Michel Boulvain - Academia.edu (original) (raw)
Papers by Michel Boulvain
BJOG: An International Journal of Obstetrics and Gynaecology, 2002
Objective To evaluate fetal and maternal adverse effects of intrathecal opioid analgesia during l... more Objective To evaluate fetal and maternal adverse effects of intrathecal opioid analgesia during labour.
European journal of obstetrics, gynecology, and reproductive biology, Jan 10, 2015
The aim of this study was to validate a French version of the prolapse-quality-of-life-questionna... more The aim of this study was to validate a French version of the prolapse-quality-of-life-questionnaire (P-QoL). The P-QoL was translated into French and administered to patients recruited in a tertiary referral teaching Hospital. The women concomitantly had a vaginal exam in supine position in order to determine prolapse stage using Pelvic Organ prolapse quantification system (POP-Q). The reliability was assessed by calculating Cronbach's alpha and by performing a test-retest analysis. The validity was evaluated by comparing scores for symptoms and quality of life between symptomatic and asymptomatic women as well as by comparing symptom scores with prolapse stages. 25 symptomatic and 22 asymptomatic patients were included. Cronbach's alphas and the test-retest analysis showed acceptable internal consistency within the domains. The total scores for seven P-QoL domain were significantly different between symptomatic and asymptomatic women (p<0.005). The scores of P-QoL were ...
Ultrasound in Obstetrics and Gynecology
high-risk population, we detected 89% of cases of trisomy 21 with a 4.5% false positive rate. In ... more high-risk population, we detected 89% of cases of trisomy 21 with a 4.5% false positive rate. In women whose age distribution reflects the antenatal population, we would expect a further reduction in the false positive rate with a modest reduction in detection.
Revue médicale suisse, Jan 26, 2011
Delivery before term (at less than 37 weeks of gestation) represents 5 to 10% of the deliveries a... more Delivery before term (at less than 37 weeks of gestation) represents 5 to 10% of the deliveries and is an important cause of perinatal mortality and morbidity. Few improvements in prevention have been made. Difficulties include the multiplicity of medical risk factors, the absence of reliable diagnostic tests and the limited effectiveness of medical treatment. Several studies have shown that psychosocial risk factors are associated with preterm labour. The identification and management of these risk factors and of unfavorable social environment may potentially reduce the risk of preterm delivery. We describe and discuss the studies evaluating psychosocial interventions aiming at reducing the risk of prematurity.
Clinical Nutrition Supplements, 2010
Ultrasound in Obstetrics & Gynecology, 2003
To evaluate intraobserver and interobserver agreement in the diagnosis of anal sphincter tears by... more To evaluate intraobserver and interobserver agreement in the diagnosis of anal sphincter tears by endosonography when performed immediately postpartum by resident obstetricians. Fifty-four primiparous women who delivered vaginally and had no anal sphincter tears (third- or fourth-degree perineal tears) diagnosed clinically were recruited. Four observers assessed photographic prints and video recordings of anal endosonography performed before the suture of the perineum. We calculated the intra- and interobserver agreement and the kappa coefficient to quantify the reliability of the diagnosis of clinically occult sphincter tears. The observers described sphincter tears in 13-28% of the prints, and in 7-32% of the video recordings. Intraobserver agreement was rated as substantial for prints (kappa, 0.63), and moderate for video recordings (kappa, 0.48). The interobserver agreement was fair for prints (kappa, 0.34) and moderate for video recordings (kappa, 0.42). Endosonography performed immediately postpartum to diagnose anal sphincter tears is of moderate reliability.
Ultrasound in Obstetrics & Gynecology, 2005
Objective To evaluate the risk of spontaneous preterm delivery in relation to cervical length in ... more Objective To evaluate the risk of spontaneous preterm delivery in relation to cervical length in severe cases of twin-to-twin transfusion syndrome (TTTS) diagnosed before 26 weeks of gestation and treated by laser coagulation of the intertwin placental anastomoses.
