The second stage of labour includes both the passive and active stages, involving expulsive efforts. The management of this phase of labour aims to minimise the maternal and neonatal complications that could be associated with a prolonged active2nd stage, but also to limit medical interventions. On the maternal side, prolonged duration of expulsive effort appears to be correlated with increased postpartum haemorrhage, perineal injury and, in the long term, urinary and anal incontinence. From a neonatal viewpoint, expulsive efforts carry risks of neonatal acidosis, asphyxia, admission to the neonatal intensive care unit and trauma. Optimal management of expulsive efforts involves several strategies. Various aspects need to be addressed in order to optimise this management, including the timing of the start of expulsive efforts, comparing immediate pushing with delayed pushing, and the duration of expulsive efforts. In addition, it is important to examine the different pushing modalities, whether intense or moderate, using open or closed-glottis pushing, as well as the maternal position during pushing. According to the current literature, no specific technique or predefined duration appears to reduce the risk of neonatal or maternal complications. It therefore seems essential to adopt an individualised approach for each woman, placing her at the centre of the care and decision-making process, in order to take account of her preferences during childbirth.

OBJECTIVE: Induction of labor in France concerns one birth out of four with 70% of induction starting by cervical ripening, either with a pharmacological (prostaglandins) or a mechanical (balloon) method. This review aims to compare these two methods within current knowledge, using the PRISMA methodology.
METHODS: Trials comparing these two methods, published or unpublished up to July 2023, in French or English were searched for in the PubMed, Cochrane Library and ClinicalTrial.govs datasets. Fifty articles including 10,689 women were selected. The outcomes of interest were those from the Core Outcome Set for trails on Induction of Labour (COSIOL) list: mode of delivery, time from induction-to-birth, maternal and neonatal morbidity, and maternal satisfaction.
RESULTS: No differences were observed between the two methods for the mode of delivery or neonatal and maternal morbidity. The time from induction-to-birth was longer for mechanical methods. Those were also associated with a greater need for oxytocin, less uterine hyperstimulation and less instrumental deliveries. Maternal satisfaction was assessed in only nine trials using various scales which made the interpretation of maternal satisfaction.
CONCLUSIONS: The efficacy of these two induction methods is similar for vaginal delivery, but it remains to be seen which one best meets women\'s satisfaction criteria.

OBJECTIVE: Cesarean section is an increasingly common life-saving procedure in obstetrics. The objectives of this study were to identify the factors associated with the decision to perform a cesarean section in the labor room and to determine the therapeutic and obstetric practices that can increase the probability of giving birth by high way.
METHODS: This was a case-control study conducted in the gynecology-obstetrics department of the General Hospital of Bonzola (HGR) in Mbujimayi from May 1, 2020 to April 30, 2021. The target population consisted of all low-risk parturients. The logistic regression model on epi-info 7.2.0 software was used to determine the predictive factors for the indication of caesarean section among parturients.
RESULTS: Indications for cesarean section were dominated by stationary dilatation with 56.2% of cases and ARCF with16.7% of cases; an Apgar≤ 3 and a birth weight ≥ 4000g were retained as essential neonatal characteristics for cesarean section in labor. After multivariate analysis by logistic regression, a Bishop score < 6 with unfavorable cervix,dilatation < 3 cm on admission, and therapy done with oxytocin, artificial rupture of membranes, and G10% during labor were identified as risk factors for cesarean section in labor.
CONCLUSIONS: Certain factors predict the risk of cesarean section in parturients at low obstetrical risk. Knowledge of these risk factors may allow practitioners to prevent it or to better prepare patients for this procedure.
UNASSIGNED: La césarienne est une intervention de plus en plus pratiquée en obstétrique pour sauver les vies. Les objectifs de cette étude étaient d\'identifier les facteurs associés à la décision de césarienne en salle de travail et de déterminer les conduites thérapeutiques et obstétricales qui peuvent augmenter la probabilité d\'accoucher par voie haute.
UNASSIGNED: Il s\'agissait d\'une étude castémoins réalisée dans le service de gynéco-obstétrique de l\'Hôpital Général de Bonzola (HGR) à Mbujimayi du premier Mai 2020 au 30 Avril 2021. La population cible était constituée de toutes les parturientes à bas risque. Le modèle de régression logistique sur logiciel épi-info 7 a été utilisé pour la détermination des facteurs prédictifs d\'indication de la césarienne chez les parturientes.
UNASSIGNED: Les indications de la césarienne étaient dominées parla dilatation stationnaire avec 56,2% de cas et l\'ARCF avec16,7% de cas ; un Apgar≤ 3 et un poids de naissance ≥ 4000g ont été retenus comme caractéristiques néonatales essentielles de la césarienne en cours de travail. Après analyse multivariée par régression logistique, un score de Bishop < 6 avec col défavorable, unedilatation < 3 cm à l\'admission et une thérapeutique faite à l\'ocytocine, rupture artificielle des membranes et G10% pendant le travail étaient des éléments identifiés comme facteurs de risque de la césarienne en cours du travail.
CONCLUSIONS: Certains facteurs permettent de prédire le risque de césarienne chez les parturientes à faible risque obstétrical. La connaissance de ces facteurs de risque peut permettre aux praticiens de le prévenir ou de mieux préparer les patientes à affronter cette intervention.

