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Emergency cesarean delivery, initial surgery and consultation. Today, I'm spending 24 hours in the shoes of a gynecologist-obstetrician. Follow me, let's go. Today, I am at the maternity ward of the private hospital in Anthony, part of the RamC health group. Julien, are you okay? Are you doing well? It's going very well. What are the main duties of a gynecologist-obstetrician? The gynecologist is responsible for the screening and monitoring of women in general. Obstetrics is the monitoring of pregnancies. Ensuring the safety of the mother and child
during pregnancy monitoring and at the time of delivery. There are people who only do gynecology, others only obstetrics. There are many different things within gynecology. There is surgery, and there are people who only do breast cancer treatment. Their job is to operate on breast cancers. Others who have cancer of the glass, we have people who take care of it who essentially do screening and then follow-up. Then we have an endocrinology component, so the problem of hormones. What happens with cycles, with menopause? Then there is everything related to the management of hormonal and surgical infertility. There are people who only do ultrasound, who have become almost radiologists, only doing follow-up and screening ultrasounds
during pregnancy. It's a very broad specialty. Good morning. What is the name of this moment, Julien, that we are about to witness? Every morning there is a review of both what happened during the night and what will happen in the future. It's a time for team coordination, and also for transmission because obviously we work on 24-hour or 12-hour periods and so on, but nobody continues indefinitely. So there needs to be something to do, what has been done that deserves to be highlighted, and it's a very part at 39 weeks of amenorrhea that was induced for convenience yesterday morning, who gave birth at 6:27 am, she has had a bakery since
7 am that brought back less than 100 cc, I haven't yet recovered her nu but at the emmo she was at 11 61, you had an em, yes, at 11 to 12, and how is she, she is, she is very well, there are plenty of things to do, to raise the problems, the things to fix. OK. Were there any particular surprises in what you learned there? Anything to watch out for? Lots of things. For example, if a patient bleeds during childbirth, a balloon is placed in the uterus to compress the uterine walls to prevent further bleeding, and she is expected to have bled 500 ml. However, her hemoglobin level has dropped considerably. All the blood.
It's a police investigation. It can cause hyperbleeding. It can bleed inside the stomach because it's not visible externally. We need to try and understand where the blood is OK. We're following you. So you're off for a 24- hour shift. Yeah, it's on until 8am tomorrow. Do you have any kind of physical and mental preparation before tackling 24 hours? Well, I do the same as you, I do 3 hours of boxing per week. It's really true. It's true. Great. Especially after the guards. Oh yeah, right after. What's your work pace like? The guards are the 24-hour guards and then there are others. So it comes back to the rate of one time out of 11, right?
So this is how it's done regularly. So how much rest do you get afterwards after you've done a shift? It's my decision, but I generally do n't work the next day. Who and the guards, it's every 11 days. Tr qu gardes per month. Isn't it too tiring? It's tiring. The more you visit, the more tiring it gets. Yeah. OK. There's that, there are the consultations afterwards, and then the operating room. Hello, I am the doctor, I am the on-call gynecologist. Good morning. Delighted. You spoke with my colleague earlier. How are you feeling right now? Alright. Here, we have the collection bag which is not very full. We are a little
surprised by your blood test. Where did he say that? Yeah. We're going to give you another update. Well, it seems like this whole thing is just lab error. Tac. So here, we have the balloon which is inflated. Above, you can still see a little bit of the uterus here. And inside, well, there are small traces of ash. Finally, there's absolutely nothing important. If there was a lot of blood here, we would have an image that would look a bit like the balloon, you know. We're going to do another blood test, just as a matter of principle, you know. So, you have to take the sample properly, not from the side of the infusion, for example. There's nothing to
explain the 6g and it doesn't add up at all. You wouldn't be as good. So the balloon, we plan to remove it this afternoon. All right. Theoretically, you can leave it for 24 hours, but I don't think it's necessary. It's still a constraint for you. Okay, see you later. Have a good day. So, regarding the blood, that was a false alarm. The patient appears to be doing extremely well. People who are truly damaged, they're not like that. They are takicardic, their heart is racing, they are a little out of it, they feel unwell, they have a feeling of discomfort. It's obvious, all sweaty. So. And especially with such a sudden
and generally quite rapid loss, it is poorly tolerated. Afterwards, there's no blood in the tube, so it's not something that just came out like that. There is no more blood in the vagina, there is no blood in the belly, there is no blood in the uterus, there is blood from elsewhere. So we're talking about illusion, about lab error. Once we've verified that there are a lot of serious things going on. We shouldn't reassure ourselves too quickly, too easily. OK, that's not what the job is about. And we'll probably have a blood test that will tell us, no, we're at, I don't know what, 10 of course, but at least it's reassuring and at least the case will be closed.
