B Guidicelli

Assistance Publique Hôpitaux de Marseille, Marseille, Provence-Alpes-Cote d'Azur, France

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Publications (19)21.6 Total impact

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    ABSTRACT: To assess preterm birth rate, in patients admitted for threatened preterm birth (TPB) in a tertiary care maternity center and evaluate our diagnostic and therapeutic tools. A retrospective cohort study, in a tertiary care maternity center (Marseille, France), reviewed all admissions for TPB from January 1 to December 31, 2009. We recorded 224 admissions for TPB (181 single pregnancies and 43 twin pregnancies), 43.8% of TPB admissions were from materno-fetal transfer. Preterm birth rate was 44.9% (n=89), 39% (n=66) for single pregnancy and 76.6% (n=23) for twins. The 15mm threshold for transvaginal sonography cervical length (CL) was the most relevant to predict the risk of preterm delivery, 77.3% (85/110) of patients with CL>15mm having full term delivery. For single pregnancy, most of the patients with cervical length>15mm have full term delivery. It seems important to us to develop the use of more efficient predictive markers of risk-premature labor in order to improve the diagnosis and management of TPB.
    Journal de Gynécologie Obstétrique et Biologie de la Reproduction 12/2013; · 0.45 Impact Factor
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    ABSTRACT: Objectives To evaluate efficacy and safety of cervical ripening with repeated administration of dinoprostone slow release vaginal pessary (Propess®) in current practice.Patients and methodsAn observational study of 111 women who underwent cervical ripening with two Propess® during the study period from 1st July 2007 to 31st October 2011. Modes of delivery, success of cervical ripening, failure of labor induction, maternal and neonatal morbidity were reported.ResultsThe nulliparous rate was 75,7%. The main indications for induction of labor were post-term pregnancy in 34,3% (38/111) and premature rupture of membranes in 25,2% (28/111). The rate of vaginal delivery was 53,1% (59/111). Cesarean sections were performed for failure of labor induction in 27/52 (51,9%) and an abnormal fetal heart rate in 17/52 (32.7%). Indication for induction of labor, nulliparous patients (44 [84.6%] versus 40 [67.8%]; P = 0.04), initial Bishop score (2.2 ± 1.2 versus 2.9 ± 1.2; P = 0.04) before the cervical ripening and Bishop score before administration of second Propess® (3.3 ± 1.4 versus 4.0 ± 1.2; P = 0.05) were significant risk factors of cesarean delivery.Discussion and conclusionIn more than half of the cases, the cervical ripening by two Propess® is efficient and allows a vaginal delivery. This practice does not appear to increase the maternal or neonatal morbidity.
    Gynécologie Obstétrique & Fertilité 06/2013; 41(6):346–350. · 0.55 Impact Factor
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    ABSTRACT: OBJECTIVES: To evaluate efficacy and safety of cervical ripening with repeated administration of dinoprostone slow release vaginal pessary (Propess(®)) in current practice. PATIENTS AND METHODS: An observational study of 111 women who underwent cervical ripening with two Propess(®) during the study period from 1st July 2007 to 31st October 2011. Modes of delivery, success of cervical ripening, failure of labor induction, maternal and neonatal morbidity were reported. RESULTS: The nulliparous rate was 75,7%. The main indications for induction of labor were post-term pregnancy in 34,3% (38/111) and premature rupture of membranes in 25,2% (28/111). The rate of vaginal delivery was 53,1% (59/111). Cesarean sections were performed for failure of labor induction in 27/52 (51,9%) and an abnormal fetal heart rate in 17/52 (32.7%). Indication for induction of labor, nulliparous patients (44 [84.6%] versus 40 [67.8%]; P=0.04), initial Bishop score (2.2±1.2 versus 2.9±1.2; P=0.04) before the cervical ripening and Bishop score before administration of second Propess(®) (3.3±1.4 versus 4.0±1.2; P=0.05) were significant risk factors of cesarean delivery. DISCUSSION AND CONCLUSION: In more than half of the cases, the cervical ripening by two Propess(®) is efficient and allows a vaginal delivery. This practice does not appear to increase the maternal or neonatal morbidity.
