Nils Chaillet - Academia.edu (original) (raw)

Papers by Nils Chaillet

Research paper thumbnail of 639: Labor dystocia and the risk of uterine rupture in women with a prior cesarean

American Journal of Obstetrics and Gynecology

Research paper thumbnail of Survey on Uterine Closure and Other Techniques for Caesarean Section Among Quebec's Obstetrician-Gynaecologists

Journal of obstetrics and gynaecology Canada: JOGC = Journal d'obstetrique et gynecologie du Canada: JOGC

Objective: To evaluate the preferred types of uterine closure at Caesarean section among Quebec&#... more Objective: To evaluate the preferred types of uterine closure at Caesarean section among Quebec's obstetrician-gynaecologists. Methods: An anonymous survey with multiple-choice and open questions was sent by email to all members of the Association des Obstétriciens-Gynécologues du Québec in clinical practice. The primary response of interest was the type of uterine closure that would be favoured for a primigravida undergoing an elective CS at term for a breech fetus. Secondary responses of interest included type of uterine closure for CS performed for other indications, and methods of closure for the bladder flap, parietal peritoneum, rectus abdominis muscle, subcutaneous tissue, and skin. Results were stratified according to the number of years in practice. Results: Of 454 persons targeted, 176 (39%) responded. Responders were more likely to have fewer years in practice than the targeted population in general. The closures for a primigravida undergoing an elective CS at term fo...

Research paper thumbnail of Sonographic lower uterine segment thickness and risk of uterine scar defect: a systematic review

Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2010

To study the diagnostic accuracy of sonographic measurements of the lower uterine segment (LUS) t... more To study the diagnostic accuracy of sonographic measurements of the lower uterine segment (LUS) thickness near term in predicting uterine scar defects in women with prior Caesarean section (CS). PubMed, Embase, and Cochrane Library (1965-2009). Studies of populations of women with previous low transverse CS who underwent third-trimester evaluation of LUS thickness were selected. We retrieved articles in which number of patients, sensitivity, and specificity to predict a uterine scar defect were available. Twelve eligible studies including 1834 women were identified. Uterine scar defect was reported in a total of 121 cases (6.6%). Seven studies examined the full LUS thickness only, four examined the myometrial layer specifically, and one examined both measurements. Weighted mean differences in LUS thickness and associated 95% confidence intervals between women with and without uterine scar defect were calculated. Summary receiver operating characteristic (SROC) analysis and summary d...

Research paper thumbnail of Validation of a prediction model for vaginal birth after caesarean

Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2013

Pregnant women with a previous Caesarean section face making the decision to undergo an elective ... more Pregnant women with a previous Caesarean section face making the decision to undergo an elective repeat Caesarean section or to attempt a trial of labour with the goal of achieving a vaginal birth after Caesarean (VBAC). One of the key factors in counselling these women is the probability of a successful VBAC. We aimed to validate a prediction model for VBAC success. We performed an analysis of women at term with one prior low-transverse Caesarean section and a live cephalic singleton pregnancy who attempted a trial of labour after Caesarean (TOLAC) at 32 hospitals in Quebec between 2008 and 2012. The individual TOLAC probabilities of success were calculated without regard to ethnicity, using a prediction model previously developed in the United States. The predictive ability of the model was assessed using receiver operating characteristic curves and the area under the curve (AUC). In addition, a calibration curve was generated by plotting the predicted and observed VBAC rates. Of ...

Research paper thumbnail of Impact of single- vs double-layer closure on adverse outcomes and uterine scar defect: a systematic review and metaanalysis

American Journal of Obstetrics and Gynecology, 2014

A systematic review and meta-analysis were performed through electronic database searches to esti... more A systematic review and meta-analysis were performed through electronic database searches to estimate the effect of uterine closure at cesarean on the risk of adverse maternal outcome and on uterine scar evaluated by ultrasound.

