Skip to Main content Skip to Navigation
Master Thesis

Rupture des membranes à terme avant travail et conditions locales favorables.
Etude multicentrique comparant trois modes de prise en charge : déclenchement d’emblée, expectative 24h et expectative 48h

Abstract : Background: premature rupture of the membranes at term (PROM) is a frequent event. Its occurrence can lead to several complications, both maternal, fetal and neonatal. Approximately 25 percent of these patients have a favorable cervix at the time of admission to maternity. As there is no consensus on management, the identification of an optimal interval for the onset of labor that minimises obstetric and infectious risks appears to be a real challenge in this context. Materials and methods: we conducted a retrospective, multi-centered, observational study in three centers with different treatment policies: immediate induction (Robert Debré maternity), 24-hours expectation (Port-Royal maternity) or 48-hours expectation (Trousseau maternity). Our main judgment criterion was caesarean section by failure to induce. Our secondary endpoints were infectious maternal outcomes, infectious neonatal outcomes, and obstetrical outcomes related to oxytocin use. Our analyses were performed with intent to treat and then per-protocol. Main results: the rate of caesarean section by failure to rinduce was similar in all three groups. In case of expectation, the extension of this one beyond 24 hours did not increase the rate of spontaneous labour. Despite higher use of oxytocin at Robert Debré, related obstetrical consequences (uterine rupture, postpartum hemorrhage) were not more frequent compared with other centers. Moreover, the waiting period did not influence the infectious outcomes of the mother-child couple. Conclusion: this study did not allow us to identify an optimal management protocol to reduce maternal-fetal risks. On the other hand, though, the data in the literature does not recommend an expectation of more than 48 hours. The decision concerning the mode of management in the case of premature rupture of the membranes at term with favorable local conditions should therefore take into account the patient's wishes and the service constraints. Further researches are needed to conclude.
Complete list of metadata

https://dumas.ccsd.cnrs.fr/dumas-02936376
Contributor : Esf Upd <>
Submitted on : Friday, September 18, 2020 - 10:34:42 AM
Last modification on : Wednesday, June 2, 2021 - 4:26:06 PM

File

memoire_esfbaudelocque_Altunda...
Files produced by the author(s)

Licence


Distributed under a Creative Commons Attribution - NonCommercial - NoDerivatives 4.0 International License

Identifiers

  • HAL Id : dumas-02936376, version 1

Collections

Citation

Huda Altundag. Rupture des membranes à terme avant travail et conditions locales favorables.
Etude multicentrique comparant trois modes de prise en charge : déclenchement d’emblée, expectative 24h et expectative 48h. Gynécologie et obstétrique. 2020. ⟨dumas-02936376⟩

Share

Metrics

Record views

41

Files downloads

34