François Goffinet

French Institute of Health and Medical Research | Inserm · Unit of Epidemiological Research on Perinatal Health and Woman's and Children's Health

Objective The objective is to evaluate changes in survival to discharge of liveborn infants less than 32 weeks’ gestational age (GA) in France, where the latest available data on very preterm survival at a national-level are from the EPIPAGE-2 (Etude épidémiologique sur les petits âges gestationnels) cohort in 2011. Design Population-based cohort...

Introduction Vaginal birth after cesarean delivery (VBAC) attempt is promoted to reduce cesarean‐related morbidity, but it carries a risk of uterine rupture, posing significant maternal and neonatal risks. This study evaluated uterine rupture incidence and risk factors in a high VBAC attempt population. Material and Methods This was a 16‐year retr...

Objective To assess the association between the decrease in the use of episiotomy and the incidence of obstetric anal sphincter injuries (OASIS) over a 10‐year period and understand their reasons by interviewing obstetricians and midwives. Design Mixed‐methods study. Setting A tertiary university public maternity hospital, Paris, France. Populat...

Background While some labor interventions are essential in preventing maternal and neonatal morbidity, there is little evidence to support systematic early augmentation of labor (EAL). Our objective was to assess the association between EAL and cesarean delivery rate, postpartum hemorrhage and adverse neonatal outcomes. Methods Population‐based st...

Purpose To describe urologic complications associated with the surgical management of placenta accreta spectrum and determine their risk factors. Methods A retrospective study was conducted on all patients diagnosed with abnormal invasive placentation who underwent surgery and delivered between 2002 and 2023 at a single expert maternity centre. In...

Background: Preterm birth (birth before 37 weeks of gestational age) is a frequent and severe adverse pregnancy outcome. Despite the growing number of scientific studies highlighting the link between vaginal microbiota composition and adverse pregnancy outcomes, data remain controversial. Objectives: To identify microbiota signatures of preterm lab...

Objective To study neonatal and maternal outcomes associated with routine maneuvers in breech vaginal delivery at term. Methods This was a secondary analysis of the multicenter PREMODA observational prospective study in France and Belgium. We included women with vaginal breech delivery, excluding those who underwent maneuvers to resolve a dystocic...

BACKGROUND The aim of this study was to assess temporal trends in incidence and underlying causes of maternal deaths from obstetric hemorrhage in France and to describe clinical care before and after implementation of the first national guidelines published in 2004 and updated in 2014. METHODS Data from all hemorrhage-related maternal deaths betwe...

Backgroud: Congenital heart defects (CHDs) are the most frequent group of major congenital anomalies, accounting for almost 1% of all births. They comprise a very heterogeneous group of birth defects in terms of their severity, clinical management, epidemiology, and embryologic origins. Taking this heterogeneity into account is an important imperat...

Introduction: Congenital heart defects (CHD) are the most frequent group of major congenital anomalies, accounting for almost 1% of all births. They comprise a very heterogeneous group of birth defects in terms of their severity, clinical management, epidemiology and embryologic origins. Taking this heterogeneity into account is an important impera...

Introduction Since the 1970s, fetal scalp blood sampling (FSBS) has been used as a second‐line test of the acid–base status of the fetus to evaluate fetal well‐being during labor. The commonly employed thresholds that delineate normal pH (>7.25), subnormal (7.20–7.25), and pathological pH (<7.20) guide clinical decisions. However, these experienced...

Introduction The aim of this study is to evaluate the benefit of cytogenetic testing by amniocentesis after an ultrasound diagnosis of isolated bilateral talipes equinovarus. Material and methods This multicenter observational retrospective study includes all prenatally diagnosed cases of isolated bilateral talipes equinovarus in five fetal medici...

Objective To develop and validate a clinical prediction model for outcomes at 5 years of age for children born extremely preterm and receiving active perinatal management. Design The EPIPAGE‐2 national prospective cohort. Setting France, 2011. Population Live‐born neonates between 24⁺⁰ and 26⁺⁶ weeks of gestation who received active perinatal ma...

Objective To explore the association between induction of labor (IOL) and postpartum hemorrhage (PPH) after vaginal delivery. Methods We included women from the merged database of three randomized prospective trials (TRACOR, CYTOCINON, and TRAAP) that measured postpartum blood loss precisely, with standardized methods. IOL was considered overall a...