Research paper thumbnail of Organochlorine Pollutants and Female Fertility: A Systematic Review Focusing on In Vitro Fertilization Studies

Reproductive Sciences, 2012

The possible adverse effects of organochlorine pollutants (OPs) on human fertility are a matter o... more The possible adverse effects of organochlorine pollutants (OPs) on human fertility are a matter of concern. Direct evaluation of the effects on female fertility was made possible by the advent of in vitro fertilization (IVF). We conducted a systematic review to assess possible associations between OP levels and selected indicators of female fertility in the context of IVF. After harmonization, OP concentrations per unit of lipid varied considerably, OP concentrations were higher in follicular than in serum and conflicting results were obtained. No significant adverse association between OP concentration and female fertility was observed in some studies. In other reports, there were indications of various degrees of significance that oocyte, embryo quality, and implantation may have been impaired. Thus, this review provides no evidence to support the hypothesis that OPs impair female fertility but insufficient evidence to reject this hypothesis. Our conclusions are limited by the diversity of the protocols used, OPs studied, and the quality of the studies selected. The IVF provides a unique context in which to assess the impact of OPs on female fertility, but it is subject to several limitations. Potential frameworks for future studies are proposed.

Research paper thumbnail of Validation of a Prediction Model for Predicting the Probability of Morbidity Related to a Trial of Labour in Quebec

Obstetrical & Gynecological Survey, 2013

section face the decision either to undergo an elective repeat Caesarean section (ERCS) or to att... more section face the decision either to undergo an elective repeat Caesarean section (ERCS) or to attempt a trial of labour with the goal of achieving a vaginal birth after Caesarean (VBAC) Both choices are associated with their own risks of maternal and neonatal morbidity We aimed to determine the external validity of a prediction model for the success of trial of labour after Caesarean section (TOLAC) that could help these women in their decision-making

Research paper thumbnail of Single- versus double-layer closure of the hysterotomy incision during cesarean delivery and risk of uterine rupture

International Journal of Gynecology & Obstetrics, 2011

Objective: To evaluate the best available evidence regarding the association between single-layer... more Objective: To evaluate the best available evidence regarding the association between single-layer closure and uterine rupture. Methods: The PubMed, Embase, and Cochrane Central Register of Controlled Trials databases were searched for relevant observational and experimental studies that included women with a previous single, low, transverse cesarean delivery who had attempted a trial of labor (TOL). The risks of uterine rupture and uterine dehiscence were assessed by pooled odds ratios (OR) calculated with a random effects model. Results: Nine studies including 5810 women were reviewed. Overall, the risk of uterine rupture during TOL after a single-layer closure was not significantly different from that after a double-layer closure (OR 1.71; 95% confidence interval [CI] 0.66-4.44). However, a sensitivity analysis indicated that the risk of uterine rupture was increased after a locked single-layer closure (OR 4.96; 95% CI 2.58-9.52, P b 0.001) but not after an unlocked single-layer closure (OR 0.49; 95% CI 0.21-1.16), compared with a double-layer closure. Conclusion: Locked but not unlocked single-layer closures were associated with a higher uterine rupture risk than doublelayer closure in women attempting a TOL.

Research paper thumbnail of Approche probabiliste de l'estimation de l'âge chez l'enfant à partir de la maturation dentaire

Comptes Rendus Biologies, 2003

Research paper thumbnail of Nonpharmacologic Approaches for Pain Management During Labor Compared with Usual Care: A Meta-Analysis

