Gynecologie Obstetrique Fertilite & Senologie最新文献

{"title":"[Axillary de-escalation, oncoplastic surgery and minimally invasive mastectomy: new requirements for the breast surgeon].","authors":"Jérémie Zeitoun","doi":"10.1016/j.gofs.2026.09.004","DOIUrl":"https://doi.org/10.1016/j.gofs.2026.09.004","url":null,"abstract":"<p><strong>Objective: </strong>To describe how axillary surgical de-escalation, the rise of oncoplastic surgery and the development of minimally invasive mastectomy are reshaping breast cancer care and redefining the role of the breast surgeon.</p><p><strong>Methods: </strong>Narrative review based on a search of MEDLINE/PubMed and the Cochrane Library up to May 2026 (keywords: breast cancer, sentinel lymph node, axillary dissection, targeted axillary dissection, oncoplastic surgery, endoscopic or robotic mastectomy, gene expression assay), prioritising randomised trials, meta-analyses and large cohorts, supplemented by international and French guidelines.</p><p><strong>Results: </strong>In patients with limited nodal involvement or very low axillary risk, axillary dissection, and even sentinel node biopsy, can be omitted without compromising overall survival or locoregional control, provided appropriate radiotherapy and systemic therapy are delivered (Z0011, AMAROS, IBCSG 23-01, SENOMAC, SOUND, INSEMA). Targeted axillary dissection allows initially node-positive patients who become ycN0 after neoadjuvant chemotherapy to avoid completion dissection, especially in HER2-positive and triple-negative tumours. Oncoplastic surgery, immediate reconstruction and endoscopic or robotic mastectomy achieve comparable oncological outcomes with improved cosmesis, at the cost of longer operating time, a learning curve and higher cost.</p><p><strong>Conclusion: </strong>This convergence represents a paradigm shift. The breast surgeon must integrate oncological decision-making, reconstructive skills and critical appraisal of trials within a multidisciplinary setting. Dedicated training pathways and formal recognition of breast surgery as a subspecialty are essential.</p>","PeriodicalId":56056,"journal":{"name":"Gynecologie Obstetrique Fertilite & Senologie","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148984204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Massive immediate postpartum haemoperitoneum from rupture of posterior uterine arterial branches after instrumental vaginal delivery: a case report].","authors":"Clara Boisaubert, Amandine Le Bert, Franck Perrotin","doi":"10.1016/j.gofs.2026.09.003","DOIUrl":"https://doi.org/10.1016/j.gofs.2026.09.003","url":null,"abstract":"","PeriodicalId":56056,"journal":{"name":"Gynecologie Obstetrique Fertilite & Senologie","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Does giving patients a choice of cervical ripening method improve women satisfaction?]","authors":"Clara Chiaradonna, Louise Moniod, Céline Chauleur, Tiphaine Raia-Barjat, Gwendoline Dorel","doi":"10.1016/j.gofs.2026.08.003","DOIUrl":"https://doi.org/10.1016/j.gofs.2026.08.003","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the overall satisfaction between women who were able to choose their cervical ripening method and those who did not have this choice. The secondary objective was to compare their willingness to recommend the method used to a friend or relative.</p><p><strong>Methods: </strong>Prospective, single-centre study conducted in the Gynaecology and Obstetrics Department of the Saint-Etienne University Hospital between September 2023 and June 2024. 187 women with an indication for induction of labour were included. Among them, 100 women were able to choose their cervical ripening method and completed a questionnaire before the start of labour induction and a second questionnaire postpartum. For 87 women, the method was imposed, as part of the department's protocol roll-out phase, and a single postpartum questionnaire was given to them.</p><p><strong>Results: </strong>Of the 100 women who had the choice, 65 chose oral misoprostol, 9 chose vaginal dinoprostone, and 26 chose the cervical balloon. Of those who chose this mechanical method, 34,6% wished to return home to continue induction. Being able to choose the cervical ripening method was not associated with a significant improvement in overall satisfaction, even after adjustment for confounding factors. No significant difference in satisfaction was observed between the different methods used. However, women who had a choice were significantly more likely to recommend the method used (adjusted OR = 2.21; 95% CI [1.04-4.82]).</p><p><strong>Conclusions: </strong>Offering women a choice of cervical ripening method is not associated with a significant improvement in overall satisfaction. This choice nevertheless appears to strengthen their willingness to recommend the method to a friend or relative.</p>","PeriodicalId":56056,"journal":{"name":"Gynecologie Obstetrique Fertilite & Senologie","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148921904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[SAFE Clinical Consensus (French College of Midwives): imaging care pathway for women with a prior caesarean bith].","authors":"G Ambroise Grandjean, A Hoquette, P A Migeon, P Bouhanna, G Berruyer","doi":"10.1016/j.gofs.2026.09.001","DOIUrl":"https://doi.org/10.1016/j.gofs.2026.09.001","url":null,"abstract":"","PeriodicalId":56056,"journal":{"name":"Gynecologie Obstetrique Fertilite & Senologie","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148921938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Evaluation of the expectations of patients with endometriosis regarding the EndOccitanie care network].","authors":"Alexa Miran, Thierry Brillac, Elodie Chantalat","doi":"10.1016/j.gofs.2026.08.002","DOIUrl":"https://doi.org/10.1016/j.gofs.2026.08.002","url":null,"abstract":"<p><strong>Objective: </strong>The management of patients with endometriosis remains marked by a long, fragmented, and poorly coordinated care pathway, leading to significant diagnostic delay. In this context, the regional EndOccitanie network is being developed to improve the organization and quality of care. The aim of this study was to identify the expectations of patients regarding this network.