Introduction: Pre-viable premature rupture of membranes (pre-viable PROM) is a rare event occurring in less than 1% of pregnancies. Nevertheless, it can be responsible for severe maternal complications, the risk of which needs to be balanced with the possibility to prolong the pregnancy up to viable gestational age. Maternal sepsis was reported in 1%-5% of women who received conservative management and prophylactic antibiotics, but information on maternal mortality is lacking. Our objective was to identify maternal deaths in women who had pre-viable PROM, describe the characteristics of the women, explore preventability factors within the care they received, and estimate the lethality of pre-viable PROM. Material and methods:We identified all maternal deaths associated with pre-viable PROM from the 2001-2015 French National Confidential Enquiry into Maternal Deaths (NCMM). Data on women's characteristics and the care they received were extracted from the ENCMM database. The lethality was determined after estimating the total number of pregnant women with pre-viable PROM from the national hospital discharge database.Results: Between 2001 and 2015, we identified seven maternal deaths associated with pre-viable PROM, representing 0.6% of all maternal deaths over this period (ie, maternal mortality ratio 0.06/100 000 live births). Six maternal deaths were attributed to sepsis after genital infection by Gram-negative bacilli and one to postpartum hemorrhage due to placenta accreta. Four of these seven cases were considered preventable. The main preventability factors were delayed diagnosis, delayed fetal extraction, and inappropriate antibiotic treatment. The estimated lethality was 4.5/10 000 women with pre-viable PROM.Conclusions: Maternal death associated with pre-viable PROM is rare but possible.Most of these deaths seem preventable, with areas for improvement related to earlier diagnosis and better treatment of uterine infections, which can evolve rapidly.

Purpose Abdominal myomectomy can be a challenging procedure, with elevated intraoperative blood loss and post-operative complications such as the need for blood transfusion and hemostasis with sometimes hysterectomy. Previous studies suggested that preemptive uterine artery embolization (PUAE) might reduce intraoperative blood loss. Materials and methods We reviewed all cases of abdominal myomectomy in our institution between January 2016 and June 2018. Out of 119 cases, 16 patients had PUAE and 103 did not. The objective of our study was to determine whereas PUAE reduced blood loss and post-operative complication rate. Results In our study, there was no difference between the two groups in regard to average blood loss (128 vs 192 mL, OR 1,00 [0.99;1,01], p = 0,73), difference between pre- and post-operative hemoglobin level (− 1,15 g/dL vs − 1,32 g/dL, OR 0,91 [0.47;1,73], p = 0,79), and post-operative complications (need for transfusion, surgical revision, post-operative embolization, hysterectomy). Conclusion Our findings could not conclude that PUAE is effective in reducing intraoperative blood loss during abdominal myomectomy, but it should still be considered an option for patients with large or multiple myomas, with a specific situation or previously operated, who wish to preserve their uterus.

Context:  40% of breast surgery patients have a lesion that requires preoperative localization, a process that demands close cooperation between radiological and surgical team. Magnetic seed localization is a new tracking technique which does not require programming the day before or on the day of the intervention. The aim of our study was to evaluate the efficacy and safety of magnetic localization of non-palpable breast lesions. Methods and patients:  This is a study of 39 consecutive preoperative ultrasound-guided implantations of a magnetic seed (MS) in 37 patients, for non-palpable breast lesions, performed at the Breast Center at Saint-Joseph Hospital in Paris, France, between May 15th and December 21st, 2018. One patient who was operated on for papillomatous lesions had a double magnetic seed implanted. In the operating room, the MS was percutaneously localized by a magnetic probe. The ex-vivo magnetism was noted and the removed tissue was sent to radiology to look for the MS, after which it was sent for histopathological examination. All localized lesions had previously been biopsied, and there were 29 infiltrative cancers, 7 atypical lesions, and 3 benign lesions. The sentinel node was identified by super paramagnetic iron peroxide in 11 cases, and by isotopes in the 18 others. Results:  Our patients were on average 57 years old (33-86 years old). All magnetic localization was realized using ultrasound. The mean ultrasound size of the lesions was 12.7 mm (5-34mm). The period of time from implantation to surgery varied from 0 to 21 days. The localization method was characterized by a rapid pose, facilitated by the excellent luminosity of the needle for the tracking. No compression pad was needed, optimizing the implementation and quality of the control mammography. The mean time for the tissue resection from incision to excision was 15 minutes for the first 10 cases. On the radiography of removed tissue: the clip was present in 38 out of 39 cases. One failure was registered, in relation to loss of the clip, found in the tumorectomy limits, in the patient with the double localization procedure. However, the target was effectively removed and detected histo-pathologically. In the 13 cases of super paramagnetic iron peroxide, the sentinel node was identified each time. All biopsied lesions were removed, and in cancerous lesions, the surgical margins were healthy in all cases. Conclusion: The MS localization technique is reliable and safe. For the patient, the main interest is a simplified procedure without long-term damage of the skin; for the radiologist, the rapidity of the procedure; for the surgeon, a real time guide for localizing the target; and for the hospital, an eased organization with regard to preoperative tracking during ambulatory surgery, with implantations possible up to 1 month prior to surgery, for instance at the time of the radiological review. The main limit to  MS’s development remains its cost.

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