Évaluation de l'influence potentielle des nouvelles définitions de la durée normale du travail et des dystocies sur le taux de césariennes : projection des recommandations pour la pratique clinique du CNSF de 2017 sur le taux de césariennes du Pôle Femmes-Parents-Enfants de l’AP-HM

Abstract : Introduction: The length of the labour is crucial and well-studied element for establishing the prognostic of the delivery. The 2017 recommendations of the National College of Midwives of France (CNSF) provide new definitions of ‘normal’ labour and dystocia that may impact indications of caesarean delivery. Objectives: To test the hypothesis that new CNSF recommendations will result in lower caesarean rates, this study projected those recommendations on caesarean deliveries done in 2015 at Public Assistance - Marseille Hospitals (AP-HM). Methods: We performed a retrospective, descriptive and comparative study enabling to generate assumptions regarding potential impact of new recommendations on caesarean delivery rates. We studied a population of women who underwent a caesarean delivery at AP-HM in 2015. We first categorized caesareans with Robson’s classification, then assessed the impact of the new recommendations on group 1 and 3 from this classification. Results: In total, 39 caesareans could have been avoided or delayed with the application of the new recommendations, which represents 25.7% of the caesareans from groups 1 and 3. If these caesareans did not occur, groups 1 and 3 contribution to total caesarean deliveries would have dropped from 12.8% to 9.8%. This would have led to a significant decrease (p=0.02) of caesareans rate in those groups. Conclusion: The projection of the application of the new recommendations on the caesarean of the AP-HM in 2015 shows a potential decrease of the rate of caesarean delivery, leading to more than a quarter decrease on groups concerned by the new recommendations.
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Élise Pêtre. Évaluation de l'influence potentielle des nouvelles définitions de la durée normale du travail et des dystocies sur le taux de césariennes : projection des recommandations pour la pratique clinique du CNSF de 2017 sur le taux de césariennes du Pôle Femmes-Parents-Enfants de l’AP-HM. Gynécologie et obstétrique. 2018. ⟨dumas-01957635⟩

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