Clinical Nutrition Supplements, 2008
Rationale: Increased length of hospital stay is one of many reported consequences of malnutrition... more Rationale: Increased length of hospital stay is one of many reported consequences of malnutrition. However, this relation is often biased by selecting the population and not taking into account disease and its severity. The main goal of this study was to assess the influence of nutritional risk on the length of stay in a nonselected general hospital population, taking into account the disease and its severity by a classification into homogeneous disease groups thanks to diagnostic coding. Methods: We analysed all medical diagnostic codes and nutritional assessment reports over a 45-month period in 9 wards of a 300-bed hospital. Malnutrition and its risk were assessed with BMI, albumin levels and by the Geriatric Nutritional Risk Index (GNRI, cut-offs at 92 for mild malnutrition and 82 for severe malnutrition). The delta length of stay (DLS, actual length of stay minus national standardized length of stay for each homogeneous disease group) was the main endpoint. Age, sex, medical vs. surgical stay were also recorded. The influence of these variables on DLS was assessed by ANOVA. Results: 1198 patients were included (599 M, 599 W, aged 71±18 years [M±SD]), totalling 1310 hospital stays (86% medical, 14% surgical). Malnutrition was absent/ mild/severe in 53/27/20% of patients (GNRI), 37/31/32% (albumin) and 73/17/10% (BMI), with a good correlation between GNRI and albumin (kappa = 0.51), GNRI and BMI (kappa = 0.37), but a low correlation between albumin and BMI (kappa = 0.05). GNRI was therefore used. It was assessed after 4.0±6.8 hospital days in non-malnourished, 5.0±6.9 days in mildly malnourished and 5.7±7.6 days in severely malnourished patients (P = 0.002 between non-malnourished and severely malnourished). 73 patients died during their stay; OR for death was 4.4 [95%CI = 2.2 9.3] in mild malnutrition and 8.7 [95%CI = 4.4 18.3] in severe malnutrition. DLS was 2.1±9.8 days in non-malnourished, 3.5±12.9 days in mildly malnourished and 3.9±14.2 days in severely malnourished patients (P = 0.05 between each group). In multivariate analysis, malnutrition was independently associated with DLS. Conclusion: The risk of malnutrition, assessed by the GNRI, influences mortality and hospital length of stay independently from age, sex, disease and its severity. This confirms the medico-economic consequences of malnutrition. Even though GNRI was calculated later in severely malnourished patients, these findings are solid in mildly malnourished patients.
Bjog-an International Journal of Obstetrics and Gynaecology, 2004
e-SPEN Journal, 2012
Background & aims: The objective of this study was to assess the validity of the individually cal... more Background & aims: The objective of this study was to assess the validity of the individually calibrated Actiheart (a combined heart rate and movement sensor device), in pregnant women against indirect calorimetry in a laboratory setting. Methods: Ten healthy pregnant women (aged 32.9 AE 3.2 yrs, pre-pregnancy BMI ¼ 21.0 AE 2.4 kg/m 2 , 36.9 AE 2.4 weeks of gestation) walked at 3, 4, 5, and 6 km/h on a treadmill, cycled at 25 W and 50 W on an ergometer and stepped on and off a 15 cm high step. During each routine, AEE was measured simultaneously with the Actiheart (AEEa) and indirect calorimetry (AEEcalo). AEE measurements were compared with paired Student's t-test, and their agreement with Bland and Altman plots. Results: The mean AEEcalo was not significantly different from AEEa for any activity except for cycling at 50 W (À45 J/kg/min, p ¼ 0.01). Cumulated AEEa and AEEcalo, combining all activities, were not different (p ¼ 0.9). All data points (100%) fell within AE2SD for all activities except for walking at 6 km/h (89% of data points). All data points fell within AE2SD for the sum of all speeds of walking (3, 4, 5, and 6 km/h). Conclusions: The Actiheart can be used as a valid method for AEE estimation in pregnant women.
Ultrasound in Obstetrics and Gynecology, 2007
procedure allowing transplacental support in order to perform bronchoscopy, decompression by need... more procedure allowing transplacental support in order to perform bronchoscopy, decompression by needle aspiration of the mass and orotracheal intubation. At 7 days of life the newborn underwent a first infiltration with OK-432, at 28 days tracheotomy was performed and three further infiltrations were made at one month intervals. The mass has progressively shrunk with improvements in sucking, swallowing and breathing. At 5 months of age the tracheostomy was closed and the patient is eating normally per os. A multidisciplinary team approach combined with an accurate prenatal diagnosis obtained through fetal ultrasound and MRI was the key to a successful outcome.