Birth, 2014

Objectives: To assess the effects of nonpharmacologic approaches to pain relief during labor, acc... more Objectives: To assess the effects of nonpharmacologic approaches to pain relief during labor, according to their endogenous mechanism of action, on obstetric interventions, maternal, and neonatal outcomes. Data source: Cochrane library, Medline, Embase, CINAHL and the MRCT databases were used to screen studies from January 1990 to December 2012. Study selection: According to Cochrane criteria, we selected randomized controlled trials that compared nonpharmacologic approaches for pain relief during labor to usual care, using intention-to-treat method. Results: Nonpharmacologic approaches, based on Gate Control (water immersion, massage, ambulation, positions) and Diffuse Noxious Inhibitory Control (acupressure, acupuncture, electrical stimulation, water injections), are associated with a reduction in epidural analgesia and a higher maternal satisfaction with childbirth. When compared with nonpharmacologic approaches based on Central Nervous System Control (education, attention deviation, support), usual care is associated with increased odds of epidural OR 1.13 (95% CI 1.05-1.23), cesarean delivery OR 1.60 (95% CI 1.18-2.18), instrumental delivery OR 1.21 (95% CI 1.03-1.44), use of oxytocin OR 1.20 (95% CI 1.01-1.43), labor duration (29.7 min, 95% CI 4.5-54.8), and a lesser satisfaction with childbirth. Tailored nonpharmacologic approaches, based on continuous support, were the most effective for reducing obstetric interventions. Conclusion: Nonpharmacologic approaches to relieve pain during labor, when used as a part of hospital pain relief strategies, provide significant benefits to women and their infants without causing additional harm. (BIRTH 41:2 June 2014)

Research paper thumbnail of Interrelations Between Four Antepartum Obstetric Interventions and Cesarean Delivery in Women at Low Risk: A Systematic Review and Modeling of the Cascade of Interventions

Birth, 2014

To critically appraise the literature on the relations between four intrapartum obstetric interve... more To critically appraise the literature on the relations between four intrapartum obstetric interventions-electronic fetal monitoring (EFM), epidural analgesia, labor induction, and labor acceleration; and two types of delivery-instrumental (forceps and vacuum) and cesarean section. This review included meta-analyses published between January 2000 and April 2012 including at least one randomized clinical trial published after 1995 and presenting results on low-risk pregnancies between 37 and 42 weeks of gestation, searched in the databases Medline, Cochrane Library, and EMBASE with no language restriction. Of 306 documents identified, 8 fulfilled the inclusion criteria and presented results on women at low risk. EFM at admission (vs intermittent auscultation) was associated with cesarean delivery (odds ratio [OR] = 1.20, 95% confidence interval [CI] 1.00-1.44) and epidural analgesia (OR = 1.25, 95% CI 1.09-1.43). Epidural on request was associated with cesarean delivery (OR = 1.60, 95% CI 1.18-2.18), instrumental delivery (OR = 1.21, 95% CI 1.03-1.44), and oxytocin use (OR = 1.20, 95% CI 1.01-1.43) when compared with epidural on request plus nonpharmacological labor pain control methods such as one-to-one support, breathing techniques, and relaxation. Induction and acceleration of labor showed heterogeneous patterns of associations with cesarean delivery and instrumental delivery. Complex patterns of associations between obstetric interventions and modes of delivery were illustrated in an empirical model. Intermittent auscultation and nonpharmacological labor pain control interventions, such as one-to-one support during labor, have the potential for substantially reducing cesarean deliveries.

Research paper thumbnail of Timing of Demirjian's tooth formation stages

Annals of Human Biology, 2006

Background: Global differences in Demirjian et al.'s method of assessing dental maturity are thou... more Background: Global differences in Demirjian et al.'s method of assessing dental maturity are thought to be due to population differences. Aim: The aim of this study was to investigate the timing of individual tooth formation stages in children from eight countries. Research design: This was a meta-analysis of previously published data from retrospective crosssectional studies of dental maturity. Method: Data of mandibular permanent developing teeth from panoramic radiographs (Demirjian's stages) were combined from Australia, and Sweden (n ¼ 9002, ages 2-16.99 years). Age-of-attainment was calculated using logistic regression for each group by sex and meta-analysis of the total. Overlapping 95% confidence intervals of the means was interpreted as no significant difference. Results: Mean ages for each group and total were significantly different in 65 out of 509 comparisons (p < 0.05). Some of these were of small sample size but there was no consistent pattern. Apex closure of the first molar was significantly later in children from Quebec and this might explain differences found in the dental maturity score. Conclusions: These results suggest no major differences in the timing of tooth formation stages between these children. This fails to explain previous findings of differences using Demirjian's dental maturity method.

