Olivier Irion

University of Geneva, Genève, Geneva, Switzerland

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Publications (99)399.05 Total impact

  • Journal of Maternal-Fetal and Neonatal Medicine 11/2015; DOI:10.3109/14767058.2015.1121476 · 1.37 Impact Factor
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    ABSTRACT: Objective: To study the obstetric outcomes of women attending a specialized clinic for women with female genital mutilation (FGM). Methods: The medical charts of women with FGM who consecutively attended a specialized clinic between 2010 and 2012 were reviewed retrospectively. The present study focused on women attending for obstetric reasons. The outcome measures were type of delivery, reason for cesarean delivery or assisted delivery, blood loss, episiotomy, perineal tear, duration of the second stage of labor, postpartum complications, weight of the neonate, and Apgar score. Outcomes were compared between women with FGM type III who underwent defibulation, and patients with FGM type I and II. Results: The clinic was attended by 129 women, 84 perinatally. Obstetric outcomes were similar to average outcomes for women without FGM presenting at the same department and in Switzerland generally. Specifically, 20 women had a cesarean delivery. An assisted delivery was performed for 18 patients; among these, only eight had experienced obstructed labor. No statistically significant differences were found for the outcome measures when women with FGM type III were compared to FGM type I and II. Conclusions: Routine obstetric follow-up combined with specialized care for women with FGM, including defibulation, can avoid inappropriate obstetric practices and reduce obstetric complications known to be associated with FGM.
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    ABSTRACT: Key Clinical MessageNontherapeutic female genital modifications can cause short- and long-term consequences. Caregivers should promote women's self knowledge on genitals' anatomy and physiology, and psychophysical and sexual health. They should also inform on possible negative consequences of vulvar nontherapeutic alterations requested and avoid the medicalization of female genital mutilation.
    10/2015; DOI:10.1002/ccr3.403
  • Michel Boulvain · Nicole Jastrow · Olivier Irion ·

    The Lancet 10/2015; 386(10004):1629-1630. DOI:10.1016/S0140-6736(15)00537-1 · 45.22 Impact Factor
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    ABSTRACT: The increasing rate of caesarean delivery is a worldwide concern. A major contributor to this evolution has been a concomitantly decline in vaginal birth after caesarean, because of the risk of intrapartum uterine rupture, which is a rare but potentially catastrophic complication of a trial of labour after caesarean (TOLAC). On the other hand, elective repeat caesarean is associated with surgical complications and risk of abnormal placentation (e.g. placenta accreta) in subsequent pregnancies. Therefore TOLAC is recommended to women with good prognosis of success and low risk of uterine rupture. The published data suggest that sonographic assessment of lower uterine segment in third trimester could potentially play an important role in the prediction of uterine rupture in women with previous caesarean.
    Ultrasound in Obstetrics and Gynecology 10/2015; DOI:10.1002/uog.15786 · 3.85 Impact Factor

  • Obstetrical and Gynecological Survey 10/2015; 70(10):601-603. DOI:10.1097/OGX.0000000000000251 · 1.86 Impact Factor
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    ABSTRACT: Macrosomic fetuses are at increased risk of shoulder dystocia. We aimed to compare induction of labour with expectant management for large-for-date fetuses for prevention of shoulder dystocia and other neonatal and maternal morbidity associated with macrosomia. We did this pragmatic, randomised controlled trial between Oct 1, 2002, and Jan 1, 2009, in 19 tertiary-care centres in France, Switzerland, and Belgium. Women with singleton fetuses whose estimated weight exceeded the 95th percentile, were randomly assigned (1:1), via computer-generated permuted-block randomisation (block size of four to eight) to receive induction of labour within 3 days between 37(+0) weeks and 38(+6) weeks of gestation, or expectant management. Randomisation was stratified by centre. Participants and caregivers were not masked to group assignment. Our primary outcome was a composite of clinically significant shoulder dystocia, fracture of the clavicle, brachial plexus injury, intracranial haemorrhage, or death. We did analyses by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00190320. We randomly assigned 409 women to the induction group and 413 women to the expectant management group, of whom 407 women and 411 women, respectively, were included in the final analysis. Mean birthweight was 3831 g (SD 324) in the induction group and 4118 g (392) in the expectant group. Induction of labour significantly reduced the risk of shoulder dystocia or associated morbidity (n=8) compared with expectant management (n=25; relative risk [RR] 0·32, 95% CI 0·15-0·71; p=0·004). We recorded no brachial plexus injuries, intracranial haemorrhages, or perinatal deaths. The likelihood of spontaneous vaginal delivery was higher in women in the induction group than in those in the expectant management group (RR 1·14, 95% CI 1·01-1·29). Caesarean delivery and neonatal morbidity did not differ significantly between the groups. Induction of labour for suspected large-for-date fetuses is associated with a reduced risk of shoulder dystocia and associated morbidity compared with expectant management. Induction of labour does not increase the risk of caesarean delivery and improves the likelihood of spontaneous vaginal delivery. These benefits should be balanced with the effects of early-term induction of labour. Assistance Publique-Hôpitaux de Paris and the University of Geneva. Copyright © 2015 Elsevier Ltd. All rights reserved.
    The Lancet 04/2015; 385(9987). DOI:10.1016/S0140-6736(14)61904-8 · 45.22 Impact Factor

