistent pulmonary hypertension was difficult to predict and presented persistent challenges in management.
Objective: Preterm birth is the first cause of perinatal morbidity and mortality. Despite continuous clinical routine improvements, the preterm rate remains steady. Moreover, the specificity of the ...early diagnosis stays poor as many hospitalized women for preterm delivery threat finally deliver at term. In this context, the use of electrohysterograms may increase the sensitivity and the specificity of early diagnosis of preterm labor. Methods: This paper proposes a clinical application of electrohysterogram processing for the classification of patients as prone to deliver within a week or later. The approach relies on non-linear correlation analysis for the contraction bursts extraction and uses computation of various features combined with the use of Gaussian mixture models for their classification. The method is tested on a new dataset of 68 records collected on women hospitalized for preterm delivery threat. Results: This paper presents promising results for the automatic segmentation of the contraction and a classification sensitivity, specificity, and accuracy of, respectively, 80.7%, 76.3%, and 76.2%. Conclusion: These results are in accordance with the gold standards but have the advantage to be non-invasive and could be performed at home. Significance: Diagnosis of imminent labor is possible by electrohysterography recording and may help in avoiding over-medication and in providing better cares to at-risk pregnant women.
The objective of this paper is to evaluate the novel method for analyzing the nonlinear correlation of the uterine electromyography (EMG). The application of this method may improve monitoring in ...pregnancy, labor detection, and preterm labor detection. Uterine EMG signals recorded from a 4 × 4 matrix of electrodes on the subjects' abdomen are used here. The propagation was analyzed using the nonlinear correlation coefficient h 2 . Signals from 49 women (36 during pregnancy and 13 in labor) at different gestational age were used. ROC curves were computed to evaluate the potential of three methods to differentiate between 174 contractions recorded during pregnancy and 115 contractions recorded during labor. The results indicate considerably better performance of the nonlinear correlation analysis (area under curve = 0.85) when compared to classical frequency parameters (area under curve = 0.76 and 0.66) in distinguishing labor contractions from normal pregnancy contractions. We conclude that the analysis of the propagation of the uterine electrical activity using the nonlinear correlation coefficient h 2 is a promising way of improving the usefulness of uterine EMG signals for clinical purposes, such as monitoring in pregnancy, labor detection, and prediction of preterm labor.
L’accouchement prématuré est un problème de santé publique dans le monde et notamment dans les pays économiquement développés avec un taux variant entre 7 et 12 % des naissances. Le diagnostic du ...risque d’accouchement prématuré est difficile à faire et les outils à notre disposition ont peu évolué ces dernières années. La contraction utérine est la conséquence directe de l’activité électrique au niveau du myomètre. Le type de contraction est lié à l’importance de l’excitabilité cellulaire et de sa diffusion à l’ensemble du myomètre. Le recueil et l’analyse de cette activité électrique par des électrodes de surface est aujourd’hui le seul moyen non invasif d’étudier, pendant la grossesse, les mécanismes qui sont à l’origine de la contraction. L’enregistrement de l’électromyogramme utérin ou électrohystérogramme (EHG) est donc prometteur pour réaliser un diagnostic et une surveillance des femmes à risque d’accouchement prématuré. Dans ce travail de thèse 3 études cliniques ont été réalisées. Dans la première, j’ai étudié différentes électrodes de surface permettant d’enregistrer les signaux électriques. Je propose à la fin de cette première partie un système d’électrodes pour permettre à la fois un enregistrement de qualité et une pose aisée compatible avec une application clinique. Dans la deuxième étude j’ai étudié la détection automatique des contractions par l’EHG avec des résultats encourageants pour l’application clinique et notamment en ambulatoire. Enfin dans la troisième étude j’ai étudié la prédiction du risque d’accouchement prématuré par l’analyse de paramètres électriques issus de l’EHG. Les résultats obtenus permettent d’améliorer la prédiction du risque d’accouchement prématuré par rapport aux outils utilisés en routine.
