Objective: To assess the impact of an oocyte retrieval simulation training program (ORSTP) on the clinical performance of residents. Design: Prospective comparative study. Setting: A tertiary care center. Population: All OR performed by residents between May 2017 and November 2020. Methods & main outcome measures: The Simulation (S) group included OR performed by residents who had undergone an ORSTP before performing them on patients (n=422) and the control (C) group included OR performed by residents who had not received prior simulation training (n= 329). Our main outcome measure was the OR rate (ORR) (number of oocytes collected/number of follicles aspirated) during the first 3 months of the rotation. Results: In the S group, 6 residents aspirated 657 ovaries while in the C group, 5 residents aspirated 508 ovaries. The mean ORR during the first 3 months of rotation were comparable between the S and C groups (59% vs 58%). ORR during the first and second month, and at the end of the rotation were also comparable between the S and C groups (54% vs 63%, 58% vs 59% et 58% vs 58%, respectively). There was no significant difference in the rate of failed OR (3.3% vs 1.8%) between the S and C groups. Finally, 16% of residents in the S group reported being stressed before their first OR compared to 40% in the C group. Conclusions: The ORSTP does not improve the residents’ clinical performance, but it could decrease their stress in clinical practice.

Objectives: To compare the neonatal morbidity of caesarean sections (CS) performed after conversion from neuraxial (NA) to general anaesthesia (GA) with CS performed under GA from the outset, and to assess whether the increase in DDI in urgent and extremely urgent cases with conversion from NA to GA increased the risk of neonatal morbidity. Design: Retrospective cohort study. Setting: University-affiliated hospital. Population: All CS performed under GA between 2015 and 2019. Methods & main outcome measures: Our main criteria used for assessing neonatal morbidity were: neonatal pH <7.10 and/or an Apgar score at 5 minutes <7. A multivariate regression analysis was performed to adjust for gestational age, birth weight, indication of CS. Results: We included 284 patients: 116 had a conversion from NA to GA (group 1) and 168 had GA from the outset (group 2). There was no significant difference in the rate of neonates having a pH<7.10 and/or Apgar score <5 between groups 1 and 2 (17.5% Vs 26.3%, p=0.08, respectively). Multivariate analysis showed that neonatal morbidity was comparable between the two groups (OR=1.58; 0.83-3.05). In very urgent CS, the mean decision-to-delivery interval (DDI) was 3 minutes longer in group 1 compared to group 2 (17 min vs 14 min, respectively), and there was no significant difference in neonatal pH and/or Apgar <7 at 5 minutes between the two groups (aOR=1.4; 0.5-4.3). Conclusion: The neonatal outcomes were comparable between CS performed after conversion from NA to GA and under GA from the outset, even in very urgent CS.

Objective: AUB-O,E,N is treated first with medical management, followed by surgery, which failure or complications have significant burden. The objective was to perform a cost-effectiveness analysis of four surgical strategies, comparing cost and avoided failure rate, using the French PMSI database. Design: Retrospective analysis performed using the French exhaustive national hospital discharge database (PMSI). Population: All incident 35-55 year-old women operated on for four types of AUB-O,E,N surgery (2nd generation, 1st generation, curettage or hysterectomy) between 2009 and 2014 were included. Methods : They were followed to collect rehospitalizations related to failure or complication and their cost, during at least 18 months. Hospital costs were estimated using the French tariffs in 2017\euro. Main Outcome measures : A cost-effectiveness analysis was performed comparing each surgical procedure to 2G, in hospitalization costs and rate of patients without failure. Results : The study included 88,154 patients. At 18 months, mean cost per patient was \euro2,448 for 2G, \euro2,100 for 1G, \euro2,275 for curettage and \euro4,157 for hysterectomy. Hysterectomy was the most effective strategy in terms of absence of failure, but also the most expensive, with an incremental cost of \euro24,008 per additional % of patient without failure. Even with a mean cost similar to 2G, curettage was the least effective strategy with a failure rate reaching 20.6% at 18 months. 1G was less expensive but also less effective than 2G, with an economy of \euro13,078 per % of patient without failure loss. Conclusion: 1G and 2G techniques are the most efficient strategie

Objectives: To investigate the perinatal outcomes of women with a history of female genital mutilation (FGM) who underwent clitoral reconstruction (CR) compared with women with FGM who did not undergo CR. Design: Retrospective case-control study Setting: Angers University Hospital, between 2005 and 2017 Methods: Inclusion criteria: pregnant women >18 years who underwent CR after FGM. Only the first subsequent delivery after CR was included. Each woman with CR was matched for age, ethnicity, FGM type, parity, and gestational age at the time of delivery with two women with FGM who did not undergo CR during the same period of time. Main outcome measures: at birth: need for episiotomy and intact perineum Results: 84 women were included (28 in the CR group; 56 in the control group). In the CR group, patients required significantly fewer episiotomies (5/17[29.4%]) compared to the control group (28/44[63.6%], p=0.02), even after excluding operative vaginal deliveries (2/13[15.4%] vs 21/36[58.3], p<0.01). CR reduces the risk of episiotomy (aOR=0.15, 95%CI [0.04-0.56]; p<0.01) after adjusting on the infant weight and the need for instrumental delivery. In the CR group, 47% of the patients had an intact perineum after delivery, compared to 20.4% in the control group (p=0.04). CR increases the odds of having an intact perineum at birth by 3.46 times (CI95%[1.04-11.49]; p=0.04). Conclusion: CR after FGM increases the chances of having an intact perineum after delivery by 3.46 times and reduces the risk of episiotomy by 0.15 times compared to women with FGM who did not underwent CR.