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Master Thesis

L’amniotomie au cours du travail spontané à terme : respect des protocoles et des recommandations pour la pratique clinique à la maternité de Port-Royal

Abstract : Background: in 2016, according to the national perinatal survey conducted in France by INSERM and DRESS, the rate of amniotomy during spontaneous labour is estimated at 41.4 %. This practice is frequent and involves a number of risks. It should therefore not be made common practice and should be performed following a precisely established obstetrical indication. Objectives: to determine the proportion of amniotomies performed during spontaneous labour in accordance with the French National Authority for Health recommendations and or the clinical protocols of the Port-Royal maternity hospital. To describe the characteristics of labour during amniotomy and to define the determinants that may influence its achievement. To compare maternal and neonatal outcomes according to compliance with recommendations and/or internal protocols. Method : we conducted a quantitative, observational, unicentric, retrospective, chart-based study of professional practice. We included low-risk obstetric women in spontaneous labour at term with a single fetus in cephalic presentation who had benefited from artificial rupture of the membranes. Our study concerns women who gave birth between January 1st 2019 and December 31st 2019 at the Port- Royal maternity hospital. Results: our population was composed of 595 patients, i.e. 22.25 % of amniotomies during spontaneous low-risk labour. The majority of amniotomies were performed before 5 cm (54.8 %). In 74.4 % of cases the amniotomy was not in accordance with the protocols and recommendations for the clinic. In the active phase of labour, the proportion of non-compliant amniotomies was significantly higher (p<0.001). The rate of non-compliant amniotomy was significantly increased in multiparous women. (p=0,002). The total duration of labour was significantly longer in primiparous women who had a compliant amniotomy (p<0.001). Obtaining the midwifery diploma more than ten years ago appears to be a determinant associated with non-compliance (p=0.020). Non-compliance of amniotomy did not result in any significant difference in maternal and neonatal outcomes. Conclusion: in light of the rate of non-compliance observed, it seems essential to make teams aware of the protocols and recommendations of good practice in order to respect the physiology of spontaneous labour and to respond to the requests of parturients.
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Submitted on : Friday, September 24, 2021 - 12:19:15 PM
Last modification on : Friday, August 5, 2022 - 2:50:25 PM


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Marine Kouri. L’amniotomie au cours du travail spontané à terme : respect des protocoles et des recommandations pour la pratique clinique à la maternité de Port-Royal. Gynécologie et obstétrique. 2021. ⟨dumas-03353759⟩



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