  • American Journal of Obstetrics and Gynecology 01/2015; 212(1):S386-S387. DOI:10.1016/j.ajog.2014.10.1004 · 4.70 Impact Factor

  • American Journal of Obstetrics and Gynecology 01/2015; 212(1):S376. DOI:10.1016/j.ajog.2014.10.983 · 4.70 Impact Factor
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    ABSTRACT: Objective To investigate missed opportunities for diagnosing female genital mutilation (FGM) at an obstetrics and gynecology (OB/GYN) department in Switzerland. Methods In a retrospective study, we included 129 consecutive women with FGM who attended the FGM outpatient clinic at the Department of Gynecology and Obstetrics at the University Hospitals of Geneva between 2010 and 2012. The medical files of all women who had undergone at least 1 previous gynecologic exam performed by an OB/GYN doctor or a midwife at the study institution were reviewed. The type of FGM reported in the files was considered correct if it corresponded to that reported by the specialized gynecologist at the FGM clinic, according to WHO classification. Results In 48 (37.2%) cases, FGM was not mentioned in the medical file. In 34 (26.4%) women, the diagnosis was correct. FGM was identified but erroneously classified in 28 (21.7%) cases. There were no factors (women’s characteristics or FGM type) associated with missed diagnosis. Conclusion Opportunities to identify FGM are frequently missed. Measures should be taken to improve FGM diagnosis and care.
    International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 06/2014; 125(3). DOI:10.1016/j.ijgo.2013.11.016 · 1.54 Impact Factor
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    ABSTRACT: The occipito-posterior (OP) fetal head position during the first stage of labour occurs in 10-34% of cephalic presentations. Most will spontaneous rotate in anterior position before delivery, but 5-8% of all births will persist in OP position for the third stage of labour. Previous observations have shown that this can lead to an increase of complications, such as an abnormally long labour, maternal and fetal exhaustion, instrumental delivery, severe perineal tears, and emergency caesarean section. Usual care in the case of diagnosis of OP position is an expectant management. However, maternal postural techniques have been reported to promote the anterior position of the fetal head for delivery. A Cochrane review reported that these maternal positions are well accepted by women and reduce back pain. However, the low sample size of included studies did not allow concluding on their efficacy on delivery outcomes, particularly those related to persistent OP position. Our objective is to evaluate the efficacy of maternal position in the management of OP position during the first stage of labour.Methods/design: A randomised clinical trial is ongoing in the maternity unit of the Geneva University Hospitals, Geneva, Switzerland. The unit is the largest in Switzerland with 4,000 births/year. The trial will involve 438 women with a fetus in OP position, confirmed by sonography, during the first stage of the labour. The main outcome measure is the position of the fetal head, diagnosed by ultrasound one hour after randomisation. It is important to evaluate the efficacy of maternal position to correct fetal OP position during the first stage of the labour. Although these positions seem to be well accepted by women and appear easy to implement in the delivery room, the sample size of the last randomised clinical trial published in 2005 to evaluate this intervention had insufficient power to demonstrate clear evidence of effectiveness. If the technique demonstrates efficacy, it would reduce the physical and psychological consequences of complications at birth related to persistent OP position.Trial registration: ClinicalTrials.gov, www.clinicaltrials.gov: (no. NCT01291355).
    BMC Pregnancy and Childbirth 02/2014; 14(1):83. DOI:10.1186/1471-2393-14-83 · 2.19 Impact Factor
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    ABSTRACT: Tocolysis is an important treatment in the improvement of outcome in preterm labor and preterm birth, provided that its use follows clear evidence-based recommendations. In this expert opinion, the most recent evidence about efficacy and side effects of different tocolytics is being reviewed and evidence-based recommendation about diagnosis and treatment of preterm labor is given. Further aspects such as progesterone administration or antibiotic treatment for the prevention of preterm birth are included. Our review demonstrates that an individualized choice of different tocolytics and additional treatments is necessary to improve short- and long-term neonatal outcome in preterm labor and preterm birth.