    Gynécologie Obstétrique & Fertilité 04/2013; · 0.55 Impact Factor
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    ABSTRACT: Objectives To assess preterm birth rate, in patients admitted for threatened preterm birth (TPB) in a tertiary care maternity center and evaluate our diagnostic and therapeutic tools. Materials and methods A retrospective cohort study, in a tertiary care maternity center (Marseille, France), reviewed all admissions for TPB from January 1 to December 31, 2009. Results We recorded 224 admissions for TPB (181 single pregnancies and 43 twin pregnancies), 43.8% of TPB admissions were from materno-fetal transfer. Preterm birth rate was 44.9% (n = 89), 39% (n = 66) for single pregnancy and 76.6% (n = 23) for twins. The 15 mm threshold for transvaginal sonography cervical length (CL) was the most relevant to predict the risk of preterm delivery, 77.3% (85/110) of patients with CL > 15 mm having full term delivery. Conclusion For single pregnancy, most of the patients with cervical length > 15 mm have full term delivery. It seems important to us to develop the use of more efficient predictive markers of risk-premature labor in order to improve the diagnosis and management of TPB.
    Journal de Gynécologie Obstétrique et Biologie de la Reproduction. 01/2013;
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    ABSTRACT: Abstract Objective: to assess the incidence of respiratory distress syndrome (RDS) in late preterm (34(0/7)-36(6/7)) and just term (37(0/7)-37(6/7)) infants born via elective caesarean section (CS) in a tertiary care maternity facility. Methods: retrospective cohort study between 2005 and 2009. 188 near term infants, divided in 2 groups: groupe A: 125 late preterm (340/7to 366/7) and group B: 63 just term (370/7to 376/7), from elective CS (except CS after premature rupture of membranes and foetuses presenting congenital malformation), were included. Results: In group A the overall incidence of RDS (RDS at or shortly after birth, requiring respiratory support or oxygen therapy) was 44% (n=55) vs 15.9% (n=10) in group B (p<0.01). The incidence of SRDS (requiring admission in the neonatal intensive care unit (NICU)) in group A was 13.6% (n=17) and 3.2% (n=2) group B (p<0.01). The risk decreased significantly as gestational age increased: for RDS, 50.9% at 34 WG, 52.5% at 35 WG, 21.5% at 36 WG, and 15.9% at 37 WG; for admission, 30.2% at 34 WG, 25% at 35 WG, 9.4% at 36 WG, and 6.3% at 37 WG. Among late preterm infants with RDS, 30.9% (n=17) developed Severe RDS. Conclusions: Late preterm infants born via elective CS are at high risk for RDS and NICU admission. The risk is influenced by each additional week spent in utero. As the incidence of CS is increasing within this population, new preventative strategies must be sought.
    The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 09/2012; · 1.36 Impact Factor
  • Archives De Pediatrie - ARCHIVES PEDIATRIE. 01/2011; 18(5).
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    ABSTRACT: Neural tube defects (NTDs) are severe congenital malformations due to failure of neural tube formation in early pregnancy. The proof that folic acid prevents NTDs raises the question of whether other parts of homocysteine (Hcy) metabolism may affect rates of NTDs. This French case-control study covered: 77 women aged 17-42 years sampled prior to elective abortion for a severe NTDs (cases) and 61 women aged 20-43 years with a normal pregnancy. Plasma and erythrocyte folate, plasma B6, B12 and Hcy were tested as five polymorphisms MTHFR 677 C --> T, MTHFR 1298 A --> C, MTR 2756 A --> G, MTTR 66 A --> G and TCN2 776 C --> G. Cases had significantly lower erythrocyte folate, plasma folate, B12 and B6 concentrations than the controls, and higher Hcy concentration. The odds ratio was 2.15 (95% CI: 1.00-4.59) for women with the MTRR 66 A --> G allele and it was decreased for mothers carrying the MTHFR 1298 A --> C allele. In multivariate analysis, only the erythrocyte folate concentration (P = 0.005) and plasma B6 concentration (P = 0.020) were predictors. Red cell folate is the main determinant of NTDs in France. Folic acid supplement or flour fortification would prevent most cases. Increased consumption of vitamins B12 and B6 could contribute to the prevention of NTDs. Genetic polymorphisms played only a small role. Until folic acid fortification becomes mandatory, all women of reproductive age should consume folic acid in a multivitamin that also contains B12 and B6.
