Cyril Huissoud

Stem Cell And Brain Research Institute, Lyons, Rhône-Alpes, France

Are you Cyril Huissoud?

Claim your profile

Publications (89)181.64 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Placental Growth Factor (PlGF) est un facteur de croissance vasculaire évalué principalement dans la prééclampsie où sa concentration est souvent abaissée. Le but de cette étude était d’évaluer la concentration de PlGF sérique maternelle dans les retards de croissance intra-utérins (RCIU) vasculaires sans prééclampsie maternelle au moment du diagnostic.
    No preview · Article · Dec 2015 · Gynécologie Obstétrique & Fertilité
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Postpartum haemorrhage (PPH) is defined as blood loss ≥500 mL after delivery and severe PPH as blood loss ≥1000 mL, regardless of the route of delivery (professional consensus). The preventive administration of uterotonic agents just after delivery is effective in reducing the incidence of PPH and its systematic use is recommended, regardless of the route of delivery (Grade A). Oxytocin is the first-line prophylactic drug, regardless of the route of delivery (Grade A); a slowly dose of 5 or 10 IU can be administered (Grade A) either IV or IM (professional consensus). After vaginal delivery, routine cord drainage (Grade B), controlled cord traction (Grade A), uterine massage (Grade A), and routine bladder voiding (professional consensus) are not systematically recommended for PPH prevention. After caesarean delivery, placental delivery by controlled cord traction is recommended (grade B). The routine use of a collector bag to assess postpartum blood loss at vaginal delivery is not systematically recommended (Grade B), since the incidence of severe PPH is not affected by this intervention. In cases of overt PPH after vaginal delivery, placement of a blood collection bag is recommended (professional consensus). The initial treatment of PPH consists in a manual uterine examination, together with antibiotic prophylaxis, careful visual assessment of the lower genital tract, a uterine massage, and the administration of 5–10 IU oxytocin injected slowly IV or IM, followed by a maintenance infusion not to exceed a cumulative dose of 40 IU (professional consensus). If oxytocin fails to control the bleeding, the administration of sulprostone is recommended within 30 minutes of the PPH diagnosis (Grade C). Intrauterine balloon tamponade can be performed if sulprostone fails and before recourse to either surgery or interventional radiology (professional consensus). Fluid resuscitation is recommended for PPH persistent after first line uterotonics, or if clinical signs of severity (Grade B). The objective of RBC transfusion is to maintain a haemoglobin concentration (Hb) >8 g/dL. During active haemorrhaging, it is desirable to maintain a fibrinogen level ≥2 g/L (professional consensus). RBC, fibrinogen and fresh frozen plasma (FFP) may be administered without awaiting laboratory results (professional consensus). Tranexamic acid may be used at a dose of 1 g, renewable once if ineffective the first time in the treatment of PPH when bleeding persists after sulprostone administration (professional consensus), even though its clinical value has not yet been demonstrated in obstetric settings. It is recommended to prevent and treat hypothermia in women with PPH by warming infusion solutions and blood products and by active skin warming (Grade C). Oxygen administration is recommended in women with severe PPH (professional consensus). If PPH is not controlled by pharmacological treatments and possibly intra-uterine balloon, invasive treatments by arterial embolization or surgery are recommended (Grade C). No technique for conservative surgery is favoured over any other (professional consensus). Hospital-to-hospital transfer of a woman with a PPH for embolization is possible once hemoperitoneum is ruled out and if the patient's hemodynamic condition so allows (professional consensus).
    Full-text · Article · Dec 2015 · European journal of obstetrics, gynecology, and reproductive biology
  • J Ancel · C Huissoud
    [Show abstract] [Hide abstract]
    ABSTRACT: Evaluate if a score based on ultrasound measurements (cervical length, perineal-fetal presentation distance, fetal occiput position) before the induction of labour is a good predictive test of vaginal delivery within 24h and compare it to Bishop score. From January to April 2014, we included in a monocentric prospective study 45 patients who underwent a labour induction in the department of obstetrics and gynecology at Croix-Rousse Hospital. Ultrasound measurements of the distance between the perineum and the foetal presentation (with transperineal ultrasound), of the cervical length (with transvaginal ultrasound) and of the position of the occiput were collected before induction. Bishop score was also calculated for these patients, without