199 research outputs found
Maternal mortality and severe maternal morbidity among migrant women in high-income countries
No full textDans les pays à haut revenu, les migrants représentent 15% de la population et plus d'un quart sont des femmes en âge de procréer. En France, une naissance sur 4 survient chez une mère migrante. Bien qu'un surrisque de complications maternelles sévères chez ces femmes migrantes ait été rapporté, la littérature internationale l'évaluant est hétérogène, et les mécanismes de cette association sont incomplètement compris. Un premier volet de cette thèse, mobilisant une revue systématique de la littérature dans les pays à haut revenu, a montré que le risque de morbi-mortalité maternelle chez les migrantes par rapport aux natives varie selon le pays d'accueil et la région de naissance. Les volets suivants de la thèse ont permis d'explorer deux mécanismes possibles de ce surrisque de morbi-mortalité maternelle chez les femmes migrantes, au travers d'analyses des données de la cohorte française PreCARE, la situation administrative et la barrière linguistique. La première analyse a constaté que, par rapport aux femmes migrantes sans barrière linguistique, celles avec barrière linguistique partielle ou totale ont un risque accru de suivi prénatal inadéquat. La seconde analyse a retrouvé un risque augmenté de morbidité maternelle sévère chez les migrantes en situation irrégulière par rapport aux natives. Ces résultats soulignent l'importance de ne pas considérer les migrantes comme un groupe homogène mais de prendre en compte certaines de leurs caractéristiques individuelles pour bien caractériser leurs risques et leurs besoins. Ils ont permis d'identifier des facteurs de risques potentiellement modifiables, à considérer en termes de politiques de santé.In high-income countries, migrants represent 15% of the population, and more than a quarter are women of childbearing age. In France, one in four births is to a migrant woman. Although an increased risk of severe maternal outcomes among migrant women has been reported, the international literature assessing this association is heterogeneous, and their mechanisms are incompletely understood. The first part of this thesis, based on a systematic review of the literature in high-income countries, showed that the risk of maternal mortality and severe maternal morbidity in migrant women compared with native-born women varies by host country and region of birth. The subsequent parts of the thesis explored two possible mechanisms for this higher risk of severe maternal outcomes among migrant women, through analyses of data from the French PreCARE cohort: legal status and language barrier. The first analysis found that, compared with migrant women with no language barrier, those with partial or total language barrier have a higher risk of inadequate prenatal care utilization. The second analysis found an increased risk of severe maternal morbidity among undocumented migrants compared with non-migrants. These results highlight the importance of not considering migrant women as a homogeneous group, but of taking into account some of their individual characteristics in order to characterize their risks and needs. They have identified potentially modifiable risk factors, for consideration in terms of health policies
Désordres hépatiques en cours de grossesse chez les femmes infectées par le VIH
No full textPARIS7-Xavier Bichat (751182101) / SudocSudocFranceF
Portage de l antigène HBs chez les femmes enceintes ( prévalence et caractéristiques démographiques des femmes dans une maternité du nord de Paris)
No full textPARIS7-Xavier Bichat (751182101) / SudocSudocFranceF
Procédures décisionnelles en situation d'extrême prématurité
No full textPARIS-BIUM (751062103) / SudocCentre Technique Livre Ens. Sup. (774682301) / SudocSudocFranceF
Conséquences obstétricales des traitements antirétroviraux à base de lopinavir chez la femme enceinte infectée par le VIH-1 (étude d'une cohorte monocentrique)
No full textPARIS7-Xavier Bichat (751182101) / SudocSudocFranceF
Authors’ reply re: Association between inadequate antenatal care utilisation and severe perinatal and maternal morbidity: an analysis in the PreCARE cohort
No full textMaternity without borders: examining disparities in healthcare and perinatal outcomes. A survey of women having given birth in Brussels and an analysis of Belgian population data