Thrombosis and Haemostasis, 2009
Sports Medicine, 2010
Regular physical activity is associated with improved physiological, metabolic and psychological ... more Regular physical activity is associated with improved physiological, metabolic and psychological parameters, and with reduced risk of morbidity and mortality. Current recommendations aimed at improving the health and well-being of nonpregnant subjects advise that an accumulation of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or =30 minutes of moderate physical activity should occur on most, if not all, days of the week. Regardless of the specific physiological changes induced by pregnancy, which are primarily developed to meet the increased metabolic demands of mother and fetus, pregnant women benefit from regular physical activity the same way as nonpregnant subjects. Changes in submaximal oxygen uptake (VO(2)) during pregnancy depend on the type of exercise performed. During maternal rest or submaximal weight-bearing exercise (e.g. walking, stepping, treadmill exercise), absolute maternal VO(2) is significantly increased compared with the nonpregnant state. The magnitude of change is approximately proportional to maternal weight gain. When pregnant women perform submaximal weight-supported exercise on land (e.g. level cycling), the findings are contradictory. Some studies reported significantly increased absolute VO(2), while many others reported unchanged or only slightly increased absolute VO(2) compared with the nonpregnant state. The latter findings may be explained by the fact that the metabolic demand of cycle exercise is largely independent of the maternal body mass, resulting in no absolute VO(2) alteration. Few studies that directly measured changes in maternal maximal VO(2) (VO(2max)) showed no difference in the absolute VO(2max) between pregnant and nonpregnant subjects in cycling, swimming or weight-bearing exercise. Efficiency of work during exercise appears to be unchanged during pregnancy in non-weight-bearing exercise. During weight-bearing exercise, the work efficiency was shown to be improved in athletic women who continue exercising and those who stop exercising during pregnancy. When adjusted for weight gain, the increased efficiency is maintained throughout the pregnancy, with the improvement being greater in exercising women. Regular physical activity has been proven to result in marked benefits for mother and fetus. Maternal benefits include improved cardiovascular function, limited pregnancy weight gain, decreased musculoskeletal discomfort, reduced incidence of muscle cramps and lower limb oedema, mood stability, attenuation of gestational diabetes mellitus and gestational hypertension. Fetal benefits include decreased fat mass, improved stress tolerance, and advanced neurobehavioural maturation. In addition, few studies that have directly examined the effects of physical activity on labour and delivery indicate that, for women with normal pregnancies, physical activity is accompanied with shorter labour and decreased incidence of operative delivery. However, a substantial proportion of women stop exercising after they discover they are pregnant, and only few begin participating in exercise activities during pregnancy. The adoption or continuation of a sedentary lifestyle during pregnancy may contribute to the development of certain disorders such as hypertension, maternal and childhood obesity, gestational diabetes, dyspnoea, and pre-eclampsia. In view of the global epidemic of sedentary behaviour and obesity-related pathology, prenatal physical activity was shown to be useful for the prevention and treatment of these conditions. Further studies with larger sample sizes are required to confirm the association between physical activity and outcomes of labour and delivery.
Reproductive Health, 2013
Intrapartum complications are responsible for approximately half of all maternal deaths, and two ... more Intrapartum complications are responsible for approximately half of all maternal deaths, and two million stillbirth and neonatal deaths per year. Prolonged second stage of labour is associated with potentially fatal maternal complications such as haemorrhage and infection and it is a major cause of stillbirth and newborn morbidity and mortality. Currently, the three main options for managing prolonged second stage of labour are forceps, vacuum extractor and caesarean section. All three clinical practices require relatively expensive equipment (e.g., a surgical theatre for caesarean section) and/or highly trained staff which are often not available in low resource settings. The specific aim of the proposed study is to test the safety and feasibility of a new device (Odón device) to effectively deliver the fetus during prolonged second stage of labour. The Odón device is a low-cost technological innovation to facilitate operative vaginal delivery and designed to minimize trauma to the mother and baby. These features combined make it a potentially revolutionary development in obstetrics, particularly for improving intrapartum care and reducing maternal and perinatal morbidity and mortality in low resource settings. This will be a hospital-based, multicenter prospective phase 1 cohort study with no control group. Delivery with the Odón device will be attempted under normal labour and non-emergency conditions on all the women enrolled in the study. One-hundred and thirty pregnant women will be recruited in tertiary care facilities in Argentina. Safety will be assessed by examining maternal and infant outcomes until discharge. Feasibility will be evaluated by observing successful expulsion of the fetal head after one-time application of the device under standardized conditions (full cervical dilation, anterior presentation, +2 station, normal fetal heart rate). Australian New Zealand Clinical Trials Registry (ANZCTR). Identifier: ACTRN12613000141741.