Research paper thumbnail of Systematic Review of Cesarean Scar Assessment in the Nonpregnant State: Imaging Techniques and Uterine Scar Defect

American Journal of Perinatology, 2012

The rate of cesareans is constantly increasing, reaching more than 30% of births in several count... more The rate of cesareans is constantly increasing, reaching more than 30% of births in several countries. Although millions of cesareans are performed worldwide, poor uterine scar healing is associated with complications, such as uterine rupture, in subsequent pregnancies. 1 Uterine rupture is one of the worst obstetric complications, associated with severe hypoxia and fetal death in 5 to 20% of cases. Recent studies have suggested that uterine scar defects, detected by transvaginal ultrasound (TVU) before next pregnancy, could represent a high risk of uterine rupture in

Research paper thumbnail of Adverse Obstetric Outcomes in Women with Previous Cesarean for Dystocia in Second Stage of Labor

American Journal of Perinatology, 2012

Trial of labor (TOL) after previous cesarean has declined dramatically over the past several deca... more Trial of labor (TOL) after previous cesarean has declined dramatically over the past several decades. 1 This decrease is explained by the fact that failed TOL is associated with potential maternal and neonatal morbidities. 2-4 On the other hand, successful TOL has been associated with lower rates of maternal and neonatal morbidities when compared with cesarean delivery. 5,6 It is therefore important to improve the selection of women with better chances of successful vaginal birth after cesarean (VBAC) and low risk of adverse outcomes, including uterine rupture. 7-10 Many factors are associated with the success or the failure of TOL after cesarean. 11-14 Among them, prior cesarean delivery secondary to cephalopelvic disproportion or labor dystocia has been associated with a lower rate of successful VBAC compared with a nonrecurrent cause. 15 In women whose previous cesarean was performed for dystocia in the second stage of Keywords ► pregnancy ► vaginal birth after cesarean ► uterine rupture ► labor dystocia

Research paper thumbnail of 684: Locked vs unlocked sutures for uterine closure and the risk of uterine rupture

American Journal of Obstetrics and Gynecology, 2011

OBJECTIVE: Uterine rupture is one of the worst obstetrical complications. While recent evidence s... more OBJECTIVE: Uterine rupture is one of the worst obstetrical complications. While recent evidence suggests that single-layer closure of hysterotomy may be associated with higher rates of uterine rupture, there is no consensus on the optimal method of closure (single-vs doublelayer, locked vs unlocked). We aimed to evaluate the role of uterine closure on the risk of uterine rupture. vaginal birth after cesarean, cesarean and closure were used to search in electronic databases PubMed, Embase and Cochrane Library. Observational studies were combined with metaanalysis using MOOSE methodology to assess the risk of uterine rupture and uterine scar dehiscence. Statistical analysis of pooled effects were done using odds ratio (OR) with random effects comparing single layer vs double layer closure, subdivided according to the type of single layer (locked vs unlocked). Heterogeneity between studies was assessed by Higgins I 2 . RESULTS: Twelve studies (6386 women) were included. Overall, we did not confirm the association between single-layer closure and uterine rupture (OR: 1.7, 95%CI 0.7-4.2, pϭ0.24). However, a "locked" single-layer closure was associated with a drastic increase in the risk of subsequent uterine rupture (OR: 5.0, 95%CI 2.6-9.5, pϽ0.001), while an "unlocked" single-layer was not (OR: 0.5, 95%CI 0.2-1.2, pϭ0.1). Homogeneity between the studies in each subgroup (I 2 : 37% and 6%, respectively, NS) compared to an overall heterogeneity (73%, pϽ0.001) support the validity of our subdivision (locked vs unlocked). Locked single-layer was also associated with uterine scar dehiscence (pϭ0.02). CONCLUSIONS: According to the best actual evidence, a "locked" single-layer closure is associated with a significant increased risk of subsequent uterine scar dehiscence and uterine rupture. However, an "unlocked" single-layer closure could be the optimal compromise between the short term benefits of single-layer closure and the long-term benefits of the double-layer.

