Revue de médecine périnatale

, Volume 1, Issue 1, pp 61–65 | Cite as

Les pratiques médicales lors de l’accouchement: comparaison France-Canada

Et Chez Vous, C’Est Comment ? / How is it Dealt with in Your Country?
  • 66 Downloads

Résumé

L’objectif de cet article est de comparer les pratiques obstétricales entre la France et le Canada et d’évaluer l’éventuel impact de ces différences sur la santé maternelle et périnatale. Nous avons plus particulièrement comparé les pratiques lors du deuxième stade du travail non compliqué. Les recommandations françaises proposent de limiter la durée totale du deuxième stade à deux heures et de limiter la durée des efforts expulsifs à trente minutes, alors que cette limite n’est pas proposée au Canada. En France, on recommande le monitorage fœtal continu pendant le travail, alors que l’auscultation intermittente est conseillée, sous certaines conditions, au Canada. La pratique d’une épisiotomie est encore beaucoup plus fréquente en France qu’au Canada, bien que les deux pays recommandent une utilisation restrictive de cette intervention. Enfin, le nombre et le rôle des sages-femmes sont très différents entre les deux pays, avec une intégration beaucoup plus importante des médecins et des sages-femmes en France et une autonomie complète des sages-femmes au Canada.

Mots clés

Accouchement Efforts expulsifs Surveillance fœtale Épisiotomie 

Medical practice during delivery: a comparison between France and Canada

Abstract

The purpose of this article is to compare the obstetric practices current in France and Canada and evaluate the possible impact of these differences on maternal and perinatal health. We compared more particularly the practices during the second stage of uncomplicated labor. French recommendations advise limiting the total duration of the second stage to two hours and the duration of active pushing to 30 minutes, whereas no limit is recommended in Canada. In France, continuous fetal monitoring during labor is recommended, whereas intermittent auscultation is advised, in certain cases only, in Canada. Episiotomies are still performed much more frequently in France than in Canada, although the two countries recommend a restricted use of this intervention. Finally, the number and role of midwives are very different in the two countries, physicians and midwives working together much more in France, whereas midwives enjoy total autonomy in Canada.

Keywords

Delivery Pushing efforts Fetal monitoring Episiotomy 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Références