Obstetrics & Gynecology, 1998
Data Sources: We searched MEDLINE, Current Contents, Index Medicus, and proceedings of meetings f... more Data Sources: We searched MEDLINE, Current Contents, Index Medicus, and proceedings of meetings for studies published between 1991 and June 1997.
Obstetrics & Gynecology, 2009
To estimate the efficacy of moxibustion between 34 and 38 weeks of gestation to facilitate the ce... more To estimate the efficacy of moxibustion between 34 and 38 weeks of gestation to facilitate the cephalic version of fetuses in breech presentation and the acceptability of this method by women.
Journal of Thrombosis and Haemostasis, 2005
Background: D-dimer (DD) measurement has proved to be very useful to exclude venous thromboemboli... more Background: D-dimer (DD) measurement has proved to be very useful to exclude venous thromboembolism (VTE) in outpatients. However, during pregnancy, the progressive increase as well as the interindividual variations of DD means that in this instance they are of poor value to rule out VTE. Only a few studies have reported measurements of DD levels in the postpartum. Objectives: To measure DD sequentially in the puerperium in order to determine when DD levels return to values obtained in non-pregnant women and can again be used in the exclusion of VTE. Patients and methods: After uncomplicated pregnancies, 150 women delivering at term either vaginally (n ¼ 100) or by cesarean section (n ¼ 50) were included. DD levels were measured immediately following delivery and next at days 1, 3, 10, 30 and 45. Results: There was a marked elevation of DD at delivery, especially when instrumental. All DD measurements were above 500 ng mL )1 at delivery, at day 1 and at day 3 postpartum. A sharp decrease in DD was observed between day 1 and day 3, followed by a slight increase at day 10. At day 30 and day 45, respectively, 79% and 93% of women in the vaginal delivery group and 70% and 83% in the cesarean group had levels below 500 ng mL )1 . Bleeding, breastfeeding and heparin prophylaxis did not modify DD levels significantly. Conclusion: Using the Vidas DD new assay, our study provides reference intervals for DD in the postpartum period. Using a cut-off at 500 ng mL )1 , DD measurement for ruling out VTE was found to be useful again 4 weeks after delivery.
The Journal of Alternative and Complementary Medicine, 2008
Objectives: Moxibustion, a Traditional Chinese Medicine technique related to acupuncture, was pro... more Objectives: Moxibustion, a Traditional Chinese Medicine technique related to acupuncture, was proposed to facilitate cephalic version of breech presentation. Several trials were conducted to evaluate the efficacy, but there are few reports on the safety of moxibustion. Our objective was to assess the side-effects and acceptability of this intervention. Design: We are conducting a randomized controlled trial to evaluate the efficacy of moxibustion for breech version. The first 12 participants randomized in the moxibustion group had additional fetal surveillance by electronic monitoring. Subjects: Pregnant women with a fetus in breech presentation are included in the trial between 34 and 36 weeks of gestation. Interventions: We performed a cardiotocogram during 10 minutes before, 20 minutes during, and 10 minutes after each session. A maximum of 9 sessions were scheduled every other day, and stopped when cephalic version was diagnosed. The recordings were assessed by 3 independent readers using the Fischer scoring system. Outcome measures: Fetal well-being was evaluated by the cardiotocogram; effect on the mother was evaluated by blood pressure recorded before and after each session; maternal views, contractions, and perceived changes in fetal movements were assessed using a questionnaire. Results: A total of 65 cardiotocograms were analyzed. All scores were considered as normal, being at 8 or more on a 0-10 scale. Acceptability for the women and compliance to the intervention were good. No significant maternal or fetal side-effect was observed. Conclusions: We have not detected alterations of fetal and maternal well-being or other side-effects associated with moxibustion applied to the BL 67 for cephalic version of breech presentations. Moxibustion appears to be safe for both the mother and the fetus.