Research paper thumbnail of 84: Randomized study comparing Foley catheter and intravaginal misoprostol as cervical ripening

American Journal of Obstetrics and Gynecology, 2011

Research paper thumbnail of 639: Labor dystocia and the risk of uterine rupture in women with a prior cesarean

American Journal of Obstetrics and Gynecology

Research paper thumbnail of Survey on Uterine Closure and Other Techniques for Caesarean Section Among Quebec's Obstetrician-Gynaecologists

Journal of obstetrics and gynaecology Canada: JOGC = Journal d'obstetrique et gynecologie du Canada: JOGC

Objective: To evaluate the preferred types of uterine closure at Caesarean section among Quebec&#... more Objective: To evaluate the preferred types of uterine closure at Caesarean section among Quebec's obstetrician-gynaecologists. Methods: An anonymous survey with multiple-choice and open questions was sent by email to all members of the Association des Obstétriciens-Gynécologues du Québec in clinical practice. The primary response of interest was the type of uterine closure that would be favoured for a primigravida undergoing an elective CS at term for a breech fetus. Secondary responses of interest included type of uterine closure for CS performed for other indications, and methods of closure for the bladder flap, parietal peritoneum, rectus abdominis muscle, subcutaneous tissue, and skin. Results were stratified according to the number of years in practice. Results: Of 454 persons targeted, 176 (39%) responded. Responders were more likely to have fewer years in practice than the targeted population in general. The closures for a primigravida undergoing an elective CS at term fo...

Research paper thumbnail of Sonographic lower uterine segment thickness and risk of uterine scar defect: a systematic review

Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2010

To study the diagnostic accuracy of sonographic measurements of the lower uterine segment (LUS) t... more To study the diagnostic accuracy of sonographic measurements of the lower uterine segment (LUS) thickness near term in predicting uterine scar defects in women with prior Caesarean section (CS). PubMed, Embase, and Cochrane Library (1965-2009). Studies of populations of women with previous low transverse CS who underwent third-trimester evaluation of LUS thickness were selected. We retrieved articles in which number of patients, sensitivity, and specificity to predict a uterine scar defect were available. Twelve eligible studies including 1834 women were identified. Uterine scar defect was reported in a total of 121 cases (6.6%). Seven studies examined the full LUS thickness only, four examined the myometrial layer specifically, and one examined both measurements. Weighted mean differences in LUS thickness and associated 95% confidence intervals between women with and without uterine scar defect were calculated. Summary receiver operating characteristic (SROC) analysis and summary d...

Research paper thumbnail of Validation of a prediction model for vaginal birth after caesarean

Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2013

Pregnant women with a previous Caesarean section face making the decision to undergo an elective ... more Pregnant women with a previous Caesarean section face making the decision to undergo an elective repeat Caesarean section or to attempt a trial of labour with the goal of achieving a vaginal birth after Caesarean (VBAC). One of the key factors in counselling these women is the probability of a successful VBAC. We aimed to validate a prediction model for VBAC success. We performed an analysis of women at term with one prior low-transverse Caesarean section and a live cephalic singleton pregnancy who attempted a trial of labour after Caesarean (TOLAC) at 32 hospitals in Quebec between 2008 and 2012. The individual TOLAC probabilities of success were calculated without regard to ethnicity, using a prediction model previously developed in the United States. The predictive ability of the model was assessed using receiver operating characteristic curves and the area under the curve (AUC). In addition, a calibration curve was generated by plotting the predicted and observed VBAC rates. Of ...

Research paper thumbnail of Impact of single- vs double-layer closure on adverse outcomes and uterine scar defect: a systematic review and metaanalysis

American Journal of Obstetrics and Gynecology, 2014

A systematic review and meta-analysis were performed through electronic database searches to esti... more A systematic review and meta-analysis were performed through electronic database searches to estimate the effect of uterine closure at cesarean on the risk of adverse maternal outcome and on uterine scar evaluated by ultrasound.