    American Journal of Medical Genetics Part A 06/2008; 146A(9):1128-33. · 2.30 Impact Factor
  • International Journal of Obstetric Anesthesia 11/2007; 16(4):383-4. · 1.80 Impact Factor
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    ABSTRACT: To develop a nomogram to predict macrosomia with a combination of clinical and ultrasound variables. Data from 194 women who underwent sonographic fetal weight estimation were used to develop and calibrate a nomogram to predict fetal macrosomia. The nomogram was subjected to 200 bootstrap resamples for internal validation and to reduce overfit bias. An Internet-based tool was developed to facilitate use of the nomogram. The macrosomia prediction nomogram, based on parity, ethnicity, body mass index and fetal weight estimated macrosomia, had good discrimination and calibration before and after bootstrapping (area under curve (AUC), 0.860 and 0.850, respectively). The predictive accuracy of our nomogram was significantly better than was sonographically estimated fetal weight using Hadlock's formula (AUC, 0.740; P<0.001). We have provided a web-based interface to predict the individual probability of macrosomia. We have developed a nomogram to predict the individual probability of macrosomia based on clinical and ultrasound findings. Our web-based interface should help to guide patients and physicians in decision-making.
    Ultrasound in Obstetrics and Gynecology 05/2007; 29(5):544-9. · 3.56 Impact Factor
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    ABSTRACT: To evaluate the efficacy of cervix ripening with vaginal controlled-release Propess. A retrospective study of all women who underwent cervical ripening with Propess during the study period from 1(st) January 2002 to 31(st) December 2004 was carried out. A total of 130 patients who experienced Propess was compared with the next following patient who delivered spontaneously matched on gestational age. Modes of delivery, failure of labor, maternal morbidity were recorded. Indications for induction of labor were: post-term pregnancies in 18.5%, pre-eclampsia in 20.8%, oligohydroamnios in 18.5%, post-term pregnancy and oligohydramnios in 10.8%, intra-uterine fetal growth in 6.9%, premature rupture of membranes in 6.9%, diminution of fetal mobility in 6.1% and miscellaneous in 11.5%. Failure of cervical ripening was 21.2%. Patients in the Propess group had a 3.5 fold higher risk of Cesarean section [95% CI: 1.5-8.3; P < 0.04]. There was no case of maternal or fetal death. There was no difference in incidence of maternal complications, and post-partum haemorrhage. Use of vaginal pessary Propess does not induce adverse maternal or fetal morbidity. However, it was associated with a higher incidence of Cesarean delivery.
    Gynécologie Obstétrique & Fertilité 06/2006; 34(6):489-92. · 0.55 Impact Factor
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    ABSTRACT: To determine risk factors of failed labor in case of fetal macrosomia. Medical charts of two hundred and forty six women who delivered macrosomic infants (>4,000g) between January 2004 and May 2005 were reviewed. Maternal and obstetrical data were analyzed by mode of delivery. Univariate and multivariate (logistic regression analysis) were performed to identify risk factors of failed labor. Rate of cesarean delivery was 18.3%. Indications for cesarean were: failure to progress in 55.6%, arrest in fetal descent in 22.2%, fetal distress in 6.7%, and other in 8.9%. There was a higher risk of failed labor in nulliparous women (p<0.001), in case of a symphysio-fundal measurements>34cm (p=0.004), in nulliparity associated with symphysio-fundal measurements>34cm (p<0.001), in case of previous cesarean delivery (p=0.004), in cases of maternal height<1.65m (p=0.02), and with ocytocin use (p=0.05). In multivariate analysis, nulliparity associated with symphysio-fundal measurements>34cm (OR=5.2; CI 1.5-18.4), previous cesarean section (OR=3.7; CI 1.1-12.4) and maternal height<1.65m (OR=2.6; CI 1.2-5.5) were independent factors of failed labor. Failure of labor in case of macrosomia can be predicted in the event of previous cesarean section, shorter maternal height, and association of nulliparity and symphysio-fundal measurements>34cm.