receiving ultrasound data (and vice versa), in order to determine the mode of induction. Receiver Operating Characteristics (ROC) curves were used to evaluate performance of the ultrasonographic score and the Bishop score for predicting vaginal delivery within 24h. The area under the ROC curve for ultrasonographic score was 84.5% (IC95% 64,6-100%). The area under the ROC curve for Bishop score was 73.2% (IC95% 64,2-82,2%). The comparison of these areas under the curve has shown a difference of 11.3% with a P-value of 0.055 in a two-tailed test. Ultrasonographic score made with a combination of these ultrasound measurements appears to be an effective test to predict the chances of vaginal delivery within 24h of induction. Copyright © 2015. Published by Elsevier SAS.
    No preview · Article · Feb 2015 · Gynécologie Obstétrique & Fertilité
  • J Le Gall · A Fichez · G Lamblin · C A Philip · C Huissoud
    [Show abstract] [Hide abstract]
    ABSTRACT: To offer a therapeutic management of cesarean scar pregnancies (GSC) in the first trimester of pregnancy with a first approach by uterine artery embolization (UAE) PATIENTS AND METHODS: This study describes seven cases of GSC diagnosed between 2009 and 2013 in the clinic of the University Hospital of the Hospital of Croix-Rousse. We present the symptoms and how imagery has led to the diagnosis and the therapeutic management conducted. The mean gestational age at diagnosis was 9 weeks gestation. There were ongoing pregnancies with cardiac activity present for each patient. An additional MRI was performed in five patients. Five patients were treated with methotrexate injection, two patients received the Mifegyne. All patients then received a selective uterine artery embolization. Finally within 48hours, suction curettage was performed in 6 patients. A patient at 13 WA+1 required a subtotal hysterectomy for placenta accreta. Intra-operative complications were represented by a bladder injury, two bleeding of 1000mL in patients at 13 WA+1 and 12 WA. For the 6 cases of GSC with a gestational age less than 10 WA, average blood loss was less than 500mL. Three patients underwent resection of scar isthmocele confirmed by EVAC. An intrauterine pregnancy was carried to term after care. Cesarean scar pregnancies is a diagnostic and therapeutic challenge, which should be diagnosed as early as soon as possible with care in a medical facility with a uterine artery embolization technical platform. Our protocol combining Mifegyne and methotrexate for termination of pregnancy and uterine artery embolization (UAE) followed by curettage for evacuation of pregnancy allows conservative treatment while minimizing the risk of bleeding (for GSC diagnosed before 10 WA). Copyright © 2015 Elsevier Masson SAS. All rights reserved.
    No preview · Article · Feb 2015 · Gynécologie Obstétrique & Fertilité
  • H Misme · C Dupont · M Cortet · R-C Rudigoz · C Huissoud
    [Show abstract] [Hide abstract]
    ABSTRACT: To describe the distribution of the volume of blood loss during vaginal and cesarean deliveries among women who delivered after 24 weeks of gestation. A descriptive study of the distribution of blood loss by delivery route and for all patients after 24 weeks of gestation over a period of two years in a type III maternity. Patient and delivery characteristics were collected and blood loss was measured prospectively based on weighing pads and the use of a collector bag for vaginal deliveries, a suction cannula for cesareans sections. The following parameters were calculated: the mean (±SD), the median, interquartile range (IQR), the 5th and 95th percentile. Seven thousand nine hundreds and eight patients were included. After vaginal delivery (n=6134), the mean volume of bleeding was equal to 180.1mL (± 224.7mL), the median to 100mL (IQR [100-200]), the 95th percentile to 500mL [CI 95% 500-550]. For cesarean sections (n=1774), the mean volume of bleeding was equal to 557.9mL (± 496.2mL), the median volume of blood loss to 400mL (IQR [300-700]), the 95th percentile to 1300mL [CI 95% 1200-1500]. The distribution of blood loss after cesarean was significantly higher than the distribution of blood loss after vaginal delivery. Copyright © 2015 Elsevier Masson SAS. All rights reserved.
    No preview · Article · Feb 2015
  • Albrice Levrat · Christian Kern · Cyril Huissoud
    [Show abstract] [Hide abstract]
    ABSTRACT: Pregnancy is associated with up-regulation of the maternal coagulation mechanism that aims to improve hemostasis during delivery of the placenta. Postpartum hemorrhage remains however one of the first causes of maternal death and coagulation disorders are systematically associated with severe maternal bleedings. This paper synthetizes the principal changes in the different pathways of hemostasis linked to pregnancy and their consequences for the management of obstetrical coagulopathies.
    No preview · Chapter · Jan 2015