Patrick, you're a gynecologist-obstrologist, we're waiting for a patient. What are we going to do with her? We will offer her a saliva test which can diagnose endometriosis through saliva. What is this disease called endometriosis? a chronic disease that will affect women of childbearing age, therefore from their first period until menopause. It is tissue that resembles uterine lining which will be placed in the abdominal cavity in various places, causing increasing discomfort and having a very significant impact on quality of life.
Elisa, how are you doing? Are you doing well? How are you. You are suspected of having endometriosis and one of the tests that can determine if you have it or not is this famous saliva test. It's called Zwig in testing. It's in the testing phase, it's not official. Although still in the evaluation phase, an important first step has been taken: there have been 2500 inclusions and now we are at the remaining 22500 and we hope to be able to prescribe it, which has a reimbursement basis and that we know exactly who to prescribe it to. So, can you explain to Elisa how it works?
You will salivate a little before you can spit into a small tube and we will send it to the laboratory in Lyon; the result should be in 3 weeks. So. OK, very good. So Elisa, of course, you can turn around if you ever want to spit in the test. We won't give you any trouble. And if women watch the video and have suspicions, what is the first step they should take? Ideally, you should consult your primary care physician who will then refer you to another doctor. Exactly. There are two tests that allow the diagnosis to be made.
Pelvic MRI is the reference examination, and endovaginal ultrasound is used when possible. It is these two examinations, with an interview and a physical examination, that can lead to a diagnosis. Previously, one had to undergo an intervention, a laparoscopy. We would put a small camera in the navel to be able to confirm the lesions and take samples. Today, fortunately, we have less invested resources. That's great. And so, to explain to you that Patrick, even though there is a technique, it's about saliva and salivating. What is recommended is to think about your favorite dish, some lemon, and then gently rub the inside of your knees and cheeks, place your tongue at the top of your soft palate, and all of this will make you salivate enough to be
able to do the test. Périne, pleased to meet you. Périne, pleased to meet you Congratulations anyway. So, how many months along are you now? 9th. 9th month. Wow! Oh yes, when is that scheduled for? Early March, first week. Yeah, it's almost Périne, do you have endometriosis? Yes, I'm late, huh. I am 33 years old now. I found out when I was around 26 years old. I suffered from it for a good 10 years, or rather, the symptoms were there. So I follow them very late. What are the most common signs of
endometriosis? So, it usually starts with abnormally painful periods. For teenagers, it will be the parents who are systematically called to the middle or high school to pick up their children. It's going to be excessively heavy periods with overflows. In my case, it's like you had a kind of electric shock, you know, a bomb. In fact, it takes hold of you, it brings back heat and your whole stomach swells up. Te fem pregnant, a belly like today, you see. Yeah. Even without being pregnant, you can have a stomach that swells so much that you might think you are pregnant.
Yeah. One day, it happened to me at work at lunchtime, I couldn't close my jeans anymore. I went to get another pair of jeans, from the shop next door, in the next size up. And it's like you have some kind of pass, but actually it contracts, it kind of takes your breath away and all that. It's really like little flashes of lightning, you know, little discharges. I have always had severe pain during my periods, bloating cramps, and so on. So it impacts the fact of not being able to do sports, not being able to do the activities we want to do on weekends or holidays, not going to the swimming pool, this kind of thing which in fact is not so normal that we tend to perhaps trivialize
especially what will also bother them will be intimate life, pain during intercourse. It's going to get worse as time goes on Patrick is in the operating room, what type of operation are you going to have there? Robot-assisted celloscopy. So it's surgery under general anesthesia. We will be helped by the machine that is right in front of us, which is the robot that will allow us to pick up the instruments that I will have previously placed on the patient. And then I'll be able to control this machine on the console that's over there. I will be sitting at that level and therefore I will see in three dimensions and in real time what is happening inside the lady's belly. The aim of
the operation is therefore to remove the endometriosis lesions to relieve the patient's pain. You're going to remove the uterus. That's it. That will be one of the injuries we're going to remove, let's go How much does this machine cost? Between 155 and 2 million euros at the time of acquisition for the establishment and it will be amortized over 5 to 7 years. In fact, it depends on many parameters but roughly for an intervention on average the cost represents 3 to 4000 € for an intervention. This is largely one of the explanations for the additional fees paid to surgeons to finance these innovations. And you were also talking about the annual maintenance, right? It costs approximately €150,000 on average for the establishment
How long is this operation going to take It will last approximately 1 hour and 3 minutes. Following this operation, what will change in the woman's life? She will no longer have her period, but she will also no longer have all the symptoms surrounding her period. So she will experience less pain, but an improvement in her digestive and urinary systems. This means that she will no longer be able to get pregnant following this operation. No, it's a difficult choice for these women. It's always a difficult choice. Even if they know that things will get better for them, it's still a complicated step and not as simple as it seems.
This is the optics, this is the camera with the cable that will allow us to see inside. Is that your GoPro? Yeah, exactly. Is this an operation you regularly perform, or is it quite rare? No, no, it's every week. So the next step is to perform the laparoscopy. Patrick, at what age can endometriosis develop? From the first period, which is called menarche, therefore from 12 to 13 years on average until the onset of menopause.
