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Master Thesis

Mode d’accouchement des prééclampsies sévères entre 34 et 36 SA + 6 J : état néonatal et maternel

Abstract : Objective. To compare the neonatal and maternal outcomes of severe preeclampsia after labour induction or planned caesarean section between 34 0/7 and 36 6/7 weeks’ gestation.Material. This observational, retrospective, multi-center cohort study included singleton pregnant women with severe preeclampsia between 34 0/7 and 36 6/7 weeks’ gestation at Grenoble alpes french hospital university (CHUGA) and at Annecy genevois french hospital (CHANGE). The first objective of this study was a composite criterion of good neonatal outcomes (no need for mechanical ventilation > 24h, umbilical artery pH> 7.10, Apgar > 7 to 5 minutes, no convulsive seizure, no neonatal death). Statistical analysis was performed using Student t test, Chi2 analysis and Fisher exact test.Results. During 13 years at the CHUGA and 10 years at the CHANGE, 293 women manifested a preeclampsia between 34 0/7 and 36 6/7 weeks’ gestation. There was 141 eligible women for inclusion: 43 women had a planned caesarean section, 105 underwent labour induction, out of these 63 had a vaginal delivery and 42 required caesarean delivery. Planned caesarean section compared to labour induction was not associated with a better neonatal outcome (85% vs 77%, p=0,24). Labour induction was however associated with a decreased need for mechanical ventilation > 24H for new-borns (84% vs 95%, p=0.04). Conclusions. Delivery mode for women with severe preeclampsia at the late preterm is not consensual, and there are no recommendations to this date. Inducing labour reduces the number of caesareans section, improving long term obstetrical prognosis, and does not seem to endanger either mother or new-born. These results could prompt to reduce the number of planned caesareans sections when there are no critical signs of preeclampsia.
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Master Thesis
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Submitted on : Monday, October 28, 2019 - 11:24:40 AM
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Aliénor Moreau. Mode d’accouchement des prééclampsies sévères entre 34 et 36 SA + 6 J : état néonatal et maternel. Médecine humaine et pathologie. 2019. ⟨dumas-02335337⟩



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