    Archives of Gynecology 01/2014; 289(4). DOI:10.1007/s00404-013-3137-9 · 1.36 Impact Factor
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    Marie Cohen · Pascale Ribaux · Manuella Epiney · Olivier Irion ·
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    ABSTRACT: Glucose-regulated protein 78 (GRP78) is an endoplasmic reticulum (ER) molecular chaperone that belongs to the heat shock protein 70 family. GRP78 is also present on the cell surface membrane of trophoblastic cells, where it is associated with invasive or fusion properties of these cells. Impaired mechanism of GRP78 relocation from ER to the cell surface was observed in preeclamptic cytotrophoblastic cells (CTB) and could take part in the pathogenesis of preeclampsia. In this study, we have investigated whether prostate apoptosis response 4 (Par-4), a protein identified as a partner of GRP78 relocation to the cell surface in prostate cancer cells, is present in trophoblastic cells and is involved in the translocation of GRP78 to the cell surface of CTB. Par-4 is indeed present in trophoblastic cells and its expression correlates with expression of membrane GRP78. Moreover, overexpression of Par-4 led to an increase of cell surface expression of GRP78 and decreased Par-4 gene expression reduced cell surface localization of GRP78 confirming a role of Par-4 in relocation of GRP78 from ER to the cell surface. Accordingly, invasive property was modified in these cells. In conclusion, we show that Par-4 is expressed in trophoblastic cells and is involved in transport of GRP78 to the cell surface and thus regulates invasive property of extravillous CTB.
    PLoS ONE 11/2013; 8(11):e80231. DOI:10.1371/journal.pone.0080231 · 3.23 Impact Factor
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    ABSTRACT: Unintended pregnancies reflect an unmet need for family planning, and are part of health disparities. Using the only database to inquire about pregnancy intention among women in Switzerland, this study examined the relationship between immigrant documentation and unintended pregnancy (UP). Among pregnant women presenting to a Swiss hospital, we compared pregnancy intention between documented and undocumented women. We used logistic regression to examine whether undocumented status was associated with UP after adjusting for other significant predictors. Undocumented women had more unintended pregnancies (75.2 vs. 20.6 %, p = 0.00). Undocumented status was associated with UP after adjustment (OR 6.23, 95 % CI 1.83-21.2), as was a history of psychological problems (OR 4.09, 95 % CI 1.32-12.7). Contraception non-use was notably associated with lower odds of UP (OR 0.01, 95 % CI 0.004-0.04). Undocumented status was significantly associated with UP, even after adjusting for well-recognized risk factors. This highlights the tremendous risk of undocumented status on UP among women in Switzerland.
    Journal of Immigrant and Minority Health 11/2013; 17(2). DOI:10.1007/s10903-013-9939-9 · 1.16 Impact Factor
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    ABSTRACT: Obstetrical emergencies may represent extremely critical situations with potential dramatic maternal and neonatal consequences. These situations should be managed by an effective and experienced multidisciplinary staff. Simulation allows a regular and repeated practice of these situations with no risk to patient safety and the possibility to analyse participants' performances in a group. This review describes different obstetrical simulation methods and summarizes the evidence for its efficiency in obstetric practice.
    Revue médicale suisse 10/2013; 9(403):1938-40, 1942.
  • Lucia Floris · Olivier Irion ·
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    ABSTRACT: This study investigated the association between anxiety experienced by the mother, a request for analgesia, and the level of pain at maternity hospital admission in early labour. Anxiety levels were measured by the State-Trait Anxiety Inventory and pain was assessed using a Visual Analogue Scale. Anxiety and Visual Analogue Scale scores were compared using a linear regression model and indicated a statistically significant association between the anxiety state and degree of pain (p < 0.016; Y = 0.895 x score + 32.656). There was no significant association between anxiety and a request for epidural analgesia. During labour, an evaluation of anxiety should be associated with an assessment of the perceived degree of pain.
    Journal of Health Psychology 10/2013; 20(4). DOI:10.1177/1359105313502695 · 1.88 Impact Factor