Endometriosis can also be triggered even after having children. Quite. It can happen at 30, 35, even 40 years old when everything was going very well, when there was no problem before. It seems like it happened during the first period. So you thought, "That's normal, it's just the rules?" No, I didn't think it was normal because I wasn't like my friends. My friends were in pain, and that was that. I was bent over, I was practically under the table. I was in bed days ago, it was complicated. Were there people at the beginning who thought you were overdoing it, that you were exaggerating? Everything is horrible. Yeah, that's actually the problem. Well, at some point, you just don't know anymore, you think to yourself,
"Is it you who has a little fart or what?" Actually, not at all. Apparently, these are very painful pains. In fact, it's really very painful. Does this last all day? At my place it really lasted all day. What relieved me a little was the show, the hot water bottles and all that, but well, when you're at work, you're not going to go to the microwave every 3 minutes. Yeah. Yeah, I understand. Did you easily find an endometriosis specialist? No, not right now. Until I was 18, I was too young for doctors to be able to have tests related to endometriosis. Were you aware of this disease, endometriosis?
Yes, I'd heard about it all along. OK. On what? On social media, a little bit through my family, girls around me who already had them. OK. So, you're making an incision, is that right Yeah. And we insert a needle into the lady's stomach until it is in the abdominal cavity and we will be able to insufflate. It will make your stomach swell. This will create a space for us to place the camera and be able to see what is happening inside and to be able to carry out the intervention. And once the belly is sufficiently distended, the first instrument can be safely introduced. So here, I introduce the first instrument and we can put the patient in, train the Imbourg 18°.
Wow! OK, so you came in here. That's it There we are, we're inside. So. So this is the uterus and there are some small adhesions. There, we see a green. It's the small spots that are here, a little white. That's what endometriosis is. Here too, the small white spots and the uterus which is a little bit too round. So, we are now putting the following instruments in place. You're actually piercing the skin. Exactly. And then we'll be able to approach the robot. Move the lasers to the intervention point.
We have a laser centering that tells us exactly where to place it. And then, the robot will position the arms all by itself. So. The tools are placed there. That's exactly it. So now I can take the controls. Can endometriosis be cured So, today, we have no medicine to cure it. It remains a chronic illness. This means that we need to teach women who have endometriosis how to live with it. But we have drug and non-drug treatments to improve their daily lives. And surgery will be required for the most severe cases. But today, we have made a lot of progress and we are able to greatly relieve these women. Yes of course.
I was on the pill continuously, so there were no more periods and frankly that was a relief. Oh yeah, that was incredible. I am already on a treatment pill which seems to suit me and which allows me to no longer have my period. So that's a big positive point. Of course. Less pain and everything. Yeah. Just with the head, like a photo booth. All right. So there you see exactly what you see on the screen. And so here you control the arms that we see moving, actually all by themselves. Exactly. and with a precision that is really superior to what we usually do without a robot. We're not going to tremble, the machine corrects our imperfections a little bit.
What is that white ball you're touching? That's the green water which is in very good condition. And this is the trunk that we're going to remove here. You detach it. Yeah, exactly. We will burn the small blood vessels so that we can remove the fallopian tube without causing bleeding, without triggering a hemorrhage. One day, you were offered surgery. That's it. That was last year. For me, it changed my life because, as a result, I was also planning to get pregnant. And I think that since the operation, if you want, it's really better in terms of bladder control because I was going to pee all the time, all the time, like I never stopped, and now I go much less.
All right. The operation went well, it wasn't too painful? How long did it last You can feel it in the following days, but after that, frankly, it goes by quickly. That's exactly what you're removing: the attachments to the uterus. Hysterosalpingography is not necessarily the only treatment for endometriosis. There are also less drastic, less radical interventions. We will be able to preserve the uterus and sometimes we will focus on the gallbladder, the urinary tract, the colon, the rectum. Experiencing pain during sexual intercourse can be a suggestive sign of endometriosis. Quite. Especially in women who had never experienced pain during sexual intercourse. Often, this allows us to make the diagnosis, to
strongly suspect it. It is more delicate with younger women who think that it may be normal, that it is not serious, that you have to deal with it and so they may not dare to talk about it and not dare to consult a doctor. Does it bother you in your personal life? Yes. Constant pain. And now we're going to get closer to the vessille. Be careful not to hurt her. Of course. The vessille, it's there. What is young is fat. Exactly. Yeah. Is it the fat that we all have that can cause endometriosis? There is a genetic component, meaning that if in your family you have a mother who has very suggestive symptoms or who has already been
diagnosed with endometriosis, you are more at risk. The same thing happened with the nuns. Then, it can affect, I would say, anyone in all societies, in all countries. It's a disease that exists all over the world, actually. Is this a new disease? So no, it's not a trendy disease. Unfortunately, some patients have heard this. Fortunately, it's a marginal phenomenon. No, it's not a trendy disease. This is nothing new. It's very old, not to say it's been there forever. It's because now we can diagnose it rather better. What we're noticing is that there are probably more of them than before. We lack figures for this, but we have the impression that there are more severe forms in younger women.
