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Master Thesis

Prématurité spontanée ou induite : quelle influence sur l'avenir du nouveau-né ?

Abstract : Objective : To assess the influence of the mode of delivery ("induced" or "spontaneous") on the outcome of preterm births. Settings and Method : A retrospective study was conducted at the University Hospital of Angers from January 1st, 2007 until December 31st, 2008. The data concerning preterm births between 28 and 33 postmenstrual weeks were collected from the maternal and paediatric files and from the medical follow-up of the children (Grandir Ensemble network). Results : Out of 188 preterm births, 105 (53%) occurred "spontaneously" and 83 (47%) by an induced labour or delivery. The 2 groups did not differ significantly according to the maternal age, birth weight or gestational age. The main causes (70%) in the "induced" group were IUGR, pre-eclampsia and placental abruption; in this group, a C section was performed in 98% (vs 38% in the"spontaneous"group). The overall mortality rate was 1.6% (1 death in the delivery room for each group). An Apgar score at 1 minute ≤7 was more frequent in the "induced" delivery group (55% vs 36%, p<0.05) tending to show adaptation problems at birth. This difference was not significant for the Apgar score at 5 mn (28% vs 20%). In the same way, respiratory support was required more frequently in this group (CPAP : 79% vs 61 %, p<0.05 ; mechanical ventilation : 38% vs 32%, NS) although the rate of ante natal corticotherapy was higher (90% vs 78%, p<0.05). Concerning long-term follow-up (n=120), the average corrected-age for sitting (9 months) and walking (15 months) showed no difference between the 2 groups, even though the incidence of cerebral palsy was higher in the "spontaneous" group (19% vs 14%, NS). The statistics are nevertheless encouraging : the fact that 76% ("induced group") and 73% ("spontaneous group") of premature babies have no developmental delay at 2 years suggests that valid decisions are being made regarding the mode of delivery.

Conclusion : The mode of delivery seems to have consequences on the follow-up of the preterm baby. Larger prospective studies are needed to help obstetricians choose "the right way to give birth".

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Submitted on : Thursday, December 2, 2010 - 4:38:25 PM
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Pauline Fournier. Prématurité spontanée ou induite : quelle influence sur l'avenir du nouveau-né ?. Gynécologie et obstétrique. 2010. ⟨dumas-00542470⟩

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