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2011
Clinical Nutrition Supplements, 2010
BJOG: An International Journal of Obstetrics and Gynaecology, 2002
Objective To evaluate fetal and maternal adverse effects of intrathecal opioid analgesia during l... more Objective To evaluate fetal and maternal adverse effects of intrathecal opioid analgesia during labour.
European journal of obstetrics, gynecology, and reproductive biology, Jan 10, 2015
The aim of this study was to validate a French version of the prolapse-quality-of-life-questionna... more The aim of this study was to validate a French version of the prolapse-quality-of-life-questionnaire (P-QoL). The P-QoL was translated into French and administered to patients recruited in a tertiary referral teaching Hospital. The women concomitantly had a vaginal exam in supine position in order to determine prolapse stage using Pelvic Organ prolapse quantification system (POP-Q). The reliability was assessed by calculating Cronbach's alpha and by performing a test-retest analysis. The validity was evaluated by comparing scores for symptoms and quality of life between symptomatic and asymptomatic women as well as by comparing symptom scores with prolapse stages. 25 symptomatic and 22 asymptomatic patients were included. Cronbach's alphas and the test-retest analysis showed acceptable internal consistency within the domains. The total scores for seven P-QoL domain were significantly different between symptomatic and asymptomatic women (p<0.005). The scores of P-QoL were ...
Ultrasound in Obstetrics and Gynecology
high-risk population, we detected 89% of cases of trisomy 21 with a 4.5% false positive rate. In ... more high-risk population, we detected 89% of cases of trisomy 21 with a 4.5% false positive rate. In women whose age distribution reflects the antenatal population, we would expect a further reduction in the false positive rate with a modest reduction in detection.
Revue médicale suisse, Jan 26, 2011
Delivery before term (at less than 37 weeks of gestation) represents 5 to 10% of the deliveries a... more Delivery before term (at less than 37 weeks of gestation) represents 5 to 10% of the deliveries and is an important cause of perinatal mortality and morbidity. Few improvements in prevention have been made. Difficulties include the multiplicity of medical risk factors, the absence of reliable diagnostic tests and the limited effectiveness of medical treatment. Several studies have shown that psychosocial risk factors are associated with preterm labour. The identification and management of these risk factors and of unfavorable social environment may potentially reduce the risk of preterm delivery. We describe and discuss the studies evaluating psychosocial interventions aiming at reducing the risk of prematurity.
Clinical Nutrition Supplements, 2010
Ultrasound in Obstetrics & Gynecology, 2003
To evaluate intraobserver and interobserver agreement in the diagnosis of anal sphincter tears by... more To evaluate intraobserver and interobserver agreement in the diagnosis of anal sphincter tears by endosonography when performed immediately postpartum by resident obstetricians. Fifty-four primiparous women who delivered vaginally and had no anal sphincter tears (third- or fourth-degree perineal tears) diagnosed clinically were recruited. Four observers assessed photographic prints and video recordings of anal endosonography performed before the suture of the perineum. We calculated the intra- and interobserver agreement and the kappa coefficient to quantify the reliability of the diagnosis of clinically occult sphincter tears. The observers described sphincter tears in 13-28% of the prints, and in 7-32% of the video recordings. Intraobserver agreement was rated as substantial for prints (kappa, 0.63), and moderate for video recordings (kappa, 0.48). The interobserver agreement was fair for prints (kappa, 0.34) and moderate for video recordings (kappa, 0.42). Endosonography performed immediately postpartum to diagnose anal sphincter tears is of moderate reliability.
Ultrasound in Obstetrics & Gynecology, 2005
Objective To evaluate the risk of spontaneous preterm delivery in relation to cervical length in ... more Objective To evaluate the risk of spontaneous preterm delivery in relation to cervical length in severe cases of twin-to-twin transfusion syndrome (TTTS) diagnosed before 26 weeks of gestation and treated by laser coagulation of the intertwin placental anastomoses.