Patrick, have you put anything in place at the hospital to help these women? So, we have set up a day hospital almost 2 years ago where patients arrive in the morning around 8am. They are going to have a pelvic MRI. This will allow us to map the lesions. Next, they will see a pain nurse in a workshop, usually in groups of four. They will be able to exchange ideas, share a little about their experiences, their pain, and get advice, tips and tricks to live better with this disease. It's a human time that is quite rich for her, quite poignant. Next, they will see a nutritionist for advice on diet, so rather anti-inflammatory diets by reducing certain foods that can cause inflammation, therefore bloating, a very distended and
uncomfortable stomach. They then go to see a midwife/sophrologist and I meet with them in the late morning/early afternoon to summarize this day hospital. So here we have the uterus that has just been removed from the patient, the fallopian tubes that are right here, the body of the uterus that is there and here is the cervix. How did the operation go? It went very well. So we were able to see the uterus at the end. What do you do with the uterus It is systematically sent for analysis as soon as something is removed from someone's body during an operation; it is sent to the pathology laboratory. This is the medical specialty that allows for the analysis of tissues.
So Julien, we're going to see a new patient. So what are you going to check? This is a patient I know. We programmed a scenario, it's just to go and say hello, see if there are any questions, explain to him that there might be cameras. Of course, incidentally. Incidentally. Okay, let's record. As soon as we 're ready, beautifully. Yeah. So, what do you think this morning? Ah yes, yes, yes, it was this morning. It's this morning. Okay, b, here we go. I trust you anyway. It's okay, everything's fine. See you later Yeah, see you later. Now, let's head to Julien's office; he's in consultation with a patient. So yes, the idea is to remove both worms, both fallopian tubes.
The one on the right has twisted himself into a ball. The open is an organ that is suspended like that, but which is held by two ligaments and it can twist as if you were winding a chain, you know, with a pendant for example, it creates pain, it twists the vessels. So that interrupts the blood flow in there. If it twists, becomes necrotic, and stops, we could say, "Well, we'll leave you alone. Is it really necessary to have surgery at 77? But you're still in pain even with medication, and you also have a slight fever. So the idea is to do this. We'll insert a camera here so we can see what's going on. Three small incisions for the instruments, and we'll remove the fallopian tubes and the worms.
Is that a movement I made? No, no, it's not your fault. It's because there's a very heavy cyst on your glass. That's what twisted it. If you like, maybe it's the Pilates. Possibly. Actually, there was a patient who twisted hers laughing at a comedy show. So she laughed, and then, oh, it hurt like this. Any movement can cause twisting, like going up stairs. Why did you Want to become a gynecologist- obstetrician? Well, the variety is incredible. You can do ultrasounds, imaging exams, surgery, deliveries-it's still a very specific, extremely broad field, whereas there are fields that are much more specialized. And
then, it's usually a joyful experience. Of course, there's always the possibility of complications in osteopathy. Overall, though, it goes quite well, even though it's not at all the same daily routine as being an oncologist. So, Julien, you're going to have an operation. It's a Bartholin gland removal. We remove it because it's a gland that sometimes gets infected. So, it's a classic gynecological emergency; it's a Bartholin's gland abscess. And when there are recurrences, after a while, we end up. Well, this gland keeps getting infected, it sends you to the ER several times a year. So, we end up removing it.
How long will this take? Half an hour, three-quarters of an hour. Okay. You were talking about a gland we're going to remove. What's the purpose of this gland, anyway? AL, it's one of the glands involved in vaginal lubrication, and like all glands, there's a part that produces the fluid, and then there's an excretory duct that carries it. The gland responsible for the skin, for example, is a kind of small ball at the base, and then an excretory duct. When the excretory duct gets blocked, the fluid that's supposed to drain can't. So, that's what causes the bumps on the skin. And it ends up getting infected and forming a small abscess. So, this gland. There are actually two, and then there are other glands involved in
bladder lubrication. So we can remove one of the glands without causing any damage. It's an operation you do regularly. It's standard in gynecological emergencies, and then sometimes, when it comes back too often, we remove the gland. The main risk is that it's a fairly vascularized area. So that means there are quite a few blood vessels, so it can bleed. So, are there two gynecologists for this kind of operation? No, no, that's our choice. Incising the abscess of the gland, that's something the residents often do in emergencies. Removing the gland itself takes a bit longer You can't operate alone. Having someone lend you their expertise is huge for us. Do
n't listen to Gu if you're contrary to what you think. Very anxiety-inducing for us. So if I faint, for example, it's very important. Yeah. Here at Anthony's private hospital, how many obstetrician-gynecologists are there? Ah, that's the job. Hello? So here we are 11 obstetrician-gynecologists, six anesthesiologists, and at least five or six pediatricians. We operate on an on-call system, meaning there's always an obstetrician-gynecologist on site because obstetrics can happen very quickly.