Premature birth is a public health problem in the world, particularly in economically developed countries with a rate varying between 7% and 12% of births. The diagnosis of the risk of premature labor is difficult to make and the tools at our disposal have changed little in recent years. Uterine contraction is a direct consequence of electrical activity at the level of the myometrium. The type of contraction is related to the importance of cell excitability and its diffusion to the entire myometrium. The analysis of this electrical activity by surface electrodes is currently the only non-invasive way to study the mechanisms that are at the origin of the contraction. The recording of the uterine electromyogram or electrohysterogram (EHG) is therefore promising for the diagnosis and surveillance of women at risk of preterm birth. In this thesis work 3 clinical studies have been carried out. In the first clinical study, different surface electrodes to record electrical signals were tested. I propose at the end of this first part a system of electrodes to allow at the same time a recording of quality and an easy pose compatible with a clinical application. In the second study , the automatic detection of contractions by the El-IG was studied with encouraging results for the clinical application and especially in ambulatory. Finally, in the third clinical experiment, I studied the prediction of the risk of premature delivery by the analysis of electrical parameters extracted from the EHG. The results obtained make it possible to improve the prediction of the risk of premature delivery compared to the tools used routinely.
In 2008, a tertiary health care maternity set up a colour code organization for emergency caesarean to reduce the delay between decision and birth to thirty minutes.
The aim of this study is to ...determine the feasibility of the implementation in secondary health care maternity.
This retrospective study was conducted in secondary health care maternity and it was divided in two phases: phase I corresponding to the period before the implementation of colour code and phase II, to the period after the implementation of colour code. All patients who had an emergency caesarean were included. Then, we compared the decision to birth delay between the two phases and the neonatal state.
Two hundred and twenty patients were included (one hundred and thirteen for the first phase and one hundred and seven for the second). The rate of caesarean sections realized within thirty minutes was no different between two groups. Decision to birth delay is variable and tends to decrease between two phases (-7 min for orange code, p = 0.91; and -15 min for red code, p = 0.0769).
The medium pH is the same in both groups (7.30, p = 0.22) and the rate of transfer in neonatology is 29% for the first group and 13% in the second (p = 0.004)
This protocol has resulted in better care for patients who had an emergency caesarean section. Two elements are to be noticed as follows: a reduction of decision to birth delay for extremely emergency caesarean (p = 0.0769) and less transfer in neonatology (p = 0.004).
Vaccination reduces the risk of acute coronavirus disease 2019 (COVID-19) in children, but it is less clear whether it protects against long COVID. We estimated vaccine effectiveness (VE) against ...long COVID in children aged 5 to 17 years.
This retrospective cohort study used data from 17 health systems in the RECOVER PCORnet electronic health record program for visits after vaccine availability. We examined both probable (symptom-based) and diagnosed long COVID after vaccination.
The vaccination rate was 67% in the cohort of 1 037 936 children. The incidence of probable long COVID was 4.5% among patients with COVID-19, whereas diagnosed long COVID was 0.8%. Adjusted vaccine effectiveness within 12 months was 35.4% (95 CI 24.5-44.7) against probable long COVID and 41.7% (15.0-60.0) against diagnosed long COVID. VE was higher for adolescents (50.3% 36.6-61.0) than children aged 5 to 11 (23.8% 4.9-39.0). VE was higher at 6 months (61.4% 51.0-69.6) but decreased to 10.6% (-26.8% to 37.0%) at 18-months.
This large retrospective study shows moderate protective effect of severe acute respiratory coronavirus 2 vaccination against long COVID. The effect is stronger in adolescents, who have higher risk of long COVID, and wanes over time. Understanding VE mechanism against long COVID requires more study, including electronic health record sources and prospective data.
Plant organ growth results from the combined activity of cell division and cell expansion. The co-ordination of these two processes depends on the interplay between multiple hormones that determine ...the final organ size. Using the semidominant Hairy Sheath Frayed1 (Hsf1) maize mutant that hypersignals the perception of cytokinin (CK), we show that CK can reduce leaf size and growth rate by decreasing cell division. Linked to CK hypersignaling, the Hsf1 mutant has an increased jasmonic acid (JA) content, a hormone that can inhibit cell division. The treatment of wild-type seedlings with exogenous JA reduces maize leaf size and growth rate, while JA-deficient maize mutants have increased leaf size and growth rate. Expression analysis revealed the increased transcript accumulation of several JA pathway genes in the Hsf1 leaf growth zone. A transient treatment of growing wild-type maize shoots with exogenous CK also induced the expression of JA biosynthetic genes, although this effect was blocked by the co-treatment with cycloheximide. Together, our results suggest that CK can promote JA accumulation, possibly through the increased expression of specific JA pathway genes.
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