  1. 1.
    Naime-Alix AF, Fourquet F, Sigue D, et al (2008) How long can we wait at full dilatation. A study of maternal and neonatal morbidity related to the duration of the second stage of labour in nulliparous women. J Gynecol Obstet Biol Reprod (Paris) 37(3):268–275Google Scholar
  2. 2.
    Cargill YM, MacKinnon CJ, Arsenault MY, et al (2004) Guidelines for operative vaginal birth. J Obstet Gynaecol Can 26(8):747–761PubMedGoogle Scholar
  3. 3.
    Cheng YW, Hopkins LM, Caughey AB (2004) How long is too long: Does a prolonged second stage of labor in nulliparous women affect maternal and neonatal outcomes? Am J Obstet Gynecol 191(3):933–938PubMedCrossRefGoogle Scholar
  4. 4.
    Janni W, Schiessl B, Peschers U, et al (2002) The prognostic impact of a prolonged second stage of labor on maternal and fetal outcome. Acta Obstet Gynecol Scand 81(3):214–221PubMedCrossRefGoogle Scholar
  5. 5.
    Menticoglou SM, Manning F, Harman C, Morrison I (1995) Perinatal outcome in relation to second-stage duration. Am J Obstet Gynecol 173(3 Pt 1):906–912PubMedCrossRefGoogle Scholar
  6. 6.
    Moon JM, Smith CV, Rayburn WF (1990) Perinatal outcome after a prolonged second stage of labor. J Reprod Med 35(3):229–231PubMedGoogle Scholar
  7. 7.
    Myles TD, Santolaya J (2003) Maternal and neonatal outcomes in patients with a prolonged second stage of labor. Obstet Gynecol 102(1):52–58PubMedCrossRefGoogle Scholar
  8. 8.
    Saunders NS, Paterson CM, Wadsworth J (1992) Neonatal and maternal morbidity in relation to the length of the second stage of labor. Br J Obstet Gynaecol 99(5):381–385PubMedGoogle Scholar
  9. 9.
    Altman MR, Lydon-Rochelle MT (2006) Prolonged second stage of labor and risk of adverse maternal and perinatal outcomes: a systematic review. Birth 33(4):315–322PubMedCrossRefGoogle Scholar
  10. 10.
    Fraser WD, Marcoux S, Krauss I, et al (2000) Multicenter, randomized, controlled trial of delayed pushing for nulliparous women in the second stage of labor with continuous epidural analgesia. The PEOPLE (Pushing Early Or Pushing Late with Epidural) Study Group. Am J Obstet Gynecol 182(5):1165–1172PubMedCrossRefGoogle Scholar
  11. 11.
    Vause S, Congdon HM, Thornton JG (1998) Immediate and delayed pushing in the second stage of labour for nulliparous women with epidural analgesia: a randomised controlled trial. Br J Obstet Gynaecol 105(2):186–188PubMedGoogle Scholar
  12. 12.
    Maresh M, Choong KH, Beard RW (1983) Delayed pushing with lumbar epidural analgesia in labor. Br J Obstet Gynaecol 90(7):623–627PubMedGoogle Scholar
  13. 13.
    Gleeson NC, Griffith AP (1991) The management of the second stage of labour in primipara with epidural analgesia. Br J Clin Pract 45(2):90–91PubMedGoogle Scholar
  14. 14.
    Fitzpatrick M, Harkin R, McQuillan K, et al (2002) A randomised clinical trial comparing the effects of delayed versus immediate pushing with epidural analgesia on mode of delivery and fecal continence. BJOG 109(12):1359–1365PubMedCrossRefGoogle Scholar
  15. 15.
    Hansen SL, Clark SL, Foster JC (2002) Active pushing versus passive fetal descent in the second stage of labor: a randomized controlled trial. Obstet Gynecol 99(1): 29–34PubMedCrossRefGoogle Scholar
  16. 16.
    Plunkett BA, Lin A, Wong CA, et al (2003) Management of the second stage of labor in nullipara with continuous epidural analgesia. Obstet Gynecol 102(1):109–114PubMedCrossRefGoogle Scholar
  17. 17.
    Menez-Orieux C, Linet T, Philippe HJ, Boog G (2005) Delayed versus immediate pushing in the second stage of labor for nulliparous parturients with epidural analgesia: a meta-analysis of randomized trials. J Gynecol Obstet Biol Reprod (Paris) 34(5):440–447Google Scholar
  18. 18.
    Recommandations pour la pratique clinique: modalités de surveillance fœtale pendant le travail (2007) In: 31es Journées nationales du Collège national des gynécologues-obstétriciens français. ParisGoogle Scholar