</p><p><strong>Methods: </strong>We conducted a descriptive epidemiological study using an online questionnaire administered through the LimeSurvey platform and distributed via the patient associations EndoFrance, Endomind, and the EndOccitanie network. Participants, all diagnosed with endometriosis, evaluated various aspects of their care pathway using a Likert scale.</p><p><strong>Results: </strong>The results highlight several priority expectations: access to clear and reliable information, the implementation of a coordinated and accessible care pathway, and a comprehensive approach to the disease, including pain management, sexuality, and fertility.</p><p><strong>Conclusion: </strong>These findings underscore the need to further strengthen the structuring of the EndOccitanie network in order to improve the accessibility, continuity, and quality of care. A future reassessment will help measure the impact of the actions implemented.</p>","PeriodicalId":56056,"journal":{"name":"Gynecologie Obstetrique Fertilite & Senologie","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148765348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Optimizing follow-up of pregnancies of unknown location: a simplified clinical algorithm for ectopic pregnancy risk].","authors":"Marie Le Naelou, Thibault Thubert, Manon Degez, Maxime Chaillot","doi":"10.1016/j.gofs.2026.08.001","DOIUrl":"https://doi.org/10.1016/j.gofs.2026.08.001","url":null,"abstract":"<p><strong>Objectives: </strong>Management of pregnancies of unknown location (PUL) relies on close monitoring with serial human chorionic gonadotropin (hCG) measurements and repeated ultrasound examinations to exclude ectopic pregnancy (EP). Although safe, this strategy leads to multiple consultations and significant organizational and economic burden. This paper aims to develop and preliminarily validate a simplified clinical algorithm to stratify the risk of EP in women presenting with PUL, in order to adapt follow-up frequency.</p><p><strong>Methods: </strong>The prospective monocentric OPTIGLI study was conducted at Nantes University Hospital between May and September 2023. All women presenting with PUL were included after informed non-opposition. Fifteen clinical, biological, and ultrasound variables were analyzed using univariate and multivariate logistic regression. A composite predictive score was constructed from significant variables, and its positive predictive value (PPV) and negative predictive value (NPV) were calculated. Economic evaluation and patient satisfaction assessment were also performed.</p><p><strong>Results: </strong>A total of 162 patients were included; the EP rate was 19.8%. Pregnancy occurring with a copper intrauterine device (IUD) was significantly associated with EP (p = 0.0089). The presence of a lateral uterine mass was associated with earlier EP diagnosis (p = 0.0169). The algorithm showed an NPV of 99.0% and a PPV of 22.0%, allowing reduced follow-up intensity in two-thirds of patients, with an estimated cost reduction of nearly euro10,000 over four months.</p><p><strong>Conclusion: </strong>The OPTIGLI algorithm is a simple and safe tool for rationalizing PUL management. Multicenter validation is required to confirm its robustness and potential integration into national clinical protocols.</p>","PeriodicalId":56056,"journal":{"name":"Gynecologie Obstetrique Fertilite & Senologie","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148690347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Aspirin and pregnancy in the era of early first-trimester screening: efficacy, indications and maternal-fetal safety].","authors":"Franck Perrotin, Amaury Poque, Amandine Le Bert, Alexander Pondaven","doi":"10.1016/j.gofs.2026.07.005","DOIUrl":"https://doi.org/10.1016/j.gofs.2026.07.005","url":null,"abstract":"<p><p>Apart from calcium supplementation, which is beneficial in women with inadequate intake, low-dose aspirin is the only drug with established efficacy for the primary prevention of preeclampsia. Its mechanism - restoration of the thromboxane A2 / prostacyclin balance through platelet cyclo-oxygenase-1 inhibition - accounts for its efficacy in placental vascular disease, and its benefit depends on a dose of 100 to 160 mg, evening intake and, above all, initiation before 16 weeks. The question is no longer whether it works, but in whom, and whether this can be known early enough. Three early identification strategies have been evaluated in turn. Clinical risk factors, used by the historical trials and then by Anglo-Saxon guidelines, are either too restrictive - a history of preeclampsia by construction excludes nulliparous women - or so broad that up to 85% of women would become eligible. First-trimester uterine artery Doppler, a direct reflection of trophoblastic invasion, offered an attractive pathophysiological rationale; the double-blind randomised trials nevertheless proved negative, including the French PERASTUN trial conducted in 1,104 nulliparous women selected on this criterion alone and treated with 160 mg before 16 weeks (16.0% vs 14.4%), Doppler alone lacking specificity and selecting a population with low absolute risk whose preeclampsia is mostly late - precisely where aspirin has no effect. Combined algorithms, associating maternal factors, mean arterial pressure, Doppler and PlGF, perform better: the ASPRE trial reduced preeclampsia before 37 weeks of gestation by 62%, though part of the benefit arose from women already identifiable by their history; the ongoing French RANSPRE trial randomises the screening strategy itself for the first time. This uncertainty about the target population explains the marked heterogeneity of international guidelines and bears directly on safety: while the fetal profile remains reassuring at antiplatelet doses, recent maternal data, including a French nationwide cohort of 5.8 million pregnancies, show an excess of haemorrhagic complications. Defining whom to treat is the condition for preserving a favourable benefit-risk balance.