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Master Thesis

Interprétation du RCF et état néonatal : quels enjeux pour l'expulsion ?

Abstract : Context: Fetal heart rate monitoring (FHR) is the usual method of perpartum fetal evaluation. French recommendations advise limiting the duration of active pushing to 30 minutes and use Melchior's classification during expulsion. In Anglo-Saxon's countries, FIGO's classification is used during labor and no limit is recommended for expulsion. Objectives: To assess the correlation between FHR and neonatal outcomes comparing FIGO's and Melchior's classification, in order to determine what classification is more predictive for a low neonatal outcome and what situation could allow pushing more than 30 minutes. Materials and methods: 255 low risk primiparous women were included in a retrospective study conducted to Port-Royal's maternity ward. A low neonatal outcome was defined by at least one of the following criteria: 5-minute Apgar Score ≤7, cord blood pH ≤7.20, newborn resuscitation and admission in neonatal intensive unit care. Results: For the expulsion, FIGO's and Melchior's classifications were different. FIGO was more specific than Melchior's classification to predict a low neonatal outcome. Cord blood pH ≤7.20 was significantly correlated with the FHR's type and more associated with FIGO's classification (p< 0,001). The more abnormal the FHR was, the more cord blood pH ≤7.20 were raised. When pushing efforts were prolonged, cord blood pH ≤7.20 (p=0,08) and admission in neonatal intensive unit care (p=0,09) were increased. When the FHR was normal during the second stage of labor, low neonatal outcome was comparable even if the duration of active pushing was more than 30 minutes. 5-minute Apgar Score ≤7 and newborn resuscitation were similar as regards the FHR's type, the classification and the duration of active pushing. Conclusion: FIGO's classification is more predictive than Melchior's classification for a low neonatal outcome and should be preferred to interpret the FHR during the expulsion. FHR's abnormalities may be an important risk factor of a low neonatal outcome. When the FHR is normal during the entire second stage of labor, women could push more than 30 minutes. But our results must be interpreted cautiously and need others studies to confirm it.
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  • HAL Id : dumas-00580521, version 1

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Delphine Lebon. Interprétation du RCF et état néonatal : quels enjeux pour l'expulsion ?. Gynécologie et obstétrique. 2010. ⟨dumas-00580521⟩

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