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Quel est le bénéfice d’une 3ème heure à dilatation complète sur le mode d’accouchement ?

Abstract : What is the benefit of delaying pushing by three hours after the diagnosis of full dilatation on the mode of delivery? Objective: the primary objective of this study was to assess the association between a protocol allowing delaying pushing up to three hours after the diagnosis of full dilatation and the mode of delivery. The secondary objective was to assess the association between a protocol allowing delaying pushing up to three hours after the diagnosis of full dilatation and maternal and neonatal morbidity. Methods: this retrospective study included low-risk primiparous women reaching full dilatation with a non-suspect fetal heart rate and delivering of a term singleton fetus in cephalic presentation, under epidural analgesia. Women were included if they had delivered between September and December 2016, in two Parisian maternity units, one having a protocol allowing delaying pushing up to three hours after the diagnosis of full dilatation (maternity A) and the other one allowing to delay pushing up to no more than two hours (maternity B). To evaluate the association between the protocol used and the mode of delivery, we performed univariate and multivariate logistic regression analyses to obtain crude and adjusted odds ratios. Results: the pre-existing characteristics, the pregnancy characteristics and the labor and delivery characteristics were comparable between the two maternity units. The average duration of the passive descent phase was higher in maternity A (3 hours at full dilatation protocol) than in maternity B (2 hours at full dilatation protocol) (p < 0,001). The women delivering in the maternity with a protocol allowing delaying pushing up to three hours after the diagnosis of full dilatation had significantly, and independently less risks of having an operative delivery (instrumental vaginal delivery and cesarean) compared to a protocol allowing no more than two hours of delayed pushing (ORa = 0,64; IC95% 0,43–0,96; p = 0,030). This association was principally due to a significant decrease of the instrumental vaginal deliveries with a protocol allowing delaying pushing up to three hours (ORa = 0,62; IC95% [0,40-0,95]; p = 0,030). There was no difference in the caesarian rate between both maternity units (p = 0,447). We did not identify any increase in maternal or neonatal morbidity associated with a protocol allowing delaying pushing up to three hours. Conclusion: this study showed a significant decrease in the operative deliveries, in particular in instrumental deliveries, with a protocol allowing delaying pushing up to three hours after the diagnosis of full dilatation when compared with a protocol allowing no more than 2 hours, without increasing the associated maternal or neonatal morbidity.
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Submitted on : Wednesday, August 29, 2018 - 2:48:08 PM
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Clara Rollet. Quel est le bénéfice d’une 3ème heure à dilatation complète sur le mode d’accouchement ? . Gynécologie et obstétrique. 2018. ⟨dumas-01864171⟩

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