</p>","PeriodicalId":56056,"journal":{"name":"Gynecologie Obstetrique Fertilite & Senologie","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148610254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Severe congenital toxoplasmosis in a previously immunized woman: A case report].","authors":"Justine Caudoux, Carine Arlicot, Mathilde Becmeur-Lefebvre, Nathalie Van Langendonck, Franck Perrotin","doi":"10.1016/j.gofs.2026.07.003","DOIUrl":"10.1016/j.gofs.2026.07.003","url":null,"abstract":"","PeriodicalId":56056,"journal":{"name":"Gynecologie Obstetrique Fertilite & Senologie","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148537783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Benefits of maternal mobility during labour: Between international guidelines and clinical practice].","authors":"Franck Perrotin, Caroline Brisson","doi":"10.1016/j.gofs.2026.07.001","DOIUrl":"10.1016/j.gofs.2026.07.001","url":null,"abstract":"<p><p>Maternal mobilisation and upright positions during labour are recommended by both the World Health Organization (WHO, 2018) and the French National Authority for Health (HAS, 2017) for low-risk women, and more recently by the 2025 SFAR-CARO-HAS guidelines on neuraxial analgesia. Physiologically, upright positions and postural changes optimise uterine dynamics through gravity, improve utero-placental perfusion by preventing aorto-caval compression, and take advantage of pelvic mobility which modifies the diameters of the pelvic inlet and outlet by several millimetres. Cochrane systematic reviews suggest that during the first stage of labour, upright positions and ambulation shorten labour duration and reduce the use of epidural analgesia, with moderate-quality evidence limited by methodological heterogeneity and risk of bias. During the second stage, upright positions shorten expulsion in women without epidural; the BUMPES trial and recent meta-analyses by Verastegui-Martín and Pan do not show a major clinical benefit of upright positions under low-dose epidural, although no detrimental effects are identified. According to the 2021 French Perinatal Survey, 82.7% of women received epidural analgesia and 74.2% used PCEA. Despite consistent guidelines, mobilisation remains underused. Barriers are organisational, technical (including the lack of one-to-one midwifery care), cultural and related to maternal preferences. Promoting a culture of mobility requires interprofessional training, suitable equipment and early antenatal information.</p>","PeriodicalId":56056,"journal":{"name":"Gynecologie Obstetrique Fertilite & Senologie","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148450535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Long-term oncological outcomes and morbidity and mortality associated with radical hysterectomy by laparoscopy versus laparotomy for early-stage cervical cancer].","authors":"Cristina Zabrian, Antoine Vanoost, Pierrick Theret, Albine Mancaux, Denis Chatelain, Fabrice Sergent","doi":"10.1016/j.gofs.2026.06.008","DOIUrl":"10.1016/j.gofs.2026.06.008","url":null,"abstract":"<p><strong>Objective: </strong>Since the LACC trial, the ESGO has favoured laparotomy over laparoscopy for radical hysterectomy in early-stage cervical cancer. The aim of our study was to compare recurrence-free survival (RFS) and morbidity between laparoscopy and laparotomy.</p><p><strong>Materials and methods: </strong>A single-centre, retrospective observational study (2005-2024) of patients treated with type C radical hysterectomy for stage IA2-IIA1 cervical cancer. The use of an intrauterine manipulator without creating a vaginal collar was routine in laparoscopic surgery.</p><p><strong>Results: </strong>One hundred and two female patients were included, 65 of whom underwent laparoscopic surgery and 37 laparotomy. With a mean follow-up of 6.2 years, no significant difference was observed in terms of disease-free survival (81.6% for laparoscopy vs 74.2% for laparotomy; P=0.24). After adjusting for stage and conisation, the hazard ratio for recurrence following laparotomy was 1.74 (95% CI: [0.67-4.51]). Long-term overall survival showed no difference between the surgical approaches. Laparoscopy offered significant advantages in terms of blood loss (140.6±264ml vs 228±229ml; P<0.05) and length of hospital stay (4.3±2.6 days vs 7.0±2.8 days; P<0.05). Major complications (Clavien-Dindo III-IV) were similar (7.7% with laparoscopy vs 5.4% with laparotomy; P=0.65).</p><p><strong>Conclusion: </strong>When performed by surgeons trained to deal with tumours of a medium size (<2cm), laparoscopy did not compromise overall survival compared with laparotomy, whilst significantly reducing perioperative morbidity.</p>","PeriodicalId":56056,"journal":{"name":"Gynecologie Obstetrique Fertilite & Senologie","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148407011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}