Clinical Nutrition Supplements, 2008
Rationale: Increased length of hospital stay is one of many reported consequences of malnutrition... more Rationale: Increased length of hospital stay is one of many reported consequences of malnutrition. However, this relation is often biased by selecting the population and not taking into account disease and its severity. The main goal of this study was to assess the influence of nutritional risk on the length of stay in a nonselected general hospital population, taking into account the disease and its severity by a classification into homogeneous disease groups thanks to diagnostic coding. Methods: We analysed all medical diagnostic codes and nutritional assessment reports over a 45-month period in 9 wards of a 300-bed hospital. Malnutrition and its risk were assessed with BMI, albumin levels and by the Geriatric Nutritional Risk Index (GNRI, cut-offs at 92 for mild malnutrition and 82 for severe malnutrition). The delta length of stay (DLS, actual length of stay minus national standardized length of stay for each homogeneous disease group) was the main endpoint. Age, sex, medical vs. surgical stay were also recorded. The influence of these variables on DLS was assessed by ANOVA. Results: 1198 patients were included (599 M, 599 W, aged 71±18 years [M±SD]), totalling 1310 hospital stays (86% medical, 14% surgical). Malnutrition was absent/ mild/severe in 53/27/20% of patients (GNRI), 37/31/32% (albumin) and 73/17/10% (BMI), with a good correlation between GNRI and albumin (kappa = 0.51), GNRI and BMI (kappa = 0.37), but a low correlation between albumin and BMI (kappa = 0.05). GNRI was therefore used. It was assessed after 4.0±6.8 hospital days in non-malnourished, 5.0±6.9 days in mildly malnourished and 5.7±7.6 days in severely malnourished patients (P = 0.002 between non-malnourished and severely malnourished). 73 patients died during their stay; OR for death was 4.4 [95%CI = 2.2 9.3] in mild malnutrition and 8.7 [95%CI = 4.4 18.3] in severe malnutrition. DLS was 2.1±9.8 days in non-malnourished, 3.5±12.9 days in mildly malnourished and 3.9±14.2 days in severely malnourished patients (P = 0.05 between each group). In multivariate analysis, malnutrition was independently associated with DLS. Conclusion: The risk of malnutrition, assessed by the GNRI, influences mortality and hospital length of stay independently from age, sex, disease and its severity. This confirms the medico-economic consequences of malnutrition. Even though GNRI was calculated later in severely malnourished patients, these findings are solid in mildly malnourished patients.
Bjog-an International Journal of Obstetrics and Gynaecology, 2004
e-SPEN Journal, 2012
Background & aims: The objective of this study was to assess the validity of the individually cal... more Background & aims: The objective of this study was to assess the validity of the individually calibrated Actiheart (a combined heart rate and movement sensor device), in pregnant women against indirect calorimetry in a laboratory setting. Methods: Ten healthy pregnant women (aged 32.9 AE 3.2 yrs, pre-pregnancy BMI ¼ 21.0 AE 2.4 kg/m 2 , 36.9 AE 2.4 weeks of gestation) walked at 3, 4, 5, and 6 km/h on a treadmill, cycled at 25 W and 50 W on an ergometer and stepped on and off a 15 cm high step. During each routine, AEE was measured simultaneously with the Actiheart (AEEa) and indirect calorimetry (AEEcalo). AEE measurements were compared with paired Student's t-test, and their agreement with Bland and Altman plots. Results: The mean AEEcalo was not significantly different from AEEa for any activity except for cycling at 50 W (À45 J/kg/min, p ¼ 0.01). Cumulated AEEa and AEEcalo, combining all activities, were not different (p ¼ 0.9). All data points (100%) fell within AE2SD for all activities except for walking at 6 km/h (89% of data points). All data points fell within AE2SD for the sum of all speeds of walking (3, 4, 5, and 6 km/h). Conclusions: The Actiheart can be used as a valid method for AEE estimation in pregnant women.
Ultrasound in Obstetrics and Gynecology, 2007
procedure allowing transplacental support in order to perform bronchoscopy, decompression by need... more procedure allowing transplacental support in order to perform bronchoscopy, decompression by needle aspiration of the mass and orotracheal intubation. At 7 days of life the newborn underwent a first infiltration with OK-432, at 28 days tracheotomy was performed and three further infiltrations were made at one month intervals. The mass has progressively shrunk with improvements in sucking, swallowing and breathing. At 5 months of age the tracheostomy was closed and the patient is eating normally per os. A multidisciplinary team approach combined with an accurate prenatal diagnosis obtained through fetal ultrasound and MRI was the key to a successful outcome.