  • No preview · Article · Dec 2014 · International Journal of Gynecology & Obstetrics
  • Source

    Full-text · Article · Nov 2014 · Journal de Gynécologie Obstétrique et Biologie de la Reproduction
  • Source

    Full-text · Article · Nov 2014 · Journal de Gynécologie Obstétrique et Biologie de la Reproduction
  • C Dupont · A-S Ducloy-Bouthors · C Huissoud
    [Show abstract] [Hide abstract]
    ABSTRACT: To describe the clinical and pharmacological procedures for the prevention of Postpartum Haemorrhage (PPH). We searched the Medline and the Cochrane Library (1st December 2004 to 1st March 2014) and we checked the international guidelines. Vaginal birth: only the use of uterotonics reduces the incidence of PPH. Oxytocin is the treatment of choice if it is readily available (grade A). Oxytocin can be used either after the shoulders expulsion or rapidly after the placental delivery (grade B). A dose of 5 or 10IU must be administrated IV over at least 1minute or directly by an intramuscular injection (professional agreement) except in women with documented cardiovascular disease in which the duration of the IV perfusion should be over at least 5minutes (professional agreement). Mechanical procedures have no significant impact on PPH. The decision to use a collector bag is left to the medical team (professional agreement). A systematic complementary oxytocin perfusion is not recommended (professional agreement). Caesarean delivery: There is no evidence to recommend a particular type of caesarean technique to prevent PPH (professional agreement) but a lower uterine section is recommended (grade B). All types of incision expansion may be used (professional agreement). A controlled cord traction is associated with lower blood losses than manual removal of the placenta (grade B). A dose of 5 or 10IU can be injected (IV) over 1minute, and over 5minutes in women with cardiovascular disease (professional agreement). Carbetocin reduces the incidence of PPH but there is presently no inferiority study comparing oxytocin and carbetocin so that oxytocin remains the gold standard therapy to prevent PPH in C-section (professional agreement). Copyright © 2014 Elsevier Masson SAS. All rights reserved.
    No preview · Article · Nov 2014
  • C. Dupont · A.-S. Ducloy-Bouthors · C. Huissoud
    [Show abstract] [Hide abstract]
    ABSTRACT: Décrire les méthodes de prévention clinique et pharmacologique de l’hémorragie du post-partum (HPP).
    No preview · Article · Nov 2014 · Journal de Gynécologie Obstétrique et Biologie de la Reproduction
  • [Show abstract] [Hide abstract]
    ABSTRACT: AimIdentify women at risk of severe post-partum hemorrhage (PPH) by building a prediction model based on clinical variables available at PPH diagnosis.Methods We analyzed data on a cohort of 7236 women with PPH after vaginal delivery from 106 maternity units. Severe PPH was defined as the loss of more than 2000 mL of blood, peripartum drop in hemoglobin of 4 g/dL or more, transfusion of at least four packed red blood cells, embolization, hemostasis surgery, transfer to an intensive care unit or death. The Akaike criterion helped selecting the covariates of a multivariate logistic regression model. The performance of the model was studied through building a receiver-operator curve (ROC). The relative utility of the final model was used to determine the importance of the model in decision-making.ResultsAmong all PPH, the prevalence of severe cases was 18.5%. Several clinical variables were significantly associated with severe PPH (e.g. parity, multiple pregnancy, labor induction, instrumental delivery). The multivariate prediction model was built. The area under the ROC for prediction of severe cases was 0.63 (95% confidence interval, 0.62-0.65). Nevertheless, the sensitivity and specificity of the prediction model were 0.49 and 0.70, respectively, for a threshold at 0.20 (near prevalence). The relative utility was 0.19 for a threshold near prevalence (20%).Conclusion Because of important misclassifications, even the best model we could build with the available clinical data cannot be reasonably recommended for routine use. Every patient with PPH should receive most optimal management. Other types of information, possibly laboratory data, are probably needed.
    No preview · Article · Oct 2014 · Journal of Obstetrics and Gynaecology Research
