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Master Thesis

Facteurs prédictifs du pH au cordon à la naissance

Abstract : Context: The occurrence of a low pH in the delivery room remains a difficult event to predict, and is associated with many factors related to patient characteristics, terms of labor and delivery practices. Sometimes it’s difficult to distinguish a physiological response of fetal adaptation from a true fetal distress which would scrutinize second line or fast extraction. Objective: Identifying risk factors in ante and intrapartum associated with low cord pH at birth and integrate them into a predictive model of this pH, in seeking to improve the obstetric management of potentially at-risk patients, thus potentially reduce the risk of fetal acidosis and associated neonatal complications. Materials and Methods: This is a descriptive, retrospective, monocentric study performed on the population of Louis Mourier Hospital, Level III maternity hospital in Colombes. The population was selected according to the pH at birth, distributed into 10 slices pH, holding the final 195 files. We sought to identify the perinatal factors predictive of neonatal acidosis, analyze the 195 ERCF and integrate them into a predictive model of this pH. Results: This study identified risk factors associated with decreased pH in univariate analysis: nulliparity, instrumental vaginal delivery, meconium amniotic fluid, abnormal fetal heart pattern during labor (as classified by CNGOF), and expulsive efforts (according to Gilstrap classification), suspicion of IUGR (Intrauterine growth restriction) and <10th percentile birth weight. Conditional logistic regression analysis was used to control significant risk factors (p <0.2) and was found as independent predictive factors of neonatal pH: abnormal fetal cardiac pattern of type 1,2 and 3 during phase 2 of work, periodic slowdown type FHR, bradycardia 90-110 / min, bradycardia <90min during expulsive efforts. The duration of RCF abnormalities was correlated significantly with pH. The multiple linear equation containing variables having obtained p <0.2 during the multivariate analysis had a value of R² in 0.44 (p<0.0001). The pH was correctly predicted in 77% of cases. Conclusion: This study allowed to create one of the first models predictive of the pH based essentially on the FHR. Other variables remain to identify to improve it.
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Olga Malai. Facteurs prédictifs du pH au cordon à la naissance. Gynécologie et obstétrique. 2018. ⟨dumas-02483355⟩

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