Thrombosis and Haemostasis, 2009
Sports Medicine, 2010
Regular physical activity is associated with improved physiological, metabolic and psychological ... more Regular physical activity is associated with improved physiological, metabolic and psychological parameters, and with reduced risk of morbidity and mortality. Current recommendations aimed at improving the health and well-being of nonpregnant subjects advise that an accumulation of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or =30 minutes of moderate physical activity should occur on most, if not all, days of the week. Regardless of the specific physiological changes induced by pregnancy, which are primarily developed to meet the increased metabolic demands of mother and fetus, pregnant women benefit from regular physical activity the same way as nonpregnant subjects. Changes in submaximal oxygen uptake (VO(2)) during pregnancy depend on the type of exercise performed. During maternal rest or submaximal weight-bearing exercise (e.g. walking, stepping, treadmill exercise), absolute maternal VO(2) is significantly increased compared with the nonpregnant state. The magnitude of change is approximately proportional to maternal weight gain. When pregnant women perform submaximal weight-supported exercise on land (e.g. level cycling), the findings are contradictory. Some studies reported significantly increased absolute VO(2), while many others reported unchanged or only slightly increased absolute VO(2) compared with the nonpregnant state. The latter findings may be explained by the fact that the metabolic demand of cycle exercise is largely independent of the maternal body mass, resulting in no absolute VO(2) alteration. Few studies that directly measured changes in maternal maximal VO(2) (VO(2max)) showed no difference in the absolute VO(2max) between pregnant and nonpregnant subjects in cycling, swimming or weight-bearing exercise. Efficiency of work during exercise appears to be unchanged during pregnancy in non-weight-bearing exercise. During weight-bearing exercise, the work efficiency was shown to be improved in athletic women who continue exercising and those who stop exercising during pregnancy. When adjusted for weight gain, the increased efficiency is maintained throughout the pregnancy, with the improvement being greater in exercising women. Regular physical activity has been proven to result in marked benefits for mother and fetus. Maternal benefits include improved cardiovascular function, limited pregnancy weight gain, decreased musculoskeletal discomfort, reduced incidence of muscle cramps and lower limb oedema, mood stability, attenuation of gestational diabetes mellitus and gestational hypertension. Fetal benefits include decreased fat mass, improved stress tolerance, and advanced neurobehavioural maturation. In addition, few studies that have directly examined the effects of physical activity on labour and delivery indicate that, for women with normal pregnancies, physical activity is accompanied with shorter labour and decreased incidence of operative delivery. However, a substantial proportion of women stop exercising after they discover they are pregnant, and only few begin participating in exercise activities during pregnancy. The adoption or continuation of a sedentary lifestyle during pregnancy may contribute to the development of certain disorders such as hypertension, maternal and childhood obesity, gestational diabetes, dyspnoea, and pre-eclampsia. In view of the global epidemic of sedentary behaviour and obesity-related pathology, prenatal physical activity was shown to be useful for the prevention and treatment of these conditions. Further studies with larger sample sizes are required to confirm the association between physical activity and outcomes of labour and delivery.
Reproductive Health, 2013
Intrapartum complications are responsible for approximately half of all maternal deaths, and two ... more Intrapartum complications are responsible for approximately half of all maternal deaths, and two million stillbirth and neonatal deaths per year. Prolonged second stage of labour is associated with potentially fatal maternal complications such as haemorrhage and infection and it is a major cause of stillbirth and newborn morbidity and mortality. Currently, the three main options for managing prolonged second stage of labour are forceps, vacuum extractor and caesarean section. All three clinical practices require relatively expensive equipment (e.g., a surgical theatre for caesarean section) and/or highly trained staff which are often not available in low resource settings. The specific aim of the proposed study is to test the safety and feasibility of a new device (Odón device) to effectively deliver the fetus during prolonged second stage of labour. The Odón device is a low-cost technological innovation to facilitate operative vaginal delivery and designed to minimize trauma to the mother and baby. These features combined make it a potentially revolutionary development in obstetrics, particularly for improving intrapartum care and reducing maternal and perinatal morbidity and mortality in low resource settings. This will be a hospital-based, multicenter prospective phase 1 cohort study with no control group. Delivery with the Odón device will be attempted under normal labour and non-emergency conditions on all the women enrolled in the study. One-hundred and thirty pregnant women will be recruited in tertiary care facilities in Argentina. Safety will be assessed by examining maternal and infant outcomes until discharge. Feasibility will be evaluated by observing successful expulsion of the fetal head after one-time application of the device under standardized conditions (full cervical dilation, anterior presentation, +2 station, normal fetal heart rate). Australian New Zealand Clinical Trials Registry (ANZCTR). Identifier: ACTRN12613000141741.