    Journal de Gynécologie Obstétrique et Biologie de la Reproduction 05/2006; 35(3):265-9. · 0.45 Impact Factor
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    ABSTRACT: To evaluate the safety and efficacy of termination of pregnancy using mifepristone and misosprostol at more than 15 weeks' gestation in patients with uterine scar due to previous cesarean section. This retrospective study was conducted in a tertiary maternity ward between January 2000 and October 2004. A total of 252 women at more than 15 weeks' gestation underwent termination of pregnancy including 50 women with uterine scar due to previous cesarean section (Group 1) and 202 control patients (Group 2) without known uterine scar. Abortion was induced with mifepristone and a prostaglandin analogue. Women between 15 and 34 weeks' gestation received misoprostol intravaginally every 3 h at doses of 200 microg (Group 1) or 400 microg (Group 2). Women at more than 34 weeks' gestation received Prostin E2 vaginal gel. Main end points were hemorrhage, fever, retained placenta, occurrence of complications including uterine rupture and dehiscence, and final outcome. A total of 13 (26%) patients in Group 1 and 79 (39.1%) in Group 2 were at more than 24 weeks' gestation. The abortion failure rate was 2% (1/50) in Group 1 and 0.5% (1/202) in Group 2 (p = .28). The median induction-to-delivery interval was 8.5 h (range, 3.0-114.2 h) for Group 1 and 9.0 h (range, 1.3-124.3 h) in Group 2 (p = .26). One case of uterine rupture and one case of dehiscence were observed, both in women in Group 1. The incidence of hemorrhage was not significantly different between Group 1 and Group 2 (2% vs. 0.9%, respectively, p = .56). The incidence of retained placenta was higher in the Group 1 (70% vs. 52.5%, respectively, p = .025). In this retrospective series of women who underwent abortion at 15-35 weeks' gestation using mifepristone and a prostaglandin analogue for labor induction abortion, history of cesarean section was not associated with higher morbidity except risk of uterine rupture. However, dose and interval of misoprostol should be determined. A larger study is needed before drawing definitive conclusions about the safety of these regimens.
    Contraception 04/2006; 73(3):244-8. · 3.09 Impact Factor
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    ABSTRACT: Objective To determine risk factors of failed labor in case of fetal macrosomia. Materials and methods Medical charts of two hundred and forty six women who delivered macrosomic infants (>4,000g) between January 2004 and May 2005 were reviewed. Maternal and obstetrical data were analyzed by mode of delivery. Univariate and multivariate (logistic regression analysis) were performed to identify risk factors of failed labor. Results Rate of cesarean delivery was 18.3%. Indications for cesarean were: failure to progress in 55.6%, arrest in fetal descent in 22.2%, fetal distress in 6.7%, and other in 8.9%. There was a higher risk of failed labor in nulliparous women (p<0.001), in case of a symphysio-fundal measurements >34cm (p=0.004), in nulliparity associated with symphysio-fundal measurements >34cm (p<0.001), in case of previous cesarean delivery (p=0.004), in cases of maternal height <1.65m (p=0.02), and with ocytocin use (p=0.05). In multivariate analysis, nulliparity associated with symphysio-fundal measurements >34cm (OR=5.2; CI 1.5-18.4), previous cesarean section (OR=3.7; CI 1.1-12.4) and maternal height <1.65m (OR=2.6; CI 1.2-5.5) were independent factors of failed labor. Conclusion Failure of labor in case of macrosomia can be predicted in the event of previous cesarean section, shorter maternal height, and association of nulliparity and symphysio-fundal measurements >34cm.
    Fuel and Energy Abstracts 01/2006; 35(3):265-269.
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    ABSTRACT: To study maternal and anthropomorphic parameters as potential risk factors for shoulder dystocia. From a series of 9667 vaginal deliveries between January 1998 and December 2003, a total of 138 cases complicated by shoulder dystocia were retrospectively identified and compared with a control group of 138 uncomplicated vaginal deliveries. In addition to maternal age, parity, diabetes, body mass index (BMI), and ethnicity, anthropometric factors including maternal height-to-infant weight ratio, characteristics of labor, management techniques, and outcome were evaluated as possible risk factors for shoulder dystocia. The overall incidence of shoulder dystocia in this retrospective series of vaginal deliveries was 1.4%. In univariate analysis, maternal obesity (OR; 95% CI: 3.6; 2.1-6.3), diabetes (OR: 19.4; 2.5-145.7), parity greater than 2 (OR: 2.5; 1.4-4.4), maternal height-to-infant weight ratio (OR: 1.02; 1.01-1.04; P < 0.001), and infant weight-to-maternal BMI ratio (OR: 1.02; 1.01-1.03; P < 0.001) were predictive of shoulder dystocia. In multiple regression analysis, obesity and multiparity were the most significant maternal risk factors for shoulder dystocia. The only anthropometric factors associated with shoulder dystocia in multiple regression analysis were maternal height <1.55 m (OR: 6.6; 1.3-34.9) and maternal height-to-infant weight ratio (OR: 1.02; 1.01-1.05). Shoulder dystocia may be anticipated in cases involving short women and discrepancy between maternal height or weight and infant weight.