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective To identify women who had measles while being pregnant during the 2011 epidemic peak in Lyon, France, and to document maternal characteristics and fetal outcomes. Methods In a retrospective survey, women who had measles while being pregnant between January and December 2011 were identified from the records of the Laboratory of Virology, Hospices Civils de Lyon. Epidemiologic data, clinical characteristics, and measles outcomes were assessed. Results In total, 11 pregnant women and 2 women who had just delivered were hospitalized with measles infection in Lyon. The most severe maternal complication was pneumonia, which occurred in 4 women (30.8%). Other maternal complications included fever (11 women; 84.6%) and elevated liver enzymes (2/6 women; 33.3%). All women delivered healthy newborns. Post-exposure prophylaxis using human polyvalent immunoglobulin was initiated for three newborns whose mothers acquired measles in the immediate postpartum period. None of these newborns subsequently acquired measles, although breastfeeding was maintained. Conclusion Although measles infections during pregnancy can have a deleterious effect on both mother and child, in many cases hospitalization is not required. Unnecessary admission should be avoided given the high risk of transmission of measles in an obstetrics ward.
    Preview · Article · Sep 2014 · International Journal of Gynecology & Obstetrics
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives Evaluate the incidence of perinatal mortality and evaluate the percentage of non optimal care management of fatal pregnancies between 2005 and 2011 in the Rhone-Alpes region in France, by the use of the Aurore network. Evaluate the development of morbi-mortality revues (MMR) in this region. Methods Retrospective study of perinatal mortality in the Aurore network, from 2005 to 2011. Systematic analysis of care management (adapted, non adapted, non evaluable), of each perinatal death that occurred in the Aurore network, by a multidisciplinary committee during regional MMR. Results The incidence of perinatal mortality has diminished from 2005 to 2011 (8,4‰ vs. 6,4‰, P < 0.07) as well as the percentage of non adapted care management (13% vs. 5,6%, P < 0.001). An underestimation of irregularities in the fetal heart rate was described in 34% of per partum deaths. The percentage of optimal care management was significantly higher when the obstetrician was in the maternity rather than on call at home (P < 0.03) and in type 3 maternities compared to type 1 and 2 maternities (P < 0.04). The attendance of the MMR organized in the AURORE network progressed between 2006 and 2011. Conclusion Since 2005, a decrease in perinatal mortality and in non-adapted care management was observed. More studies are necessary to evaluate the link between the development of MMR in this network and the amelioration of these two indicators.
    No preview · Article · Jul 2014 · Journal de Gynécologie Obstétrique et Biologie de la Reproduction
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective Echogenic bowel (EB) represents 1 % of pregnancy and is a risk factor of fetal pathology (infection, cystic fibrosis, aneuploidy). The aim of our study was to determine the fetuses’ outcomes with isolated EB. Patients and methods This is a retrospective study of all patients who presented singleton gestations with a fetal isolated echogenic bowel between 2004 and 2011 in two prenatal diagnosis centers. Search of aneuploidy, infection and cystic fibrosis was systematically proposed as well as an ultrasound monitoring. Results On 109 fetus addressed for isolate echogenic bowel five had other signs associated and 74 had a real isolated echogenic bowel (without dilatation, calcification, intrauterine growth restriction). In 30 cases, the EB was not found. Eighty-five percent of the patients had in the first trimester a screening for trisomy 21. None fetus with isolated EB had trisomy, infection or cystic fibrosis. One fetus died in utero and one newborn died of a metabolic disease without digestive repercussions. Discussion and conclusion The risk of trisomy 21 and the risk to have a serious disease appear low for the fetus with EB. It does not seem necessary to propose a systematic amniocentesis in case of isolated echogenic bowel.
    No preview · Article · Jun 2014 · Gynécologie Obstétrique & Fertilité