No full textAccess to antenatal care is considered a given in high-income countries, where virtually all women are guaranteed skilled birth attendants and emergency care in the case of complications. However, significant perinatal health disparities persist based on women's migration history.Considering the importance of building equity from the early life stages, it seems necessary to identify the underlying causes of these inequalities and, at health system’s level, to determine whether access barriers or inadequate perinatal care disproportionately affect the populations most at risk of adverse outcomes.In this context, this doctoral thesis aimed to investigate women's utilisation and experiences of perinatal healthcare services in Brussels, focusing on the effect of maternal birthplace and socioeconomic factors. Additionally, the thesis aimed to analyse the impact of legal status on perinatal health outcomes such as mortality and prematurity.The study involved adapting the Migrant Friendly Maternity Care Questionnaire for use in a multi-centre survey in Brussels. Face-to-face interviews were conducted with approximately 900 postnatal mothers, including immigrants from North Africa and Sub-Saharan Africa, as well as women born in Belgium. Antenatal care timing, frequency, and patient experiences were compared across maternal birth regions, while socioeconomic and migration-related predictors were identified. Furthermore, using Belgian population data spanning seven years, the association between maternal registration in the National Population Registry (as a proxy for legal status) and pregnancy outcomes was assessed.Overall, the results indicated adequate care in terms of initiation, frequency of consultations, and self-reported access, and positive experiences for both immigrants and non-immigrants. However, disparities in healthcare use and experiences were highlighted from a migration-related perspective (e.g. women born in Sub-Saharan Africa more likely to initiate antenatal care later) but also, from a socioeconomic perspective. Specific socioeconomic determinants, such as unstable housing situation, unemployment, lack of health insurance, single motherhood, and language barriers, were identified as independent risk factors for inadequate perinatal care. Additionally, the absence of maternal legal residency at the time of birth was associated with increased rates of prematurity and low birthweight, independent of other socioeconomic factors. Moreover, immigrants lacking legal status had higher risks of perinatal mortality compared to legally residing immigrants from the same region, which were linked to their greater socioeconomic vulnerability. These results suggest that among the immigrant populations, those living in the most precarious situations experience an excess burden in terms of contact with perinatal healthcare and, ultimately, pregnancy outcomes.The discussion explores interpretations and implications of the results, focusing on understanding why particular immigrant and socioeconomically vulnerable groups fare worse. We consider that while perinatal healthcare in Brussels appears adequate for most, improvements are needed to address the needs of the most vulnerable minorities. The findings underline the multifactorial nature of social inequalities in perinatal health and call for actions within and beyond of the healthcare sector.Doctorat en Sciences de la santé Publiqueinfo:eu-repo/semantics/nonPublishe
Associations between maternal obesity and severe maternal morbidity: Findings from the French EPIMOMS population‐based study
No full textInternational audienc
Cervical adenocarcinoma presenting as a cardiac tamponade in a 57-year-old woman: a case report
No full textAbstract Introduction Pericardial effusion as a complication of malignant gynecological disorders is rare. Few cases of endometrial cancer, squamous cell carcinoma of the cervix, ovarian cancer and uterine carcinosarcoma have been previously reported. We report the first case of cardiac tamponade secondary to a cervical adenocarcinoma. Case presentation A 54-year-old Caucasian woman, without any relevant medical history and no gynecological aftercare, was admitted to our hospital emergency room with severe dyspnea. Echocardiography revealed severe pericardial effusion with a swinging heart. An emergency pericardial drainage was performed through a pericardial window, which permitted the draining of 700 mL of bloody fluid and a pericardial biopsy. Cytological examination of the fluid revealed atypical cells, and the biopsy specimen showed tumor emboli suggestive of adenocarcinoma. Magnetic resonance imaging showed a 35 mm cervical lesion indicative of an endocervical tumor. Exploratory laparoscopy revealed diffuse peritoneal lesions and histological examination of cervical curettage showed a poorly differentiated micropapillary adenocarcinoma of the cervix. Conclusion Carcinomatous pericarditis as the first symptom of a malignant gynecological adenocarcinoma has not, to the best of our knowledge, been documented before. This case highlights the extreme severity of pericardial effusion secondary to cervical adenocarcinoma, a sign of advanced disease. Gynecological malignancies have to be considered in cases of neoplastic pericardial effusion.</p
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