Comparaison des protocoles de maturation cervicale, à Port-Royal et Robert Debré, chez les patientes nullipares à partir de 41 SA
Abstract
Port-Royal and Robert Debré maternity wards: a comparison of cervical ripening protocols in nulliparous women at 41 weeks gestation or beyond.
The benefit of cervical ripening in labor induction has been demonstrated many times. But there are few studies evaluating the impact of the length of induction on maternal and neonatal outcomes. We have conducted a retrospective comparative study about maternal and neonatal outcomes in nulliparous women who were ripened at or beyond 41 weeks gestation at Port-Royal (N=147) and Robert Debré (N=145) maternity wards from 2007 to 2011. Differences observed on maternal and neonatal issues are the consequences of variations in the way of managing labor and delivery. C-section rate is increased when the length of cervical ripening is more than 24 hours (p=0,02) and remains the same for PPH (p=0,04). No evidence of an impact on Neonatal outcomes was found. We found no benefit in increasing the length of cervical ripening beyond 24 hours. An upscale study must be performed to precise the interest of increasing the length of cervical ripening to enhance spontaneous delivery rate.
The benefit of cervical ripening in labor induction has been demonstrated many times. But there are few studies evaluating the impact of the length of induction on maternal and neonatal outcomes. We have conducted a retrospective comparative study about maternal and neonatal outcomes in nulliparous women who were ripened at or beyond 41 weeks gestation at Port-Royal (N=147) and Robert Debré (N=145) maternity wards from 2007 to 2011. Differences observed on maternal and neonatal issues are the consequences of variations in the way of managing labor and delivery. C-section rate is increased when the length of cervical ripening is more than 24 hours (p=0,02) and remains the same for PPH (p=0,04). No evidence of an impact on Neonatal outcomes was found. We found no benefit in increasing the length of cervical ripening beyond 24 hours. An upscale study must be performed to precise the interest of increasing the length of cervical ripening to enhance spontaneous delivery rate.
Si le bénéfice de la maturation cervicale dans le cadre du déclenchement du travail, à partir de 41 SA est reconnu, peu d'études ont évalué l'impact de la durée de la phase de maturation sur les issues maternelles et néonatales. C'est la raison pour laquelle nous avons réalisé une étude rétrospective comparative des issues maternelles et néonatales chez les patientes nullipares ayant bénéficié d'une maturation cervicale à partir de 41 SA à Port Royal (N=147) et Robert Debré (N=145) entre 2007 et 2011. Les différences observées sur les issues maternelles et néonatales sont le fruit de variations dans le mode de prise en charge du travail et de l'accouchement. Le taux de césariennes est augmenté quand la durée de maturation dépasse 24 heures (p=0,02) ainsi que le taux d'HPP (p=0,04). L'état néonatal n'est pas affecté par la durée de maturation. Nous n'avons pas mis en évidence dans notre série un bénéfice à prolonger la phase de maturation au-delà de 24 heures. Une évaluation sur un plus grand échantillon permettrait de mieux déterminer les intérêts d'une prolongation de la phase de maturation sur la voie d'accouchement.
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