Research paper thumbnail of Organochlorine Pollutants and Female Fertility: A Systematic Review Focusing on In Vitro Fertilization Studies

Reproductive Sciences, 2012

The possible adverse effects of organochlorine pollutants (OPs) on human fertility are a matter o... more The possible adverse effects of organochlorine pollutants (OPs) on human fertility are a matter of concern. Direct evaluation of the effects on female fertility was made possible by the advent of in vitro fertilization (IVF). We conducted a systematic review to assess possible associations between OP levels and selected indicators of female fertility in the context of IVF. After harmonization, OP concentrations per unit of lipid varied considerably, OP concentrations were higher in follicular than in serum and conflicting results were obtained. No significant adverse association between OP concentration and female fertility was observed in some studies. In other reports, there were indications of various degrees of significance that oocyte, embryo quality, and implantation may have been impaired. Thus, this review provides no evidence to support the hypothesis that OPs impair female fertility but insufficient evidence to reject this hypothesis. Our conclusions are limited by the diversity of the protocols used, OPs studied, and the quality of the studies selected. The IVF provides a unique context in which to assess the impact of OPs on female fertility, but it is subject to several limitations. Potential frameworks for future studies are proposed.

Research paper thumbnail of Validation of a Prediction Model for Predicting the Probability of Morbidity Related to a Trial of Labour in Quebec

Obstetrical & Gynecological Survey, 2013

section face the decision either to undergo an elective repeat Caesarean section (ERCS) or to att... more section face the decision either to undergo an elective repeat Caesarean section (ERCS) or to attempt a trial of labour with the goal of achieving a vaginal birth after Caesarean (VBAC) Both choices are associated with their own risks of maternal and neonatal morbidity We aimed to determine the external validity of a prediction model for the success of trial of labour after Caesarean section (TOLAC) that could help these women in their decision-making

Research paper thumbnail of Single- versus double-layer closure of the hysterotomy incision during cesarean delivery and risk of uterine rupture

International Journal of Gynecology & Obstetrics, 2011

Objective: To evaluate the best available evidence regarding the association between single-layer... more Objective: To evaluate the best available evidence regarding the association between single-layer closure and uterine rupture. Methods: The PubMed, Embase, and Cochrane Central Register of Controlled Trials databases were searched for relevant observational and experimental studies that included women with a previous single, low, transverse cesarean delivery who had attempted a trial of labor (TOL). The risks of uterine rupture and uterine dehiscence were assessed by pooled odds ratios (OR) calculated with a random effects model. Results: Nine studies including 5810 women were reviewed. Overall, the risk of uterine rupture during TOL after a single-layer closure was not significantly different from that after a double-layer closure (OR 1.71; 95% confidence interval [CI] 0.66-4.44). However, a sensitivity analysis indicated that the risk of uterine rupture was increased after a locked single-layer closure (OR 4.96; 95% CI 2.58-9.52, P b 0.001) but not after an unlocked single-layer closure (OR 0.49; 95% CI 0.21-1.16), compared with a double-layer closure. Conclusion: Locked but not unlocked single-layer closures were associated with a higher uterine rupture risk than doublelayer closure in women attempting a TOL.

Research paper thumbnail of Approche probabiliste de l'estimation de l'âge chez l'enfant à partir de la maturation dentaire

Comptes Rendus Biologies, 2003

Research paper thumbnail of Nonpharmacologic Approaches for Pain Management During Labor Compared with Usual Care: A Meta-Analysis