You might have to perform a cesarean section in less than 10 minutes. Anesthesia, and anti-inflammatories, you must have them too. No, there's a patient who just called me who has a problem with heavy menstrual bleeding. I'll see her again next Monday, but thanks to modern technology, I can send her a prescription for further testing. This morning at the meeting you Listen, there's a baby who was transferred, a child who was born with a diaphragmatic hernia that was discovered during delivery, which hadn't been detected prenatally. The intestine is normally divided into compartments in the abdomen. It's separated by a muscle called the diaphragm, and sometimes there's an abnormal opening there. So, part of the
digestive tract can reach the chest, compressing the lungs and preventing proper breathing. Okay. So the child couldn't breathe at birth. It's extremely dangerous. So, this baby was transferred. The pediatricians then get the information. Your job ends when the woman gives birth. Well, we're not qualified in pediatrics. So, we know how to do prenatal diagnosis. Obviously, we can detect malformations that are incompatible with life and tell people, well, this is a child who will be very severely disabled anyway. And so, we can terminate the pregnancy. Another aspect, which is a little less well-known, is delivering babies in
places where they will be immediately taken care of in a competent hospital. Okay. So what are you going to do then? So, I'm going to perform a spinal block. We use two techniques, an epidural and a spinal block at the same time We even perform an epidural in the case of a cesarean section. Yes, exactly. But we change the medications we use depending on the stage of labor. In fact, the woman will be numb from about her chest down to her feet. You've chosen the right approach, okay, it will allow her to relax.
Well, yes. We'll start with a local anesthetic. How many epidurals do you perform per week on a shift? We can do 10, 15. I'm going to apply the sedative to the back, madam; it's really something you do every day. Yes, all the time. Now, I'm preparing All the equipment beforehand. This is the epidural equipment and this is the equipment for removing it. You'll do this every time I do something and you'll let me know if there's anything wrong, you'll tell me. Okay. I'm going to do the local anesthetic first, okay? It might feel warm here. It's always a bit stressful for mothers.
Yeah. Well, yes. Yes, because she can't see what we're doing. Relax, let her shoulders drop. There, that's great. Very good. So, you're going to feel it pushing in your back. I'm already doing the epidural. I'm going to do what we call removing it. So you might feel a little click in your back. I'm going to inject the medication. It might feel warm in your legs or buttocks. You'll see, it's quite quick. There you go. So now, I'm going to insert the small uterine tube. Is that okay?
Yeah, yeah, that's fine. Don't fall into the snags there. It's good. How are you, ma'am? I'm fine, I can't wait. First epidural or second epidural? It's the second one. It's a bit unusual because I went through IVF for my first daughter. Okay. And we'd been on the IVF path for 7 years. We tried again a second time after our daughter. I had a lot of failures, and now this is a healthy little baby Oh, magnificent. It's beautiful. Does endometriosis prevent having children? In 40% of cases, it is indeed involved in infertility, but that still means that in the majority of cases, there is no infertility for these women with endometriosis. But
indeed, as soon as there is ovarian or fallopian tube involvement, there is a higher risk. that there was associated infertility. I knew I was going to have trouble getting pregnant before I even tried. My cycle wasn't normal anymore. For months, there was nothing, and then it would come back every two weeks. You see, I couldn't really calculate or plan. I have a very low ovarian reserve. We still tried naturally. Well, we saw that in the end, the diagnosis was what it was, it wasn't working. Then we started fertility treatment, it lasted 5 or 6 years. They retrieve eggs so they can match with your husband's sperm, and then there's a transfer in the other direction. Except when you have a low ovarian reserve
, well, they had nothing to retrieve from me And then, yeah, I'd say about last year, so 6 years later, we switched to donor eggs and they matched them with my husband's sperm, and the first try, the first Success! Wow! Congratulations again. So, how are things going? How was your pregnancy? A lot of stress, you know. You're thinking, "Well, nothing can go wrong." I didn't really want to get my hopes up because there had been so many failures before. Yeah. It kind of held me back. Of course, of course. That's what I also found difficult about the fertility treatment process. So, it basically controls your life, it takes up your vacation time, you go out. You know, when they tell you it's
now, it's now. It's not next week. Having a child is a real project, actually Yeah, it's a real project. It's a big investment, I think, psychologically speaking. Actually, I think you're also overprotecting yourself because you're afraid of what might happen. I mean, I think until the baby is here, well, it's not here. So, we're on A first consultation. That's what gynecology is. So you don't have any medical problems No. No health issues, no diabetes, hypertension, or heart disease, no drug allergies either. What age is "first"? 5th grade. I'd say 5th grade is 12 years old.
