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Master Thesis

Évolution des voies d’accouchement des grossesses gémellaires (GG) à partir de 24 semaines d’Aménorrhée (SA) au CHUN

Abstract : Objectives: compare the delivery routes of twin pregnancies from 24 weeks of amenorrhea between two periods separated by the publication of the MODe D'Accouchement des Jumeaux (JUMODA) study, regardless of the presentation of the first twin (T1) and assess the criteria of morbi-neonatal mortality of the second twin (T2).
Method: retrospective unicentric cohort comparing women who gave birth to living twins from 24 weeks of amenorrhea between 2014-2015 and 2017-2018, matched on the type of presentation of J1, the scar uterus, the term and chorionicity.
Results: 274 patients were included after matching (n = 137 in each period). Between 2014-2015 and 2017-2018: The rate of scheduled caesarean (SC) tends to decrease (16.1% versus 8.8% p = 0.09) while the rate of vaginal attempt (RVA) increases (83, 9% versus 91.2% p = 0.1) whatever the presentation of J1 and the term. Among the SCs, 100% of the patients gave birth by the high way. Among RVAs, the rate of effective cesarean sections tends to decrease (50.4% versus 39.2% p = 0.09) regardless of the presentation of J1. The rate of effective bass pathway increases significantly (46.1% versus 60% p = 0.04) when T1 is in cephalic presentation from 32 weeks of amenorrhea and tends to increase when T1 is in non-cephalic presentation whatever the term. The attempted vaginal delivery tends to be associated with low morbidity-composite neonatal mortality on J2 from 32 weeks and does not decrease or increase before 32 weeks.
Conclusion: the evolution of professional practices as regards twin birth, between the two periods studied, seems to be influenced by the JUMODA study.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03206450
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Submitted on : Friday, April 23, 2021 - 12:11:50 PM
Last modification on : Friday, September 24, 2021 - 3:14:34 AM

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Gaëlle Michel. Évolution des voies d’accouchement des grossesses gémellaires (GG) à partir de 24 semaines d’Aménorrhée (SA) au CHUN. Médecine humaine et pathologie. 2020. ⟨dumas-03206450⟩

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