  • No preview · Article · Jun 2014 · Ultrasound in Obstetrics and Gynecology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: to test the hypothesis that placental fetal thrombotic vasculopathy (FTV) is associated with obstetric complications and predisposes the child to unfavorable outcomes. Methods: 54 placentas with FTV lesions and 100 placentas without FTV lesions were collected over a 5-year period at the Croix-Rousse Pathology Department. Clinical findings including maternal, fetal, neonatal condition and pediatric outcome up to three years were collected for each case and control observation. The statistical analyses were assessed with Wald's chi-square derived from conditional logistic regression modeling. Results: FTV was associated with a significantly higher frequency of obstetric complications: (pregnancy-induced hypertension (OR 3.620, CI 1.563-8.385), preeclampsia (OR 3.674, CI 1.500-8.998), emergency delivery procedures (OR 3.727, CI 1.477-9.403), cesarean sections (OR 2.684, CI 1.016-7.088)), poor fetal condition (intrauterine growth restriction (IUGR) (OR 5.440, CI 2.007-14.748), nonreassuring fetal heart tracing (OR 6.062, CI 2.280-16.115), difficulties in immediate ex utero adaptation (OR 3.416, CI 1.087-10.732)) and perinatal or early childhood demise (OR 3.043, CI 1.327-6.978). On pathological examination, FTV was associated with marginal cord insertion (OR 3.492, CI 1.350-9.035), cord stricture and hypercoiled cord (OR 3.936, CI 1.209-12.813). Thromboembolic events were significantly more frequent in cases with FTV (OR 2.154, CI 1.032-5.622). Neurological complications within the first 3 years of life were also more frequent in the FTV group compared to the control group, but this association was not statistically significant. Conclusions: FTV is associated with maternal complications, pathological findings in the placenta, especially gross cord abnormalities, IUGR, and poor perinatal or early childhood outcome. It may also predispose children to somatic thromboembolic events.
    Full-text · Article · May 2014 · Placenta
  • [Show abstract] [Hide abstract]
    ABSTRACT: Severe postpartum haemorrhage after vaginal delivery: a statistical process control chart to report seven years of continuous quality improvement OBJECTIVE: To use statistical process control charts to describe trends in the prevalence of severe postpartum haemorrhage after vaginal delivery. This assessment was performed 7 years after we initiated a continuous quality improvement programme that began with regular criteria-based audits STUDY DESIGN: Observational descriptive study, in a French maternity unit in the Rhône-Alpes region. Intervention: Quarterly clinical audit meetings to analyse all cases of severe postpartum haemorrhage after vaginal delivery and provide feedback on quality of care with statistical process control tools. Main outcome measures: The primary outcomes were the prevalence of severe PPH after vaginal delivery and its quarterly monitoring with a control chart. The secondary outcomes included the global quality of care for women with severe postpartum haemorrhage, including the performance rate of each recommended procedure. Differences in these variables between 2005 and 2012 were tested. From 2005 to 2012, the prevalence of severe postpartum haemorrhage declined significantly, from 1.2% to 0.6% of vaginal deliveries (p<0.001). Since 2010, the quarterly rate of severe PPH has not exceeded the upper control limits, that is, been out of statistical control. The proportion of cases that were managed consistently with the guidelines increased for all of their main components. Implementation of continuous quality improvement efforts began seven years ago and used, among other tools, statistical process control charts. During this period, the prevalence of severe postpartum haemorrhage after vaginal delivery has been reduced by 50%.