Birth, 2014

Objectives: To assess the effects of nonpharmacologic approaches to pain relief during labor, acc... more Objectives: To assess the effects of nonpharmacologic approaches to pain relief during labor, according to their endogenous mechanism of action, on obstetric interventions, maternal, and neonatal outcomes. Data source: Cochrane library, Medline, Embase, CINAHL and the MRCT databases were used to screen studies from January 1990 to December 2012. Study selection: According to Cochrane criteria, we selected randomized controlled trials that compared nonpharmacologic approaches for pain relief during labor to usual care, using intention-to-treat method. Results: Nonpharmacologic approaches, based on Gate Control (water immersion, massage, ambulation, positions) and Diffuse Noxious Inhibitory Control (acupressure, acupuncture, electrical stimulation, water injections), are associated with a reduction in epidural analgesia and a higher maternal satisfaction with childbirth. When compared with nonpharmacologic approaches based on Central Nervous System Control (education, attention deviation, support), usual care is associated with increased odds of epidural OR 1.13 (95% CI 1.05-1.23), cesarean delivery OR 1.60 (95% CI 1.18-2.18), instrumental delivery OR 1.21 (95% CI 1.03-1.44), use of oxytocin OR 1.20 (95% CI 1.01-1.43), labor duration (29.7 min, 95% CI 4.5-54.8), and a lesser satisfaction with childbirth. Tailored nonpharmacologic approaches, based on continuous support, were the most effective for reducing obstetric interventions. Conclusion: Nonpharmacologic approaches to relieve pain during labor, when used as a part of hospital pain relief strategies, provide significant benefits to women and their infants without causing additional harm. (BIRTH 41:2 June 2014)

Research paper thumbnail of Interrelations Between Four Antepartum Obstetric Interventions and Cesarean Delivery in Women at Low Risk: A Systematic Review and Modeling of the Cascade of Interventions

Birth, 2014

To critically appraise the literature on the relations between four intrapartum obstetric interve... more To critically appraise the literature on the relations between four intrapartum obstetric interventions-electronic fetal monitoring (EFM), epidural analgesia, labor induction, and labor acceleration; and two types of delivery-instrumental (forceps and vacuum) and cesarean section. This review included meta-analyses published between January 2000 and April 2012 including at least one randomized clinical trial published after 1995 and presenting results on low-risk pregnancies between 37 and 42 weeks of gestation, searched in the databases Medline, Cochrane Library, and EMBASE with no language restriction. Of 306 documents identified, 8 fulfilled the inclusion criteria and presented results on women at low risk. EFM at admission (vs intermittent auscultation) was associated with cesarean delivery (odds ratio [OR] = 1.20, 95% confidence interval [CI] 1.00-1.44) and epidural analgesia (OR = 1.25, 95% CI 1.09-1.43). Epidural on request was associated with cesarean delivery (OR = 1.60, 95% CI 1.18-2.18), instrumental delivery (OR = 1.21, 95% CI 1.03-1.44), and oxytocin use (OR = 1.20, 95% CI 1.01-1.43) when compared with epidural on request plus nonpharmacological labor pain control methods such as one-to-one support, breathing techniques, and relaxation. Induction and acceleration of labor showed heterogeneous patterns of associations with cesarean delivery and instrumental delivery. Complex patterns of associations between obstetric interventions and modes of delivery were illustrated in an empirical model. Intermittent auscultation and nonpharmacological labor pain control interventions, such as one-to-one support during labor, have the potential for substantially reducing cesarean deliveries.

Research paper thumbnail of Timing of Demirjian's tooth formation stages

Annals of Human Biology, 2006

Background: Global differences in Demirjian et al.'s method of assessing dental maturity are thou... more Background: Global differences in Demirjian et al.'s method of assessing dental maturity are thought to be due to population differences. Aim: The aim of this study was to investigate the timing of individual tooth formation stages in children from eight countries. Research design: This was a meta-analysis of previously published data from retrospective crosssectional studies of dental maturity. Method: Data of mandibular permanent developing teeth from panoramic radiographs (Demirjian's stages) were combined from Australia, and Sweden (n ¼ 9002, ages 2-16.99 years). Age-of-attainment was calculated using logistic regression for each group by sex and meta-analysis of the total. Overlapping 95% confidence intervals of the means was interpreted as no significant difference. Results: Mean ages for each group and total were significantly different in 65 out of 509 comparisons (p < 0.05). Some of these were of small sample size but there was no consistent pattern. Apex closure of the first molar was significantly later in children from Quebec and this might explain differences found in the dental maturity score. Conclusions: These results suggest no major differences in the timing of tooth formation stages between these children. This fails to explain previous findings of differences using Demirjian's dental maturity method.

