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Master Thesis

Accouchement avec contre-indication aux efforts de poussée

Abstract : Background: in women affected by pre-existing diseases, vigorous pushing efforts may be noxious because of Valsalva biophysical effect or even impossible to achieve due to maternal exhaustion. Method: retrospective consecutive series of 205 women from Caen and Paris in whom a vaginal delivery was planned. Results: there were 4 groups of medical conditions: cardiac (107), neurologic (72), pneumological (18) or other diseases (8). Each patient was affected to a pushing effort category: contra-indicated (68) or limited (137). Vaginal delivery occurred in 141 cases (68.8%). There were 64 C-sections: 17 prelabor (8.3%) of which 5 emergency cases, and 47 during labour (22.9%). There were 27 (13.2%) premature deliveries: 15 were elective (5 prelabour C-sections, 10 inductions of labour) and 12 were spontaneous preterm labour. 69 patients deliver spontaneously. There were 31 vacuum extractions and 41 forceps. The average duration of the expulsive efforts was 7 minutes (maximum 28 minutes), and the average duration of the active phase was 12 minutes. These durations were significantly shorter in the EECI group (respectively 1.2 and 9.3 min) than in the EEL group (respectively 9.3 and 13.1), p<0.05. Post-partum haemorrhage occurred in 12 cases (5.9%). The rate of episiotomy (22.7%) and vaginal tears (50.4%) was related to the high incidence of instrumental delivery. Apart from complications related to maternal general anaesthesia, of foetal exposure to maternal drugs, paediatric outcome was unremarkable. Conclusion: our results suggest that in selected cases, women affected by a significant medical condition can deliver a baby safely with minimal pushing efforts or no effort at all.
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Submitted on : Thursday, September 17, 2020 - 12:18:32 PM
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SALMON Capucine Gyn Obs.pdf
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Capucine Salmon. Accouchement avec contre-indication aux efforts de poussée. Médecine humaine et pathologie. 2020. ⟨dumas-02941774⟩



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