Obstetrics & Gynecology, 1998
Data Sources: We searched MEDLINE, Current Contents, Index Medicus, and proceedings of meetings f... more Data Sources: We searched MEDLINE, Current Contents, Index Medicus, and proceedings of meetings for studies published between 1991 and June 1997.
Obstetrics & Gynecology, 2009
To estimate the efficacy of moxibustion between 34 and 38 weeks of gestation to facilitate the ce... more To estimate the efficacy of moxibustion between 34 and 38 weeks of gestation to facilitate the cephalic version of fetuses in breech presentation and the acceptability of this method by women.
Journal of Thrombosis and Haemostasis, 2005
Background: D-dimer (DD) measurement has proved to be very useful to exclude venous thromboemboli... more Background: D-dimer (DD) measurement has proved to be very useful to exclude venous thromboembolism (VTE) in outpatients. However, during pregnancy, the progressive increase as well as the interindividual variations of DD means that in this instance they are of poor value to rule out VTE. Only a few studies have reported measurements of DD levels in the postpartum. Objectives: To measure DD sequentially in the puerperium in order to determine when DD levels return to values obtained in non-pregnant women and can again be used in the exclusion of VTE. Patients and methods: After uncomplicated pregnancies, 150 women delivering at term either vaginally (n ¼ 100) or by cesarean section (n ¼ 50) were included. DD levels were measured immediately following delivery and next at days 1, 3, 10, 30 and 45. Results: There was a marked elevation of DD at delivery, especially when instrumental. All DD measurements were above 500 ng mL )1 at delivery, at day 1 and at day 3 postpartum. A sharp decrease in DD was observed between day 1 and day 3, followed by a slight increase at day 10. At day 30 and day 45, respectively, 79% and 93% of women in the vaginal delivery group and 70% and 83% in the cesarean group had levels below 500 ng mL )1 . Bleeding, breastfeeding and heparin prophylaxis did not modify DD levels significantly. Conclusion: Using the Vidas DD new assay, our study provides reference intervals for DD in the postpartum period. Using a cut-off at 500 ng mL )1 , DD measurement for ruling out VTE was found to be useful again 4 weeks after delivery.
The Journal of Alternative and Complementary Medicine, 2008
Objectives: Moxibustion, a Traditional Chinese Medicine technique related to acupuncture, was pro... more Objectives: Moxibustion, a Traditional Chinese Medicine technique related to acupuncture, was proposed to facilitate cephalic version of breech presentation. Several trials were conducted to evaluate the efficacy, but there are few reports on the safety of moxibustion. Our objective was to assess the side-effects and acceptability of this intervention. Design: We are conducting a randomized controlled trial to evaluate the efficacy of moxibustion for breech version. The first 12 participants randomized in the moxibustion group had additional fetal surveillance by electronic monitoring. Subjects: Pregnant women with a fetus in breech presentation are included in the trial between 34 and 36 weeks of gestation. Interventions: We performed a cardiotocogram during 10 minutes before, 20 minutes during, and 10 minutes after each session. A maximum of 9 sessions were scheduled every other day, and stopped when cephalic version was diagnosed. The recordings were assessed by 3 independent readers using the Fischer scoring system. Outcome measures: Fetal well-being was evaluated by the cardiotocogram; effect on the mother was evaluated by blood pressure recorded before and after each session; maternal views, contractions, and perceived changes in fetal movements were assessed using a questionnaire. Results: A total of 65 cardiotocograms were analyzed. All scores were considered as normal, being at 8 or more on a 0-10 scale. Acceptability for the women and compliance to the intervention were good. No significant maternal or fetal side-effect was observed. Conclusions: We have not detected alterations of fetal and maternal well-being or other side-effects associated with moxibustion applied to the BL 67 for cephalic version of breech presentations. Moxibustion appears to be safe for both the mother and the fetus.
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2011
Clinical Nutrition Supplements, 2010