Aim: To describe the circumstances, causes and timing of death in extremely preterm infants. Methods: We included from EPIPAGE-2 study infants born at 24-26 weeks in 2011 admitted to neonatal intensive care units (NICU). Vital status and circumstances of death were used to define 3 groups of infants: alive at discharge, death with or without wit...

Background: The efficacy of antenatal corticosteroids on neonatal preterm complications wanes beyond 7 days after treatment. The neurodevelopmental effects of longer treatment-to-birth intervals have not been adequately evaluated. Objective: To study the impact of antenatal corticosteroid timing on survival without moderate or severe neurologica...

Introduction Our objective was to study the strength of the association between meconium‐stained amniotic fluid and severe morbidity among neonates of nulliparas with prolonged pregnancies. Material and methods This was a secondary analysis of the NOCETER randomized trial that took place between 2009 and 2012 in which 11 French maternity units inc...

Background: Because there is no consensual method of assessing postpartum blood loss, the comparability and relevance of the postpartum hemorrhage-related literature is questionable. Quantitative blood loss assessment using a volumetric technique with a graduated collector bag has been proposed to overcome limitations of intervention-based outcome...

Objectives: To determine the publication rate of mandatory research projects conducted by obstetrics residents and to evaluate the publication-associated factors and reported obstacles. Study design: This retrospective cohort study included all consecutive residents in an academic obstetrics-gynecology department in Paris, France, between 2010 a...

Objective: To evaluate the risk of disseminated intravascular coagulation (DIC) in postpartum hemorrhage (PPH) associated with intrauterine infection. Material and methods: A retrospective cohort study of pregnancies complicated by PPH performed at a tertiary academic center in France from 2017 through 2021. Patients giving birth after 22 weeks...

Objective To evaluate the mother–child separation rate in twin pregnancies delivered in maternity units offering an appropriate level of neonatal care. Methods JUMODA is a French, prospective, population‐based cohort study of twin deliveries, including 7998 women who gave birth in maternity units with appropriate levels of neonatal care based on t...

Background: Many questions remain about the appropriate utilization of intrauterine balloon devices in postpartum hemorrhage after vaginal delivery refractory to first-line uterotonics. Available data suggest that an early use of intrauterine balloon tamponade might be beneficial. Objective: To compare, in women with PPH after vaginal delivery r...

Objective To compare the neurodevelopmental outcomes of preterm twins at 5½ years by chorionicity of pregnancy. Design Prospective nationwide population‐based EPIPAGE2 (Etude Epidémiologique sur les Petits Âges Gestationnels) cohort study. Setting A total of 546 maternity units in France, between March and December 2011. Population A total of 11...

Introduction The global sequence of the pathogenesis of preterm labor remains unclear. This study aimed to compare amniotic fluid concentrations of extracellular matrix‐related proteins (procollagen, osteopontin and IL‐33), and of cytokines (IL‐19, IL‐6, IL‐20, TNFα, TGFβ, and IL‐1β) in asymptomatic women with and without subsequent spontaneous pre...

Objective: To investigate the management and survival of very preterm singletons born because of fetal growth restriction (FGR) with or without maternal hypertensive disorders in France. Study design: From a population-based cohort of very preterm births between 22 and 31 weeks in France in 2011, the study population included all non-anomalous s...

Introduction: Previous publications have shown that glucose supplementation could reduce labor duration in women with induction of labor with a favorable cervix but none have shown it for women with an unfavorable cervix. The purpose of our study was to assess the impact on labor duration of a protocol of glucose supplementation used for induction...

Objective To assess the association between gestational age at delivery and postpartum severe acute maternal morbidity (SAMM) in twin pregnancies. Methods Secondary analysis of the JUMODA cohort, a national, prospective, population‐based study of twin pregnancies in France. We excluded women with delivery before 32 weeks of pregnancy, with a fetal...

Objective To determine whether birth outside a level-3 centre (outborn) is associated with a difference in the combined outcome of mortality or moderate-to-severe neurological impairment at 5.5 years of age compared with birth in a level-3 centre (inborn) when antenatal steroids and gestational age (GA) are accounted for. Design Individual matched...

