[Show abstract][Hide abstract] ABSTRACT: Background: Cytomegalovirus (CMV) is the most frequent cause of congenital infection and commonly associated with sensorineural deficit. At present, there is neither prophylaxis nor treatment during pregnancy. The objective of this study was to evaluate the level of awareness regarding CMV infection and its consequences in women delivering at the University of Geneva Hospitals (Geneva, Switzerland). Methods: The study consisted of a validated questionnaire completed by women in the immediate postpartum period. Results: The questionnaire was completed by 59% (314/528) of delivering women. Only 39% (123/314) knew about CMV and 19.7% (62/314) had received information about preventive measures. Women were more aware about other congenital diseases, such as toxoplasmosis (87%); human immunodeficiency virus (99%); syphilis (85.5%); rubella (92.3%); and group B Streptococcus (63%). Factors associated with CMV awareness were Swiss nationality, high education level, employment in health care or with children, and being followed by an obstetrician. Regarding quality of information, few were aware of the main CMV complications (deafness, 25.2%; mental retardation, 34.5%). Among those informed about CMV, most (74.6%) knew about preventive measures. Among these, 82.5% thought that these were easily applicable. Conclusions: Most women were unaware of CMV infection and its potential risks during pregnancy. It is crucial to improve CMV information given to pregnant women to prevent the risks for the fetus/newborn.
Preview · Article · Dec 2015 · International Journal of Environmental Research and Public Health
[Show abstract][Hide abstract] ABSTRACT: Objective: Threatened preterm labor (tPTL) is a complication of pregnancy. Identification of women and clinical definition differs between countries. This study investigated differences in tPTL and effectiveness of vaginal progesterone to prevent preterm birth (PTB) between two countries.Methods: Secondary analysis of a randomized controlled trial (RCT) from Argentina and Switzerland comparing vaginal progesterone to placebo in women with tPTL (n = 379). Cox proportional hazards analysis was performed to compare placebo groups of both countries and to compare progesterone to placebo within each country. We adjusted for baseline differences. Iatrogenic onset of labor or pregnancy beyond gestational age of interest was censored.Results: Swiss and Argentinian women were different on baseline. Risks for delivery <14 days and PTB < 34 and < 37 weeks were increased in Argentina compared to Switzerland, HR 3.3 (95% CI 0.62–18), 54 (95% CI 5.1–569) and 3.1 (95% CI 1.1–8.4). In Switzerland, progesterone increased the risk for delivery <14 days [HR 4.4 (95% CI 1.3–15.7)] and PTB <37 weeks [HR 2.5 (95% CI 1.4–4.8)], in Argentina there was no such effect.Conclusion: In women with tPTL, the effect of progesterone may vary due to population differences. Differences in populations should be considered in multicenter RCTs.
Full-text · Article · Nov 2015 · Journal of Maternal-Fetal and Neonatal Medicine
[Show abstract][Hide abstract] 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.
[Show abstract][Hide abstract] 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.
[Show abstract][Hide abstract] 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.