Research paper thumbnail of Systematic Review of Cesarean Scar Assessment in the Nonpregnant State: Imaging Techniques and Uterine Scar Defect

American Journal of Perinatology, 2012

The rate of cesareans is constantly increasing, reaching more than 30% of births in several count... more The rate of cesareans is constantly increasing, reaching more than 30% of births in several countries. Although millions of cesareans are performed worldwide, poor uterine scar healing is associated with complications, such as uterine rupture, in subsequent pregnancies. 1 Uterine rupture is one of the worst obstetric complications, associated with severe hypoxia and fetal death in 5 to 20% of cases. Recent studies have suggested that uterine scar defects, detected by transvaginal ultrasound (TVU) before next pregnancy, could represent a high risk of uterine rupture in

Research paper thumbnail of Adverse Obstetric Outcomes in Women with Previous Cesarean for Dystocia in Second Stage of Labor

American Journal of Perinatology, 2012

Trial of labor (TOL) after previous cesarean has declined dramatically over the past several deca... more Trial of labor (TOL) after previous cesarean has declined dramatically over the past several decades. 1 This decrease is explained by the fact that failed TOL is associated with potential maternal and neonatal morbidities. 2-4 On the other hand, successful TOL has been associated with lower rates of maternal and neonatal morbidities when compared with cesarean delivery. 5,6 It is therefore important to improve the selection of women with better chances of successful vaginal birth after cesarean (VBAC) and low risk of adverse outcomes, including uterine rupture. 7-10 Many factors are associated with the success or the failure of TOL after cesarean. 11-14 Among them, prior cesarean delivery secondary to cephalopelvic disproportion or labor dystocia has been associated with a lower rate of successful VBAC compared with a nonrecurrent cause. 15 In women whose previous cesarean was performed for dystocia in the second stage of Keywords ► pregnancy ► vaginal birth after cesarean ► uterine rupture ► labor dystocia

Research paper thumbnail of 684: Locked vs unlocked sutures for uterine closure and the risk of uterine rupture

American Journal of Obstetrics and Gynecology, 2011

OBJECTIVE: Uterine rupture is one of the worst obstetrical complications. While recent evidence s... more OBJECTIVE: Uterine rupture is one of the worst obstetrical complications. While recent evidence suggests that single-layer closure of hysterotomy may be associated with higher rates of uterine rupture, there is no consensus on the optimal method of closure (single-vs doublelayer, locked vs unlocked). We aimed to evaluate the role of uterine closure on the risk of uterine rupture. vaginal birth after cesarean, cesarean and closure were used to search in electronic databases PubMed, Embase and Cochrane Library. Observational studies were combined with metaanalysis using MOOSE methodology to assess the risk of uterine rupture and uterine scar dehiscence. Statistical analysis of pooled effects were done using odds ratio (OR) with random effects comparing single layer vs double layer closure, subdivided according to the type of single layer (locked vs unlocked). Heterogeneity between studies was assessed by Higgins I 2 . RESULTS: Twelve studies (6386 women) were included. Overall, we did not confirm the association between single-layer closure and uterine rupture (OR: 1.7, 95%CI 0.7-4.2, pϭ0.24). However, a "locked" single-layer closure was associated with a drastic increase in the risk of subsequent uterine rupture (OR: 5.0, 95%CI 2.6-9.5, pϽ0.001), while an "unlocked" single-layer was not (OR: 0.5, 95%CI 0.2-1.2, pϭ0.1). Homogeneity between the studies in each subgroup (I 2 : 37% and 6%, respectively, NS) compared to an overall heterogeneity (73%, pϽ0.001) support the validity of our subdivision (locked vs unlocked). Locked single-layer was also associated with uterine scar dehiscence (pϭ0.02). CONCLUSIONS: According to the best actual evidence, a "locked" single-layer closure is associated with a significant increased risk of subsequent uterine scar dehiscence and uterine rupture. However, an "unlocked" single-layer closure could be the optimal compromise between the short term benefits of single-layer closure and the long-term benefits of the double-layer.

Research paper thumbnail of 84: Randomized study comparing Foley catheter and intravaginal misoprostol as cervical ripening

American Journal of Obstetrics and Gynecology, 2011