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Master Thesis

Comparaison de deux politiques de prise en charge en cas de rupture prématurée des membranes à terme avec un col défavorable

Abstract : Introduction and Objective : Premature rupture of the membranes (PROM) at term occurs in approximatively 8% of pregnancies. Two managements are possible: early induction of labor or expectant management. Our objective was to evaluate if the policy chosen for the delay before induction in cases of premature rupture of the membranes at term with an unfavourable cervix is associated with materno-fetal morbidity. Matérial and méthods : We conducted an observational retrospective study, com-paring the policies of two maternity units: la Pitié-Salpêtrière (maternity A), with an interventionist policy (induction after 12 hours), and Port-Royal (maternity B), with an expectant policy (up to 48 hours). Inclusion criteria were a single pregnancy with PROM from 37 weeks gestation and an unfavourable cervix at admission. The pri-mary outcome was the frequency of cesarean section, and secondary outcomes were early-onset sepsis, neonatal admission to neonatal intensive care unit and postpartum endometritis. We compared maternal and neonatal characteristics be-tween the two maternity units and we assessed the association between the center policy and the primary outcome using univariate and multivariate logistics regres-sions. Results : We included 298 patients (119 in the maternity A and 179 in the maternity B). The frequency of cesarean section was 12,6% and 12,8% in maternities A and B, respectively (p=0,95). Expectant management was not associated with a decrease risk of cesarean section (adjusted odds ratio = 1.0 [95% confidence interval 0.4-2.3]). There was no association between expectant management and early-onset sepsis, neonatal admission to neonatal intensive care unit, or postpartum endometritis. Conclusion : In cases of PROM at term with an unfavourable cervix, expectant management is not associated with a decrease frequency of the cesarean section, nor with increased maternal or neonatal infectious morbidity.
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https://dumas.ccsd.cnrs.fr/dumas-03251438
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Submitted on : Monday, June 7, 2021 - 10:04:45 AM
Last modification on : Sunday, June 13, 2021 - 3:25:01 AM

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Déborah Belhassen. Comparaison de deux politiques de prise en charge en cas de rupture prématurée des membranes à terme avec un col défavorable. Gynécologie et obstétrique. 2018. ⟨dumas-03251438⟩

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