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Master Thesis

Évaluation de l'association entre âge gestationnel et morbidité maternelle sévère des césariennes dans le contexte de la prématurité

Abstract : Background: Survival of preterm infants born between 22 and 28 weeks of gestation (weeks) has increased these last decades worldwide. The improvement of survival of these extremely preterm infants is related to development of neonatal proactive management, and to active antenatal care such as caesarean delivery in case of foetal indications. Preterm caesarean delivery rates have regularly increased and particulary before 26 weeks. Objective: The aim of the study is to evaluate if the risk of Severe Maternal Morbidity (SMM) of preterm caesarean delivery is associated with lower gestational age. Study design: We performed an observational retrospective cohort in two tertiary university hospitals in Marseille (France) between January and December 2018. We included all mothers of preterm infants born by caesarean delivery between 22 and 34 weeks. The principal endpoint, Severe Maternal Morbidity (SMM), was a composite outcome defined as the occurrence of at least one of the following complications: classical uterine incision, postpartum haemorrhage defined by blood loss ≥ 500 mL, blood transfusion, any injury of adjacent organs, unplanned procedure/return to theatre, Intensive Care Unit (ICU) stay more than 24 hours, postpartum fever, eclampsia, or death. Results: During the study period, 252 women were included. SMM occurred in 89 (35.3%) cases. Gestational age was independently associated with SMM (adjusted Odds Ratio [aOR] 0.87; 95% Confidence Interval [CI] 0.78-0.97, p=0.01). The other variables statistically associated with SMM were type of pregnancy with a negative association with twin pregnancy (aOR, 0.44; 95% CI, 0.20-0.93), and with general anaesthesia (aOR, 2.52; 95% CI, 1.25-5.13). Conclusion: Our study showed that gestational age is independently and negatively associated with SMM of preterm caesarean delivery between 22 and 34 weeks. These results should encourage reflection and teamwork between neonatologists and obstetricians to improve agreement and shared-decision making process with parents.
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Delphine Sirgant. Évaluation de l'association entre âge gestationnel et morbidité maternelle sévère des césariennes dans le contexte de la prématurité. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02515146⟩



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