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Master Thesis

Particularités des rythmes cardiaques fœtaux à l’expulsion des présentations podaliques comparées aux présentations céphaliques : étude de cohorte rétrospective sur trois ans, dans deux maternités des Alpes-Maritimes.

Abstract : Objective: the objective of this study is to access fetal heart rate patterns during expulsion of breech presentations compared to vertex presentations and their distribution by Melchior’s classification.
Methods: this was a retrospective bicentric study, including vaginal deliveries of singleton fetuses, born alive and in term in breech presentation between 2018 and 2020.Maternal, labor, delivery, post-partum and newborn characteristics were noted in a breech presentation group and in a vertex presentation group.
Results: 228 mothers and newborns were included, 114 in the breech presentation group and 114 in the vertex presentation group. Distribution of fetal heart rate (FHR) is broadly similar in both groups (p = 0.34) but we find a majority of Melchior’s type 0 for the vertex presentations (22% vs 13%, p = 0.08) and a majority of Melchior’s type 1 for the breech presentations (52% vs 45%, p = 0.22), with a decrease of the variability for the breech fetus (12% vs 6%, p = 0.10). Neonatal results were significantly less favourable for breech presentations with more neonatal resuscitation (24% vs 3%, p < 0.001), respiratory distress (21% vs 3%, p < 0.001), pH < 7,15 (21% vs 4%, p < 0.001) and lactates ≥ 5 (42% vs 27%, p = 0.02), but without any increase of neonatology transfer (5% vs 2%, p = 0.45) or morbi-mortality in the long-term.
Conclusion: even if the Melchior’s type repartition is not significant between the both presentations, there is more abnormal heart rate patterns with a moderate risk of acidosis in the breech presentation. However, it seems possible to tolerate this type of fetal heart rate pattern during expulsion of breech presentation subject to close monitoring. Melchior’s expulsion FHR types seem to be applicable for breech presentation.
Document type :
Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03560710
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Submitted on : Monday, February 7, 2022 - 4:53:25 PM
Last modification on : Saturday, March 26, 2022 - 3:26:21 AM
Long-term archiving on: : Sunday, May 8, 2022 - 7:09:45 PM

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  • HAL Id : dumas-03560710, version 1

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Anne-Lise Hernigou. Particularités des rythmes cardiaques fœtaux à l’expulsion des présentations podaliques comparées aux présentations céphaliques : étude de cohorte rétrospective sur trois ans, dans deux maternités des Alpes-Maritimes.. Médecine humaine et pathologie. 2021. ⟨dumas-03560710⟩

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