No preview · Article · Oct 2015 · Ultrasound in Obstetrics and Gynecology
[Show abstract][Hide abstract] ABSTRACT: Macrosomia can increase risk of operative vaginal delivery, perineal trauma, shoulder dystocia, and other neonatal morbidities. To reduce these risks, patients can either elect for cesarean delivery or induction of labor that will prevent further fetal growth. In regard to the latter strategy, previous studies have reported increased risk of cesarean delivery without decrease in risk of neonatal trauma. However, these studies were limited by small sample sizes, gestational age (>40 weeks), and use of birth weight (>4000 g) instead of estimated fetal weight. Consequently, the authors of the present study hypothesize that upon addressing these limitations induction of labor would, in fact, decrease risk of major neonatal and maternal morbidities with no significant changes in the risk of cesarean delivery. This was a large, multicenter (19 tertiary-care university hospitals), randomized, unblinded, controlled trial. A total of 818 women with macrosomic fetuses (eligible for the study if estimated weight of fetus was >95th percentile, or 3500 g at 36 weeks, 3700 g at 37 weeks, and 3900 g at 38 weeks) were randomized into 2 groups, the induction-of-labor group (n = 407) and expectant management or control group (n = 411). Authors induced labor between 37 and 38 weeks' gestation within 3 days of randomization. It is of note that they induced labor in only 89% of the women in the induced-labor group, as the others experienced spontaneous delivery, and so on. The primary outcome was a composite of significant shoulder dystocia, fracture of the clavicle or a long bone, brachial plexus injury, intracranial hemorrhage, or death of the neonate. The secondary outcomes were a range of neonatal and maternal morbidities. Statistical analysis was by intention to treat. Shoulder dystocia and fracture of the clavicle occurred more frequently for neonates in the control group than in the induction-of-labor group (6% vs 2%; risk difference, 4%; P = 0.004). In addition, frequency of primary outcome increased when neonates were 4000 g or greater, especially in the control group (21 vs 5 neonates). No difference was seen in terms of secondary outcomes for the neonates except for phototherapy use, which was higher in the induction group, especially for those randomized before 38 weeks' gestation (13% induced-labor vs 7% expectant group). In terms of maternal outcomes and morbidities, the incidence of cesarean delivery and operative vaginal delivery did not differ between the 2 groups. However, spontaneous vaginal delivery occurred more often in the induced-labor group than in the expectant group (59% vs 52%). In addition to being unblinded, a limitation of this study was that the sample size was smaller than initially anticipated; authors were intending to recruit 1000 patients, but recruitment was cut short by funding issues. Nevertheless, the findings of this study show that induction of labor for large-for-date fetuses in women between 37 and 39 weeks' gestation can significantly reduce risk of neonatal shoulder dystocia and bone fracture. There is also increased likelihood of spontaneous delivery without increased risk of cesarean delivery.
No preview · Article · Oct 2015 · Obstetrical and Gynecological Survey
[Show abstract][Hide abstract] ABSTRACT: Objective
To investigate missed opportunities for diagnosing female genital mutilation (FGM) at an obstetrics and gynecology (OB/GYN) department in Switzerland.
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.
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.
Opportunities to identify FGM are frequently missed. Measures should be taken to improve FGM diagnosis and care.
Full-text · Article · Jun 2014 · International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics
[Show abstract][Hide abstract] ABSTRACT: To evaluate the efficacy of the hands and knees position during the first stage of labour to facilitate the rotation of the fetal head to the occiput anterior position. Randomised controlled trial. Geneva University Hospitals, Switzerland. A total of 439 women with a fetus in the occiput posterior position during the first stage of labour. The women in the intervention group were invited to take a hands and knees position for at least for 10 minutes. Women allocated to the control group received the usual care. For both groups, 15 minutes after randomisation, women completed a short questionnaire to report their perceived pain and the comfort of their position. The rotation of the fetal head in occiput anterior position confirmed by ultrasonography 1 hour after randomisation. One hour after the randomisation, 35 of 203 (17%) fetuses were diagnosed as being in the occiput anterior position in the intervention group compared with 24 of 209 (12%) in the control group. This difference was not statistically significant (relative risk 1.50; 95% CI 0.93–2.43; P = 0.13). The change in the evaluation of comfort between the randomisation and 15 minutes after showed an improvement in 70 and 39 women, no change in 82 and 78 women and a decrease in 56 and 86 women in the intervention and control groups, respectively (P = 0.02). This study could not demonstrate a benefit of the hands and knees position to correct the occiput posterior position of the fetus during the first stage of labour, but the women reported an increase in their comfort level. Hands and knees position does not facilitate rotation into occiput anterior but increases the comfort level of women.
Full-text · Article · Feb 2014 · BMC Pregnancy and Childbirth
[Show abstract][Hide abstract] 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.
No preview · Article · Jan 2014 · Archives of Gynecology
[Show abstract][Hide abstract] 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.
[Show abstract][Hide abstract] 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.
Preview · Article · Nov 2013 · Journal of Immigrant and Minority Health
[Show abstract][Hide abstract] 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.
No preview · Article · Oct 2013 · Revue médicale suisse
[Show abstract][Hide abstract] 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.
No preview · Article · Oct 2013 · Journal of Health Psychology
[Show abstract][Hide abstract] 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.
[Show abstract][Hide abstract] 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.
Full-text · Article · Aug 2013 · European journal of obstetrics, gynecology, and reproductive biology