[Neonatal issues and duration of expulsive efforts: Observationnal data in 138 French maternity units]

Autor: Le Ray, Camille, Winer, Norbert, Dreyfus, Michel, Audibert, François, Goffinet, François
Přispěvatelé: Recherche Epidémiologique en Santé Périnatale et Santé des Femmes et des Enfants ( UMR_S 953 ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université Paris Descartes - Paris 5 ( UPD5 ) -Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Université Paris-Sud - Paris 11 ( UP11 ), Maternité Port-Royal [CHU Cochin], CHU Cochin [AP-HP]-Assistance publique - Hôpitaux de Paris (AP-HP), Service d'obstétrique-gynécologie [Nantes], Centre hospitalier universitaire de Nantes ( CHU Nantes ), Service de Gynécologie - Obstétrique et médecine de la reproduction [Caen], CHU Caen, Département d'Obstétrique Gynécologie, Université de Montréal-CHU Sainte Justine [Montréal], Direction de la recherche clinique de l'AP-HP (PHRC 2001), INSERM U 149 (Recherches Épidémiologiques en Santé Périnatale et Santé des Femmes), Collège National des Gynécologues et Obstétriciens Français, Société Française de Médecine Périnatale, Fonds National de la Recherche Scientifique (Belgique)., Recherche Epidémiologique en Santé Périnatale et Santé des Femmes et des Enfants (UMR_S 953), Université Paris-Sud - Paris 11 (UP11)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre hospitalier universitaire de Nantes (CHU Nantes), Service de Gynécologie-Obstétrique et Médecine de la Reproduction [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Université de Montréal (UdeM)-CHU Sainte Justine [Montréal], Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Descartes - Paris 5 (UPD5)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Université Paris-Sud - Paris 11 (UP11), Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)
Jazyk: francouzština
Rok vydání: 2009
Předmět:
durée des efforts expulsifs
Time Factors
MESH: Asphyxia Neonatorum
MESH : Prospective Studies
MESH: Pregnancy
MESH: Practice Guidelines as Topic
Pregnancy
primipares à bas risque
MESH : Apgar Score
MESH : Female
Prospective Studies
Asphyxia Neonatorum
Labor
Obstetric
MESH: Infant
Newborn
MESH : Extraction
Obstetrical
[ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie
Extraction
Obstetrical
MESH : Adult
MESH : Practice Guidelines as Topic
MESH: Young Adult
Practice Guidelines as Topic
MESH: Hospitals
Maternity
Female
France
MESH : Time Factors
Adult
MESH : Young Adult
Hospitals
Maternity
MESH : Infant
Newborn
Young Adult
Humans
MESH : France
MESH: Humans
MESH : Hospitals
Maternity
MESH: Time Factors
MESH : Humans
Infant
Newborn
MESH: Adult
MESH: Labor
Obstetric
MESH: Prospective Studies
MESH: Apgar Score
MESH: France
MESH : Pregnancy
MESH : Labor
Obstetric
Apgar Score
[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie
MESH : Asphyxia Neonatorum
MESH: Female
MESH: Extraction
Obstetrical
état néonatal
Zdroj: Journal de Gynécologie Obstétrique et Biologie de la Reproduction
Journal de Gynécologie Obstétrique et Biologie de la Reproduction, Elsevier Masson, 2010, 39 (4), pp.297-304. 〈10.1016/j.jgyn.2010.03.010〉
Journal de Gynécologie Obstétrique et Biologie de la Reproduction, 2010, 39 (4), pp.297-304. ⟨10.1016/j.jgyn.2010.03.010⟩
Journal de Gynécologie Obstétrique et Biologie de la Reproduction, Elsevier Masson, 2010, 39 (4), pp.297-304. ⟨10.1016/j.jgyn.2010.03.010⟩
ISSN: 1773-0430
0368-2315
DOI: 10.1016/j.jgyn.2010.03.010〉
Popis: In agreement with national guidelines published in 2007, limiting duration of expulsive efforts to 30 minutes is a common obstetrical practice in France. In many other countries, there is no fixed limit for pushing duration. The objective of our work is to analyze mode of delivery and neonatal issues according to duration of expulsive efforts.It is a secondary analysis of an observational prospective study, among low-risk primiparous women, in 138 French maternity units. According to duration of expulsive efforts, we determined proportions of spontaneous and instrumental vaginal deliveries. Then, we analyzed the risk of neonatal asphyxia (defined by pHor=7.10 and/or 5-minute Apgar scoreor=7) according to duration of expulsive efforts, with stratification on mode of delivery.Three thousand three hundred and thirty low-risk primiparous women were included. Median duration of expulsive efforts was 15 minutes and 18.5 % (n=602) of women pushed more than 30 minutes. Among women with a duration of expulsive efforts longer than 30 minutes, 57 % had a spontaneous vaginal delivery. In our population, 1.4 % of neonates had an arterial pH at birthor=7.10 and 1.0 % a 5-minute Apgar scoreor=7. We found no association between duration of expulsive efforts and risk of neonatal asphyxia in the spontaneous delivery group (p=0.38) as well as in the instrumental delivery group (p=0.21). Moreover, we found no association between duration of expulsive efforts and adverse neonatal outcomes.In a context of adequate surveillance of the fetal well-being during labor, a duration of expulsive efforts longer than 30 minutes does not increase the risk of neonatal asphyxia or adverse neonatal outcomes. Expulsive efforts could be continue beyond 30 minutes in case of normal FHR.
Databáze: OpenAIRE
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