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Le type de poussée et la position maternelle pendant le 2e stade du travail ont-ils un impact sur les issues obstétricales ou néonatales ?

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42es Journées nationales de la Société Française de Médecine Périnatale (Montpellier 17–19 octobre 2012)

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Résumé

L’objectif principal de ce travail était d’évaluer la sécurité maternelle et néonatale des positions verticales comparée aux positions dites « classiques » en décubitus dorsal, durant le 2e stade du travail (volet 1). L’objectif secondaire était de déterminer la sécurité maternelle et néonatale selon le type de poussée (glotte ouverte ou fermée), durant le 2e stade du travail (volet 2).

Matériels et méthodes. Nous avons recherché les méta-analyses et les essais randomisés sur le sujet. Nous avons sélectionné les articles publiés entre 1999 et 2011, pour le volet 1, et de 1980 à 2011 pour le volet 2.

Résultats. (Volet 1) Dans la métaanalyse de Gupta, les issues maternelles montrant une différence statistiquement significative entre le groupe expérimental « positions verticales ou en décubitus latéral » et le groupe « dorsal quel qu’il soit » étaient les extractions instrumentales qui étaient diminuées dans le groupe expérimental (OR = 0,8 ; IC 95 % : 0,69–0,92) et les hémorragies immédiates du postpartum (HPP) qui étaient augmentées dans le groupe expérimental (OR = 1,63 ; IC 95 % : 1,29–2,05). Concernant les issues néonatales, on ne pouvait conclure. (Volet 2) Il n’y a pas eu de différence statistiquement significative concernant les issues maternelles. Pour les issues néonatales, les différences observées variaient selon les auteurs.

Conclusion : les études posent des problèmes méthodologiques. Par ailleurs, la compliance aux positions maternelles assignées ou aux types de poussées était médiocre. Les HPP sont plus fréquentes dans les positions verticales. Les études sont à poursuivre, notamment pour étudier les issues néonatales.

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Authors and Affiliations

  1. Pôle de gynécologie-obstétrique et Reproduction humaine, CHU de Clermont-Ferrand, 1, place Lucie-Aubrac, 63000, Clermont-Ferrand, France

    F. Vendittelli

  2. AUDIPOG Faculté de médecine, RTH Laennec, Lyon, France

    F. Vendittelli

  3. EA 4681, PEPRADE, Clermont Université Université d’Auvergne, Clermont-Ferrand, France

    F. Vendittelli

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Vendittelli, F. (2013). Le type de poussée et la position maternelle pendant le 2e stade du travail ont-ils un impact sur les issues obstétricales ou néonatales ?. In: 42es Journées nationales de la Société Française de Médecine Périnatale (Montpellier 17–19 octobre 2012). Springer, Paris. https://doi.org/10.1007/978-2-8178-0385-2_12

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  • DOI: https://doi.org/10.1007/978-2-8178-0385-2_12

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