Our contemporary lifestyles offer little incentive to be physically active, and give us far fewer opportunities to be active than in the past, with many of our tasks being sedentary and most of our transport being motorized. While it\'s easy to acknowledge a lack of physical activity, putting it into practice is eminently more complex, and many researchers are trying to answer the thorny question: how can we enable people to be more physically active in their daily lives? With this in mind, the aim of this article is to show that active transport is an effective way of getting sedentary people to engage in regular physical activity.

For women with endometriosis, pain, fatigue and digestive problems affect the quality of their daily lives. Many professionals work to help them find a balance between the disease and their activities, expectations and needs.

Some jobs, particularly in the service sector, involve little physical activity on the part of employees. To improve their health, several areas or periods could be used to increase the amount of daily physical activity. Active transport to and from work is one such initiative, but physical activity can also be envisaged outside and during working hours. The aim of this article is to provide insights and research perspectives to better measure the importance of physical activity in the workplace.

OBJECTIVE: Immersion in water during labor could reduce pain and use of epidural anesthesia during childbirth. The main objective of this study was to evaluate the influence of immersion in water during labor on the use of epidural anesthesia in a midwife care setting.
METHODS: We conducted a single-center retrospective study of all women who gave birth in the physiological ward of Saint-Étienne University Hospital between October 2020 and December 2022.
RESULTS: The study did not find difference between immersion group and control group concerning the use of epidural anesthesia (P=0.49). The immersion group counted more women with a duration of labor greater than 6hours than in the control group. The multivariate analysis adjusted for parity and duration of labor did not find difference between both groups [OR 0.58; 95% CI (0.30; 1.09)].
CONCLUSIONS: Even if it does not seem to modify the use of epidurals, immersion in water does not seem to increase maternal and neonatal morbidity and mortality. It represents a therapeutic alternative with reasonable cost to offer for pregnant women who wish to give birth without epidural anesthesia.

暂无摘要。

BACKGROUND: The impact of cancer on working ability in the military environment remains a matter of concern. The primary aim of this study was to identify sociodemographic, professional and disease related factors influencing the professional outcome in the military population.
METHODS: Descriptive, retrospective study on active military cancer patients treated in the oncology department of the Military Hospital of Tunis between January 2016 and December 2018. Data collection was based on a previously established survey sheet. The professional development was checked by phone calls.
RESULTS: Our study included 41 patients. Mean age was 44 years±8.3. The population was predominantly male (56%). Seventy-eight percent of patients were non-commissioned officers. Most frequent primary tumors were breast (44%) and colorectal tumors (22%). The resumption of professional activity concerned 32 patients. Exemptions were granted to 19 patients (60%). Predictive factors identified in univariate statistical analysis associated with return-to-work were the stage of the disease, the performance status of patients at the time of diagnosis (P=0,001) and the need for psychological support (P=0,003).
CONCLUSIONS: Several factors were involved in the resumption of professional activity after cancer disease, especially in the military population. It therefore seems essential to anticipate the return to work in order to overcome the difficulties that may be encountered during the recovery.

Présenter des données probantes et des recommandations sur la maturation cervicale et le déclenchement artificiel du travail. Fournir de l\'information aux professionnels accoucheurs et aux personnes enceintes sur les soins périnataux optimaux et la prévention des interventions obstétricales inutiles.
Toutes les patientes enceintes. BéNéFICES, RISQUES ET COûTS: La mise en application interprofessionnelle et cohérente de la présente directive, l\'équipement adéquat et le personnel compétent améliorent la sécurité des soins per partum. Les personnes enceintes et leurs personnes de soutien doivent être informées des risques et bénéfices du déclenchement artificiel du travail. DONNéES PROBANTES: La littérature publiée jusqu\'en mars 2022 a été passée en revue. Une recherche a été effectuée dans les bases de données PubMed, CINAHL et Cochrane Library pour répertorier des revues systématiques, des essais cliniques randomisés et des études observationnelles sur la maturation cervicale et le déclenchement artificiel du travail. La littérature grise (non publiée) a été obtenue à l\'aide de recherches menées dans des sites Web d\'organismes s\'intéressant à l\'évaluation des technologies dans le domaine de la santé et d\'organismes connexes, dans des collections de directives cliniques, des registres d\'essais cliniques et des sites Web de sociétés de spécialité médicale nationales et internationales. MéTHODES DE VALIDATION: Les auteurs ont évalué la qualité des données probantes et la force des recommandations en utilisant le cadre méthodologique GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). Voir l\'annexe A en ligne (tableau A1 pour les définitions et tableau A2 pour l\'interprétation des recommandations fortes et conditionnelles [faibles]). PROFESSIONNELS CONCERNéS: Tous les fournisseurs de soins obstétricaux. DÉCLARATIONS SOMMAIRESMISOPROSTOL: OCYTOCINE: RECOMMANDATIONS.