Objective: To characterize the strength and patterns of association between birth weights and severe postpartum hemorrhage in twin pregnancies. Methods: This was a secondary analysis of the JUMODA (JUmeaux Mode d'Accouchement) cohort, a national, prospective, population-based study of twin deliveries, conducted from February 2014 to March 2015 i...

(Abstracted from J Pediatr 2022;244:148–153) Congenital heart defects are the most common cause of infant death linked to congenital malformations (CHDs). This group of congenital disorders therefore remains a cause for concern, despite improvements in medical and surgical management that have resulted in higher survival rates.

To develop a new tool to assess the global quality of care for post-partum hemorrhage (PPH)—the leading preventable cause of maternal mortality worldwide—and to identify characteristics of maternity units associated with inadequate PPH management. This is a secondary analysis of the EPIMOMS population-based study conducted in 2012–2013 in 119 frenc...

Objective To identify risk factors for moderate or severe hypoxic-ischemic encephalopathy (HIE), or neonatal death in clinical placental abruption. Material and methods A nested case-control study within a cohort of singleton pregnancies complicated by placental abruption with a live born infant at two academic reference centers in France, from 20...

Résumé Objectif : Déterminer les procédures permettant de réduire la morbidité maternelle lors de la réalisation d’une césarienne. Matériel et méthodes : Méthodologie GRADE® avec questions formulées sous le format PICO (Patients, Intervention, Comparison, Outcome) et critères de jugement définis a priori et classifiés selon leur importance. Recherc...

Background Pregnancy-related venous thromboembolism is a leading cause of maternal morbidity and mortality, and thromboprophylaxis is indicated in pregnant and post-partum women with a history of venous thromboembolism. The optimal dose of low-molecular-weight heparin to prevent recurrent venous thromboembolism in pregnancy and the post-partum peri...

Objective: To evaluate the use of cervical dilators concurrently with misoprostol to shorten labor in second-trimester medical termination of pregnancy. Methods: This multicenter randomized controlled trial compared the efficacy of cervical dilators inserted concurrently with misoprostol with that of misoprostol, alone, to shorten labor for wome...

OBJECTIVES Recent studies suggest an association between COVID-19 infection during pregnancy and preeclampsia. Nonetheless, these studies are subject to numerous biases. We compared the onset of preeclampsia in a group with symptomatic COVID-19 during pregnancy to that in a group whose non-exposure to the virus was certain, in a center where pregna...

Introduction The objective of this study was to assess the performance of ultrasound and magnetic resonance imaging (MRI) features in helping to classify the type of placenta accreta spectrum (PAS; accreta/increta vs percreta), alone or combined in a predictive score. Material and Methods We conducted a retrospective study in 82 pregnant women wit...

Purpose : Given contradictory evidence about preterm birth (PTB) decreases during COVID-19 lockdowns, we investigate PTB rates during France's strict nationwide lockdown (03/17/2020 to 05/10/2020). Methods . This is an interrupted time series analysis using data on maternal delivery hospitalizations in France from 01/01/2016 to 07/31/2020 (3,448,2...

Importance: Endometriosis is an inflammatory disease with a heterogeneous presentation that affects women of childbearing age. Given the limitations of previous retrospective studies, it is still unclear whether endometriosis has adverse implications for pregnancy outcomes. Objective: To evaluate the association between the presence of endometri...

Objectives To identify subgroups with a congenital heart defect (CHD) at risk of health-related quality of life (QoL) impairment at 8 years of age according to their medical and surgical management (MSM) Study design From a prospective population-based cohort study, 598 with CHD were subdivided according to their medical and surgical management: 1...

Introduction Success rates of external cephalic version (ECV) are heterogenous in the published literature. Some individual factors are already known to be associated with ECV success but probably do not fully explain the differences. The objective of this review is to assess the association between hospitals’ cesarean delivery rates for breech pre...

Objective: To assess survival to discharge without severe neonatal morbidity by planned mode of delivery for twins born before 32 weeks of gestation. Methods: The JUMODA (JUmeaux MODe d'Accouchement) study was a French national prospective, population-based, cohort study of twin deliveries conducted from February 2014 to March 2015. This planned...