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    ABSTRACT: Cardiovascular diseases are the principal cause of death in women in developed countries and are importantly promoted by hypertension. The salt sensitivity of blood pressure (BP) is considered as an important cardiovascular risk factor at any BP level. Preeclampsia is a hypertensive disorder of pregnancy that arises as a risk factor for cardiovascular diseases. This study measured the salt sensitivity of BP in women with a severe preeclampsia compared with women with no pregnancy hypertensive complications. Forty premenopausal women were recruited 10 years after delivery in a case-control study. Salt sensitivity was defined as an increase of >4 mm Hg in 24-hour ambulatory BP on a high-sodium diet. The ambulatory BP response to salt was significantly increased in women with a history of preeclampsia compared with that of controls. The mean (95% confidence interval) daytime systolic/diastolic BP increased significantly from 115 (109-118)/79 (76-82) mm Hg on low-salt diet to 123 (116-130)/80 (76-84) on a high-salt diet in women with preeclampsia, but not in the control group (from 111 [104-119]/77 [72-82] to 111 [106-116]/75 [72-79], respectively, P<0.05). The sodium sensitivity index (SSI=Δmean arterial pressure/Δurinary Na excretion×1000) was 51.2 (19.1-66.2) in women with preeclampsia and 6.6 (5.8-18.1) mm Hg/mol per day in controls (P=0.015). The nocturnal dip was blunted on a high-salt diet in women with preeclampsia. Our study shows that women who have developed preeclampsia are salt sensitive before their menopause, a finding that may contribute to their increased cardiovascular risk. Women with a history of severe preeclampsia should be targeted at an early stage for preventive measures of cardiovascular diseases.
    Hypertension 08/2013; 62(4). DOI:10.1161/HYPERTENSIONAHA.113.01916 · 6.48 Impact Factor
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    ABSTRACT: Obstetric work generates important subjective and objective mental stress and is perceived as a physically demanding activity by obstetricians. The aim of this study was to quantify physical and mental stress levels in obstetricians at work and during leisure activities to investigate their association with overall physical activity levels and professional experience. 18 obstetricians at the maternity unit of the University of Geneva Hospitals were enrolled in a prospective observational study. Physical activity and stress levels were measured in two different activity sectors (delivery room and outpatient clinic) and outside work. Physical activity was assessed by questionnaire, visual analogue scale (VAS), and accelerometer. Mental stress levels were assessed by validated questionnaires, VAS, measurement of urine catecholamines and salivary cortisol, and night-time heart rate variability indices. Daily stress levels were higher at work compared to outside work (all, P=0.002). Adrenalin (P=0.002) and dopamine (P=0.09) levels were elevated after a labour suite shift and a trend was observed for reduced heart rate variability during the night after this shift. The median average daily number of steps was 7132 (range, 5283-8649). Subjects reached a median of 32min (range, 19-49min) of moderate or higher intensity (≥1952counts/min) daily physical activity. Contrary to perception, obstetrics work is not physically demanding. It is, however, accompanied by important subjective and objective mental stress that may have a negative impact on health when combined with a lack of regular daily physical activity.
    European journal of obstetrics, gynecology, and reproductive biology 08/2013; 171(1). DOI:10.1016/j.ejogrb.2013.08.020 · 1.70 Impact Factor

  • American journal of obstetrics and gynecology 06/2013; 209(5). DOI:10.1016/j.ajog.2013.06.016 · 4.70 Impact Factor
  • Olivier Irion ·

    Circulation 03/2013; 127(9):e477. DOI:10.1161/CIRCULATIONAHA.112.112227 · 14.43 Impact Factor

Publication Stats

2k Citations
399.05 Total Impact Points


  • 1998-2015
    • University of Geneva
      • • Department of Obstetrics and Gynaecology
      • • Division of Obstetrics
      Genève, Geneva, Switzerland
    • Centre Hospitalier Universitaire de Québec (CHUQ)
      Québec, Quebec, Canada
  • 2014
    • Inselspital, Universitätsspital Bern
      • Department of Obstetrics and Gynaecology
      Berna, Bern, Switzerland
  • 1998-2011
    • Hôpitaux Universitaires de Genève
      • • Département de gynécologie et d'obstétrique
      • • Unité de développement en obstétrique
      Genève, Geneva, Switzerland
  • 1996
    • Université du Québec
      Québec, Quebec, Canada