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Master Thesis

Patientes à bas risque obstétrical : accouchement en plateau technique en maternité de type I versus prise en charge classique en niveau III

Abstract : Introduction. - The first aim of this study was to confirm the hypothesis that a natural childbirth, with an independent midwife on a technical support, involves more probabilitiy of vaginal delivery without intervention compared to a classic care. The second aim was to compared the maternal and neonatal complications betwenn the two kind of nursing. Patients and method. - This cohot study included 162 patients in obstétrical low-risk. Results. - All parity aside, there is no significant difference regarding the delivery's outcome, (80,2% of spontaneous vaginal delivery in natural childbirth versus 69,1% in classic care). In naturel birth, there were signicant low rates of epidural analgesia (29,6% versus 86,4% p < 0,01), of systematic controlled placenta birth (18,7% versus 86,2% p < 0,001) but without any signicant difference related to the rate of ante partum hemorrhage (10% in both groups). There was no significant difference concerning neonatal state and neonatal transfer (3,7% in natural childbirth versus 4,9% in classic care). As regards primiparous women, in the natural childbirth groups, the rate of spontaneous vaginal delivery was signicantly higher (78,5% versus 46,1% p < 0,01), the rate of vaginal delivery with intervention was signicantly lower (9,5% versus 38,8% p < 0,01), as same as the episiotomy's rate (13,9% versus 53,3% p< 0,01). Conclusion. - For low-risk pregancy, a natural care during labour and delivery, with an independent midwife on a technical support does not involve more risk for the mother and the child.Quite the opposite, this kind of nursing brings best osbtétrical results, particularly concerning the delivery's outcome and the state of the perineum. As for the neonatal results, they seem to be not modified.
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Justine Pépin. Patientes à bas risque obstétrical : accouchement en plateau technique en maternité de type I versus prise en charge classique en niveau III. Médecine humaine et pathologie. 2016. ⟨dumas-01539699⟩

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