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Master Thesis

Rupture prématurée des membranes à terme et conditions locales défavorables : comparaison de deux politiques de prise en charge (interventionniste versus expectative)

Abstract : Background: pre-labour rupture of the membranes (PROM) at term affects between 6 % and 19 % of all pregnancies. There are two policies for antenatal management: either an interventionist approach with planned early birth (which can be associated with an increased risk of caesarean section) or an expectative management (which can be associated with an increased risk of maternal and neonatal infectious morbidity). Objective: evaluate whether the management policy (expectant management vs planned early birth) for women with PROM and unfavourable cervix is associated or not with maternal-foetal morbidity. Materials and methods: we performed an observational retrospective study between May 2017 and April 2018, comparing two policies of care in two Parisian maternity units, la Pitié-Salpêtrière (with induction of labour after 12 hours of PROM) and Trousseau (with induction of labour after 48 hours of PROM). We included all the women that presented simultaneously: a PROM at term (≥ 37 SA) associated with an unfavourable cervix (Bishop < 6), a singleton foetus in cephalic presentation and a negative GBS vaginal swab. The primary outcome was caesarean section and secondary outcomes were the respective frequencies of early-onset neonatal sepsis and maternal infection (chorioamnionitis, post-partum endometritis). We compared maternal, foetal and neonatal characteristics and evaluated the association between the unit policy and the primary outcome using univariate and multivariate logistic regression models, obtaining crude and adjusted odds ratios (ORa) with 95 % confidence intervals (95%CI). Results: we included 281 patients, 105 in the “interventionist” maternity and 176 in the "expectant” maternity. The frequency of caesarean section was of 19.0 % in the “interventionist” maternity versus 13.6 % in the “expectant” maternity (p=0.23). An expectative management was not associated with a decrease of caesarean section (ORa = 0.80 95%CI [0.33-1.91]), and no statistical difference was observed concerning maternal and neonatal infections. Conclusion: in case of PROM at term with an unfavourable cervix, a policy of expectative management was not associated with a decrease of caesarean section nor with an increase of maternal and neonatal infectious morbidity.
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Mélissa Sahini. Rupture prématurée des membranes à terme et conditions locales défavorables : comparaison de deux politiques de prise en charge (interventionniste versus expectative). Gynécologie et obstétrique. 2019. ⟨dumas-02316426⟩

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