    No preview · Article · Apr 2014 · European journal of obstetrics, gynecology, and reproductive biology
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective Demonstrate the feasibility of high-intensity focused ultrasound (HIFU) applied to the placental unit using a toroidal-shaped transducer within an ex-vivo model.Materials and methodsA toroidal HIFU transducer working at 2.5 MHz and composed of 32 ring-shaped emitters was used. An ultrasound imaging probe was placed in the center of the HIFU transducer. First, the attenuation coefficient of human placentae was measured and integrated in a numerical model for simulating HIFU lesions. Second ex-vivo experiments were performed using acoustic parameters from this preliminary study. An animal abdominal wall simulating the maternal wall was used. Single and juxtaposition of HIFU lesions were performed and studied on sonograms and macroscopically.ResultsAttenuation coefficients of 12 human placentae were measured and ranged from 0.07 to 0.10 Np.cm−1.MHz−1 according to the gestational age (17 to 40 weeks). Thirty-three human placentae (from 17 to 40 weeks) were included and exposed to HIFU. 25 single HIFU lesions were obtained, with an average diameter and depth of 7.1 ± 3.2 mm, and 8.2 ± 3.1mm respectively. Eight placentae were used for juxtaposing 6 HIFU lesions. The average diameter of these HIFU lesions was 23 ± 5 mm and the average depth was 11 ± 5 mm. The average thickness of the abdominal wall was 10.5 ± 1.8 mm. No lesions or damage were observed in intervening tissues.Conclusion This study demonstrates the feasibility, the reproducibility, the harmlessness and the effectiveness of HIFU applied to the placental unit within an ex-vivo model.
    No preview · Article · Apr 2014 · Ultrasound in Obstetrics and Gynecology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Major nonprimate-primate differences in corticogenesis include the dimensions, precursor lineages, and developmental timing of the germinal zones (GZs). microRNAs (miRNAs) of laser-dissected GZ compartments and cortical plate (CP) from embryonic E80 macaque visual cortex were deep sequenced. The CP and the GZ including ventricular zone (VZ) and outer and inner subcompartments of the outer subventricular zone (OSVZ) in area 17 displayed unique miRNA profiles. miRNAs present in primate, but absent in rodent, contributed disproportionately to the differential expression between GZ subregions. Prominent among the validated targets of these miRNAs were cell-cycle and neurogenesis regulators. Coevolution between the emergent miRNAs and their targets suggested that novel miRNAs became integrated into ancient gene circuitry to exert additional control over proliferation. We conclude that multiple cell-cycle regulatory events contribute to the emergence of primate-specific cortical features, including the OSVZ, generated enlarged supragranular layers, largely responsible for the increased primate cortex computational abilities.
    Preview · Article · Feb 2014 · Neuron

Publication Stats

1k Citations
181.64 Total Impact Points

Institutions

  • 2009-2015
    • Stem Cell And Brain Research Institute
      Lyons, Rhône-Alpes, France
  • 2008-2015
    • CHU de Lyon - Hôpital de la Croix-Rousse
      • Service de Gynécologie et d'Obstétrique
      Lyons, Rhône-Alpes, France
  • 2005-2015
    • Claude Bernard University Lyon 1
      Villeurbanne, Rhône-Alpes, France
  • 2010-2014
    • University of Lyon
      Lyons, Rhône-Alpes, France
  • 2008-2014
    • Hospices Civils de Lyon
      Lyons, Rhône-Alpes, France
  • 2008-2010
    • French Institute of Health and Medical Research
      • Stem Cell and Brain Research Institute
      Lutetia Parisorum, Île-de-France, France