    Acta Obstetricia Et Gynecologica Scandinavica 01/2006; 85(5):567-70. · 1.85 Impact Factor
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    ABSTRACT: Objective To evaluate the efficacy of cervix ripening with vaginal controlled-release Propess®.Patients and methodsA retrospective study of all women who underwent cervical ripening with Propess® during the study period from 1st January 2002 to 31st December 2004 was carried out. A total of 130 patients who experienced Propess® was compared with the next following patient who delivered spontaneously matched on gestational age. Modes of delivery, failure of labor, maternal morbidity were recorded.ResultsIndications for induction of labor were: post-term pregnancies in 18.5%, pre-eclampsia in 20.8%, oligohydroamnios in 18.5%, post-term pregnancy and oligohydramnios in 10.8%, intra-uterine fetal growth in 6.9%, premature rupture of membranes in 6.9%, diminution of fetal mobility in 6.1% and miscellaneous in 11.5%. Failure of cervical ripening was 21.2%. Patients in the Propess® group had a 3.5 fold higher risk of Cesarean section [95% CI: 1.5–8.3; P < 0.04]. There was no case of maternal or fetal death. There was no difference in incidence of maternal complications, and post-partum haemorrhage.Discussion and conclusionUse of vaginal pessary Propess® does not induce adverse maternal or fetal morbidity. However, it was associated with a higher incidence of Cesarean delivery.
    Gynécologie Obstétrique & Fertilité 01/2006; 34(6):489-492. · 0.55 Impact Factor
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    ABSTRACT: Cancer of the biliary tract has a poor prognosis and its association with pregnancy is uncommon. Early diagnosis allowing curative surgical resection offers the only hope of long-term survival. This report describes the case of a young 26-week-pregnant woman admitted for cholestatis documented by clinical and laboratory examination. Ultrasonography (US) and magnetic resonance cholangiopancreatography (MRCP) were indicative of common bile tract obstruction. Caesarian section was performed at 32 weeks of pregnancy and the tumor was promptly biopsied. Histology demonstrated carcinoma of the ampulla of Vater. The patient underwent a Whipple procedure. Both mother and baby survived. Pregnant patients with digestive cancer require careful management. Acute non-invasive assessment and radical surgery improve outcome for both the mother and fetus.
    European Journal of Obstetrics & Gynecology and Reproductive Biology 05/2005; 119(2):246-9. · 1.84 Impact Factor
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    ABSTRACT: Fetal brain tumors are rare and teratoma is considered as the most common. Fetal MR Imaging is currently used to evaluate cases of ventricular dilatation. We report a case of cerebral immature teratoma detected by ultrasonography because of ventricular dilatation at 24 gestational weeks. MRI was the more accurate imaging method in depicting the tumor and its consequences on brain development as well as in taking a decision with regard to the management of pregnancy.
    Prenatal Diagnosis 03/2003; 23(2):104-7. · 2.68 Impact Factor
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    ABSTRACT: Découverte de plusieurs masses cardiaques développées dans le ventricule gauche au cours d’une échographie foetale à 32 semaines d’aménorrhée.
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    ABSTRACT: PURPOSE/AIM To understand the added value of fetal MRI used conjointly with ultrasound screening in the work-up of isolated orofacial clefts. CONTENT ORGANIZATION 1. Dynamic step-by-step analysis of the normal and abnormal embryology of the fetal face 2. Up-to-date performances of ultrasonography for the diagnosis of orofacial clefts 3. Added value of MRI in isolated orofacial clefts: Why? How? When? 4. Classification of orofacial clefts revisited through ultrasonography, MRI and neonatal correlations 5. Benefits for the fetus, the parents, and the multidisciplinary medico-surgical team SUMMARY Isolated orofacial clefts concern 1/700 births. Their prenatal diagnosis leads to major consequences for the parents, but also for the prenatal counseling, follow-up and postnatal care of their baby to come. Fetal ultrasonography (US), when performed by a trained physician, allows the diagnosis of cleft with a sensitivity up to 63% according to the literature. Fetal MRI, thanks to high contrast resolution, is an interesting additional tool in situations of sub-optimal foetal and/or maternal conditions. Its reproducibility and easier understanding by the surgical team are some valuable arguments that should lead multidisciplinary teams to encourage its use.
    Radiological Society of North America 2013 Scientific Assembly and Annual Meeting;