Yeah. People aren't sick at that age. What about people who are 15, 20, or 25? What often happens? The establishment of the menstrual cycle between 10 and 20 years old is often a bit erratic. It can be extremely painful, so it can impact schooling, for example. It's not always endometriosis, but it can be. And then there are the first sexual encounters and the risks involved. The first is an unwanted pregnancy. Always traumatic, whether you keep the baby or have an abortion. There's no abnormal flow. No, that seems like it. Yes, it's regular. You're not using contraception with the. No. Have you had intercourse before?
No. So, we were saying, obviously no full gynecological exam with the speculum and all that. We're not going to do a vaginal ultrasound either because you haven't had intercourse. We can still look at your abdomen with an ultrasound. That allows us to see the uterus, the green water, to check that everything is okay, that there are no cysts or anything, that there's nothing atypical. I can show you the exam in the sea if you want to see. And do you need contraception then No, no, you don't need it. Very good. No pain relief for periods either. No, that's fine. Everything is fine. On the platform, actually, so we have to prevent period pain, contraception, and then going with contraception, there are all sorts of infectious problems. And nature is
a bit unfair in that respect, women pay a. Their tribes are less susceptible to genital infections than men in general because it can damage the fallopian tubes, it can compromise future fertility. So there's a way you can get an infection at 18 and then end up needing in vitro fertilization at 30 because of the infection. When it affects the cervix, it's actually an infectious disease linked to the HPV virus, which gradually triggers cancer. There are now vaccinations for adolescents between 11 and 14 years old. We get infected with HPV through first sexual intercourse. OK. There you go. People who never have sexual intercourse are not in contact with HPV.
A little over and on the other side too. Perfect, thank you very much On social media, people often talk about PCOS, what is it means polycystic ovary syndrome. PCOS is quite common. The egg follicles will mature, but they will remain stuck at an intermediate stage. They won't reach ovulation. So, how do we know? Sometimes it's in patients who don't have periods at all because this cycle blockage results in an absence of menstruation. We also see fertility problems with this because the patients don't ovulate. And then, it's quite common, as it's often accompanied by a metabolic disorder; these patients can have acne problems, irsutism. That's hair that grows abnormally on the thighs, chest, face, for
example. People who are more at risk of developing type 2 diabetes, lipid problems, and so on. It's a metabolic disorder, but with a link to genetics. We're setting up the fields. As soon as we're ready, we'll let Dad in. Okay. See you in a bit. When we do surgery, we always wash our hands; the idea is to reduce the bacterial load as much as possible Yeah. Now, you're getting everything ready. It's Okay. We count the drapes, we always count the textiles before procedures so we can count them at the end and be sure we have everything.
Alright, let's go. So, we're cleaning. Yeah, it's normal that you have some sensations. The important thing is that you don't feel the cold, I think. Yeah, this is the drape. So, it looks like it usually does. We'll see. There are windows. We'll discover them with you. Ah, there we go. You see? Hop! Oh yeah! Everyone has their own window. We're doing a test, checking that the anesthesia is working well. Yeah, the test is good.
It's good, we're good. The lady already had a cesarean section. Yes, that's why there's a scar. We're going through the same area then. Exactly. Okay, are you all ready now? Well, you're ready. Yes. Incision. Now, you go through the different layers. Yeah, there are a whole bunch of tissues. They're even more fibrous because we've already had surgery. So we gradually cut them to get right down to the muscle. How many layers do you have to go through?
Well, there's obviously the skin, there are membranes called fascia, and then what's most important is what's called the aponeurosis. The aponeurosis is the sheath of the muscle and what gives the abdominal wall its real strength. We get to the rectus abdominis muscles, the famous six-pack, the ones you've been working on, and we detach them from the aponeurosis. How's the mom doing? I feel good, but you can feel something happening in the belly. You can feel movements, things you're touching, jostling.
It's a little stressful because there are lots of things going on around us, but then I'm kind of in my own little world. You don't feel any particular pain? No, you just feel it moving. Yeah. We're going to start the final part. We're having a stethoscope, you can put your arms out. Look at the box there. You see? You can grab it. Okay, I'm going to grab it. There we go. Wait. Hop Well, congratulations.
Whoa! So, how did it go, Julien? So, it's a standard C-section. Is it normal that there's no crying or screaming? Yeah, yeah, yeah. Babies only have a minute, you know, to move. A minute is a long time. A minute seems incredibly long. So what are you doing right now Here, we're going to close the uterus. We're closing the organ that we opened to get the baby out. Does giving birth still give you feelings, or are you used to it now? Me, I don't give birth, I create. Not living people, you know. So we make sure things go smoothly. Actually, I see it as a correction.