Background Preterm prelabor rupture of membranes (PPROM) before 34 weeks of gestation complicates 1% of pregnancies and accounts for one-third of preterm births. International guidelines recommend expectant management, along with antenatal steroids before 34 weeks and antibiotics. Up-to-date evidence about the risks and benefits of administering to...

Objective The number of cesarean deliveries on maternal request (CDMR) is unknow in France. We aimed to evaluate the rate of obstetricians willing to perform a CDMR in 2020 in Paris and to compare OB/GYN seniors’ and residents’ points of view about CDMR using six hypothetical clinical scenarios. Study Design A survey was conducted between January...

Objective: To compare the performance of estimated fetal weight (EFW) charts at the third-trimester ultrasound for detecting small and large for gestational age (SGA/LGA) newborns with adverse outcomes DESIGN: Nationally representative observational study. Setting: French maternity units in 2016. Population: 9940 singleton live births with an...

Background In contrast with birthweight or other growth charts, a feature of most intrauterine charts is that they are not differentiated by sex. Differences in weight by sex during pregnancy are considered to be relatively minor, however, small systematic differences may affect the sensitivity and specificity of screening for fetuses with growth r...

The survival rate of infants born before 25 weeks of gestational age in France is extremely low compared with that of many other countries: 0%, 1%, and 31% at 22, 23, and 24 weeks' in the last national cohort study. A non-optimal regionalization and variations in practice are prevalent. Some parents in social media and support groups have reported...

Introduction In case of term prelabor rupture of membranes (PROM), expectant management is a reasonable option. We aimed at assessing the frequency of spontaneous onset of labor after two days of term PROM and its associated factors. Material and Methods Women delivering at a tertiary center of a singleton in cephalic presentation, after a term PR...

Objective: To assess the association between gestational age at delivery and postpartum severe acute maternal morbidity (SAMM) in twin pregnancies. Design: Population-based, national, prospective, cohort study Setting: From 02/2014 to 03/2015 in France Population: Women with twin pregnancies who gave birth after 32 weeks of gestation. We excluded w...

Objective To assess obstetric factors associated with hysterotomy extension among women undergoing a second-stage cesarean. Study design This 5-year retrospective cohort study (2013–2017) included all women with second-stage cesarean deliveries of live-born singleton fetuses in cephalic presentation at term. It took place at a tertiary center that...

(Abstracted from Acta Obstet Gynecol Scand 2021;100:964–970) Although rare, fetal bradycardia caused by cord prolapse, placental abruption, or uterine rupture is associated with sudden and prolonged deceleration of the fetal heart rate. When this occurs, there is an association between the bradycardia-to-delivery interval and umbilical artery pH at...

Background Negative childbirth experience may affect mother wellbeing and health. However, it is rarely evaluated in studies comparing methods of induction of labor (IoL). Aim To compare women’s experience of IoL according to the method, considering the mediating role of interventions and complications of delivery. Methods We used data from the M...

Background The prevalence of COVID-19 infection during pregnancy is not known. COVIPREG is a prospective French multicenter study to assess the seroprevalence at the time of delivery and the maternal and neonatal impact of COVID-19 infection during pregnancy. In order to study factors associated with poor outcomes after COVID-19 Infection during pr...

Background No population-based prospective cohort study has assessed the neurodevelopmental outcomes of school-aged children with CHD. Objective To assess whether some groups of CHDs, more specifically cyanotic CHD (CCHD) with or without heart failure and non CCHD with heart failure, are at greater risk of adverse neurodevelopmental outcomes at 8...

Background Cancer during pregnancy is rare (about 1/1000 pregnancies) and its diagnosis raises the question of whether or not to continue the pregnancy. Objectives The primary objective of our study was to evaluate associated factors with termination of pregnancy in cases of cancer during pregnancy. Secondary objectives were to evaluate maternal a...

Objective To assess whether children with symptomatic CHD at birth (cyanosis and/or heart failure) are at greater risk of adverse neurodevelopmental outcomes at 8 years of age. Study design From a prospective population-based cohort study of newborns with CHD (EPICARD), we included 473 children with available neurodevelopmental assessments at 8 ye...