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Master Thesis

Évaluation des pratiques de la corticothérapie anténatale : étude rétrospective portant sur 307 patientes ayant accouché avant 32 semaines d'aménorrhées au CHU de bordeaux pendant 2 ans

Abstract : Objectives: to evaluate the protocol of Antenatal Corticosteroids (ACS) for fetal maturation in relation with the recommandations of CNGOF of 2016 which preconize a single course of ACS in situation at risk of preterm delivery. Method: retrospective unicentric study, between January 2017 and December 2018 at the Centre Aliénor d’Aquitaine, maternity hospital of the Bordeaux University Hospital, evaluating the rational policy of corticosteroids in patients who gave birth before 32 weeks of gestation, and more particularly in the situations at risk of extrem prematurity (24-26 weeks of gestation). The main outcome measure was the number of patients who delivered before 32 weeks of gestation without receiving corticosteroid therapy. The secondary outcomes were: -The proportion of patients who delivered in optimal timeframe after ACS, according to the term of admission, and to the medical indication. - The occurrence of complications related to preterm birth and survival at 6 months depending on time interval between antenatal corticosteroids and delivery Results: a total of 307 patients who delivered to live-born infants before 32 weeks of gestation were included in this study. The proportion of patients who received ACS was 93.5% (287/307), and only 6.5% (20/307) of the patients delivered without prior corticosteroid therapy. The unexposure of ACS was related either to a context of fetal abandon (decided by the couple), or to a short delay between admission and birth. Only an avoidable case is linked to a refusal of care by the patient. The rate of delivery within 24 hours after the ACS exposure was 27.7% (85/307). The birth rate between 24 hours and 7 days after the ACS administration, considered as optimal in the international literature, was 30.6% (94/307). Finally, 16,6% (51/307) of patients delivered 7 to 14 days after the first ACS administration and 17.3% (53/307) delivered more than 14 days after the ACS. In addition, 13% (40/307) of patients delivered between 24 and 26 weeks of gestation. Among them, 82,5% (33 /40) had recived ACS and 70% of these patients (28/40), delivered whtihn 7 days after ACS. Only 12.5% (5/40) delivered more than 7 days after the ACS, and none after 14 days. Conclusion: the improvment of ACS-administration in our center leads to a good rate of ACS-exposed newborn, without increasing the rate of ACS-unexposed infants.
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Submitted on : Thursday, February 27, 2020 - 4:23:58 PM
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Amaury Brot. Évaluation des pratiques de la corticothérapie anténatale : étude rétrospective portant sur 307 patientes ayant accouché avant 32 semaines d'aménorrhées au CHU de bordeaux pendant 2 ans. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02493268⟩

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