Childbirth isn't an illness. Besides, patients say it all the time. I'm not sick, I'm pregnant, but it's still dangerous. There are lots of things that can go wrong, and we make sure things go well. Do you have an unusual anecdote that happened to you? I did emergency surgery quite a while ago, 15 years ago I think, a patient came in with an intrauterine pregnancy who was very unwell, so we operated because she also had an ectopic pregnancy. It was actually a pregnancy resulting from fertilization of vitreous humors. They had transferred two embryos, one into the uterus, the other into the fallopian tube, and the one in the tube caused it to rupture, so she had internal bleeding with a lot of blood. During a hyper-
emergency procedure, they removed the pregnancy that was in the uterus, and eight months later I received the birth announcement for the child who was still in the womb and who was born in Australia. You see what I was saying earlier about the idea of correcting what could go wrong? Of course, when everything goes well, that's great, but what happens when an operation goes wrong? You think about complications, for example, or things that weren't planned, weren't anticipated, and so on. There can be disputes, for example, in healthcare, just like everywhere else.
Medicine isn't immune to that. So, there can be surgery- it's true in all surgeries, in all medical procedures-a prosthesis that doesn't work, something that gets infected, well, you know, it can always happen. That's why there's a lot of information beforehand to tell people, "Be careful, we're going to do this." But there are always risks. Even childbirth, there's always a risk. Always, always. In fact, risks are everywhere in life. All the time. The question is how to quantify them. There's no point in being afraid of something that never happens. We take a plane, it's going to crash. Actually, no,
when you look at the statistics, you're much more likely to die in a car than in a plane. There are situations where it's relatively easy. If it's extremely urgent, there's a risk of death, we say there's a complication, we'll see another day because right now it's becoming a catastrophe. If you have cancer, don't have surgery, the complications of the surgery, well, it's the same. But the more you go towards unnecessary surgical procedures, typically cosmetic surgery, functional surgeries to improve life a little but which ultimately we could do without, yeah. The fewer complications we tolerate. So There's a risk management process involved. Have you had colleagues who've received complaints?
Yes, it happens. People file complaints, in my opinion, when they're not entirely innocent. accompanied. Something's not going well and the doctor isn't taking proper care of it, he's not coming to explain it to them, well, that's what happened. and so on, to explain what had happened Valérie, what is this? So what we have in the box, this is the placenta, so with the face, with the cotyledons. Let's imagine that my hand is the word of the uterus. He is like this. Yeah. And there, there is the cord, ah the vecal cord, which is inside this sac that exchanges nutrients between the baby and the mother.
Is the placenta rich in protein? I'm telling you this because there are people who eat the placenta, or that's just an idea. It seems very much like a nutrient, perhaps. It's not worth a protein shake. But uh Julien, I have a question. Can women request to give birth only by cesarean section, or is vaginal birth always offered? How does it work? So, they can ask, some do ask, but we discourage them and we can also refuse to do that. It's still better for women's health to give birth normally. It's still surgery. If you open the abdomen, there is a greater risk of phlebitis, pulmonary embolism, and there are many other
dangerous things, especially secondary risks for subsequent pregnancies. If I want to have four children, what cesarean sections? The more you have, the more complicated it gets. And then there are also risks to the way the placenta will settle in the uterus for ulterary pregnancies. Ah yes, I understand. OK. And so it can be very, very dangerous. So there you have it. There are many reasons, even reasons for children, because passing through the basin deflates their lungs, compresses their chest, and they cough up all the amniotic fluid. There are specific health problems for people born by Caesar, so low wood is preferred and low wood is preferred for 1000 reasons. But that doesn't mean that a cesarean section is a bad
procedure, you know. It's extremely useful when there's a good indication, when there's a good reason to do it. From there to saying that it should be generalized as it is done in some countries, for somewhat absurd reasons. You don't need the studies you did for that job. 6 years of common core medical studies and then there is a competition which at the time was called the internship but I 'm old it's not called that anymore. In short, there is a second national competitive examination, a national ranking examination, and then there are 5 years, but that has also changed. Now we say junior doctors, so people who work a little longer, but in my day there were 6 years of
common core and 5 years of specialization, it was to learn precisely the surgical part of the professions. So what are you doing here? So I'll just cut off his jorbon. I'll examine her, touch her, and she'll go back to making a cuddle with mom or dad. Is it always the father who cuts the cord, or does that change? It depends, please Yeah, we went to get the scissors. Mission: It's a pair of left-handed Ouidex scissors. Ah good? How are you. Go for it. That's how it is That's perfect. Congratulations. The baby will rot its waste immediately. That's it. Quite. It's already surprising that she didn't do it to her mother.
It's about to explode. work what. Yeah. What's tiring is when you have very, very long blocks. I remember once when I was an intern, there was a 15-hour block of work, uh, tired for good reasons, you know. So here we are with Ruben, who is a gynecologist and obstetrician. What type of consultation are you going to do there? So today we are going to see a patient for an examination which is a diagnostic hysteroscopy where we go with a small camera inside the uterus to see if there may be a polyp, a fibroid, a malformation, all sorts of explanations that can explain why people have heavy periods or who may have difficulty getting pregnant. So we're going to see why the lady is here because it's the first time I've seen her.
This is for a prenatal check-up, right? Yes, because I am undergoing fertility treatment. Do you already have children? No, she's already had miscarriages and pregnancy terminations, so she's never been pregnant? OK. Because I had an ultrasound before which they said I had fibroids. So, it's possible that you have fibroids in the wall of the uterus but that they are not inside the uterine cavity. If that's the case, it's not a problem. Exactly. So, what we're going to do is, we're going to go over there, there's a small chair, you're going to take off your pants and underwear. and we will insert a small speculum to see your cervix and we will use a small camera to look inside
the uterus. We will prepare the equipment. I'm going to use a sterile glove. So diagnostic histoscopy is an examination that can be done in consultation without anesthesia. But I still took a back seat because I'm afraid of the pain. Okay, you're right. Normally it doesn't hurt, but sometimes the passage at the level of the cervix can be a little sensitive. So there's more installation than testing, as we always say. So madam, you're going to lower your buttocks properly. I'm going to insert the speculum. We're taking it very slowly. So. Let your legs hang down completely. So, this is an examination that can also be done using what is called vaginoscopy, that is to say without a speculum, by entering directly with the camera. It's a matter
of experience, of the doctor's choice. OK, a little bit of water will flow. Here we go. I am looking for the cervical opening, the canal, so that I can find the path that will lead us into the uterine cavity. So, I'm going to remove the speculum, it's going to make a small bump. Perfect. So here we are in the uterus. We look, we use the camera to see the start of the trunk, finally the arrival of the trunk on the left, the trunk on the right and then we move back. And you don't have a polyp, so everything is normal for the lady who doesn't have a fibroid, no polyp. So there is no need for you to have an operation to remove a fibroid or polyp before your treatments. We're going to take a small sample from inside the
uterus because they asked for it at the hospital to see if there's endometritis, which is a small infection inside the uterus. There, I'm putting the speculum back in. Gynecology is a very personal matter. When you receive patients, do you always ask for their consent before performing any procedure? Yes, but actually it comes up quite naturally in conversation. It's a question of consent. It's a matter of tact to understand the people you're dealing with. There are people who are clearly very, very scared and who, for example, will say yes when they mean no. You have to be able to say no, but wait, we don't have to
do that. Ah, I'm so relieved. So it's more, it's more delicate than a simple paper assignment, you know. You have to be able to say something, or to persuade someone else to say something. I understand that you don't want us to do the exam, but it's still important for xx reasons. Just because we signed a paper doesn't mean that people, moreover, it is noted in the texts that the consortium can be withdrawn at any time, etc. This will clearly show that it is more about maintaining a dialogue with people and not doing just anything. There are very often questions of childhood trauma, for example, many patients who have vaginismus have very, very strong vaginal contractions, and this is sometimes quite often linked to
childhood touching, things like that. So the paper isn't going to protect you then. We need to ask questions, try to understand what is happening. There are sometimes possibilities for self-collection. Discussion is more important than paperwork. So I'm going to send this to the lab for analysis. All right. How are you doing? Yes, it's fine. Well, we didn't torture you too much? So, wait before getting up because a little bit of water has spilled. OK.
Anne will help you and then I will prepare a short report for you and we will do a short summary afterwards. OK. What would you say to people watching this video who want to become obstetrician-gynecologists? Don't do that. They need to be motivated. We need to motivate them. You won't be able to sleep at night. Well, that's the positive side, the positive side is you won't be replaced by a piti cat. It's manual labor. There is a robustness to artisanal trades, but that's true for plumbing, it's true for just about everything. There is no problem with the meaning of the activity. That's when you wake up in the morning, you know what you're going to do.
It's very simple, isn't it? If we have managed to do what was necessary at the right time and everyone is doing well, there is a baby for example to motivate them. Is it well paid? Is it paid enough? Yes, yes, if we look at it on the scale of the French population, we earn a very good living. But you still have to consider that we work 24 hours straight, we work at night, we work on public holidays, it's an overwhelming responsibility, it's very stressful. You have to work all the time because you have to constantly update your skills. So it's not a relaxing job at all. If people's goal in life is to make money for the sake of making money, I definitely advise them against doing that.
Becoming an Instagrammer or influencer is simpler. You can speculate on the stock market, whatever you want. For women who have endometriosis, or for their loved ones, if they want to know more, how can they do so? So, I advise them to turn to the patient associations endommind and endofance which have done a great job for almost 15 years. We were starting from scratch with regard to endometriosis. They did this work with doctors who supported and helped them to raise awareness of this disease at the ministry level, at the highest level, so that things could change. And there have been a huge number of results. Now, there are other steps to come. The work is not finished. Once these young people and slightly older women
have a diagnosis of endometriosis, they need to know who to turn to, how to live with this disease, how to get follow-up care, and so this is the work of what we call support networks that are put in place. So it's a network across the territory so that each patient knows where to go, which doctor she should see, in which structure, which hospital so that she knows what her personalized care is. Thank you very much anyway. Good luck with the rest of the shift.