  19. 19.
    Le Ray C, Audibert F (2008) Duration of pushing in labor: literature review. J Gynecol Obstet Biol Reprod (Paris) 37(4):325–328Google Scholar
  20. 20.
    Schaal JP, Dreyfus M, Bretelle F, et al (2008) Length of pushing efforts: pushing is not playing. Reply to the article of C. Le Ray and F. Audibert. J Gynecol Obstet Biol Reprod (Paris) 37(7):715–723 [[ Epub 2008 Sep 20 ]]Google Scholar
  21. 21.
    Liston R, Crane J, Hughes O, et al (2002) Fetal health surveillance in labor. J Obstet Gynaecol Can 24(4):342–355PubMedGoogle Scholar
  22. 22.
    Alfirevic Z, Devane D, Gyte GM (2006) Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labor. Cochrane Database Syst Rev 3: CD006066Google Scholar
  23. 23.
    Gupta JK, Hofmeyr GJ (2004) Position for women during second stage of labor. Cochrane Database Syst Rev (1): CD002006Google Scholar
  24. 24.
    Brement S, Mossan S, Belery A, Racinet C (2007) Delivery in lateral position. Randomized clinical trial comparing the maternal positions in lateral position and dorsal position for the second stage of labor. Gynecol Obstet Fertil 35(7–8):637–644PubMedCrossRefGoogle Scholar
  25. 25.
    Graham ID, Graham DF (1997) Episiotomy counts: trends and prevalence in Canada, 1981–1982 to 1993–1994. Birth 24(3):141–147PubMedCrossRefGoogle Scholar
  26. 26.
    Fritel X, Pigné A (1997) La controverse sur l’épisiotomie ou faut-il continuer à prévenir les déchirures périnéales ? In: 27e Journée nationale de médecine périnatale. VichyGoogle Scholar
  27. 27.
    Graham ID, Carroli G, Davies C, Medves JM (2005) Episiotomy rates around the world: an update. Birth 32(3):219–223PubMedCrossRefGoogle Scholar
  28. 28.
    Carroli G, Belizan J (2000) Episiotomy for vaginal birth. Cochrane Database Syst Rev (2):CD000081Google Scholar
  29. 29.
    CNGOF (2006) Episiotomy: recommendations of the CNGOF for clinical practice (December 2005) Gynecol Obstet Fertil 34(3):275–279CrossRefGoogle Scholar
  30. 30.
    Klein MC (1995) Episiotomy results stand despite lack of compliance. CMAJ 153(12):1708–1710PubMedGoogle Scholar
  31. 31.
    Fenner DE, Genberg B, Brahma P, et al (2003) Fecal and urinary incontinence after vaginal delivery with anal sphincter disruption in an obstetrics unit in the United States. Am J Obstet Gynecol 189(6):1543–1549 (Discussion 1549–1550)PubMedCrossRefGoogle Scholar
  32. 32.
    Kudish B, Blackwell S, McNeeley SG, et al (2006) Operative vaginal delivery and midline episiotomy: a bad combination for the perineum. Am J Obstet Gynecol 195(3):749–754PubMedCrossRefGoogle Scholar
  33. 33.
    Rodriguez A, Arenas EA, Osorio AL, et al (2008) Selective versus routine midline episiotomy for the prevention of third- or fourth-degree lacerations in nulliparous women. Am J Obstet Gynecol 198(3):285.e1–e4PubMedGoogle Scholar
  34. 34.
    Fritel X, Schaal JP, Fauconnier A, et al (2008) Pelvic floor disorders four years after first delivery: a comparative study of restrictive versus systematic episiotomy. BJOG 115(2):247–252PubMedCrossRefGoogle Scholar
  35. 35.
    Langer B, Minetti A (2006) Immediate and long-term complications of episiotomy. J Gynecol Obstet Biol Reprod (Paris) 35(Suppl 1):1S59–1S67Google Scholar
  36. 36.
    Sheiner E, Levy A, Walfisch A, et al (2005) Third degree perineal tears in a university medical center where midline episiotomies are not performed. Arch Gynecol Obstet 271(4):307–310PubMedCrossRefGoogle Scholar
  37. 37.
    Aytan H, Tapisiz OL, Tuncay G, Avsar FA (2005) Severe perineal lacerations in nulliparous women and episiotomy type. Eur J Obstet Gynecol Reprod Biol 121(1):46–50PubMedCrossRefGoogle Scholar
  38. 38.
    Coats PM, Chan KK, Wilkins M, Beard RJ (1980) A comparison between midline and mediolateral episiotomies. Br J Obstet Gynaecol 87(5):408–412PubMedGoogle Scholar
  39. 39.
    Sooklim R, Thinkhamrop J, Lumbiganon P, et al (2007) The outcomes of midline versus mediolateral episiotomy. Reprod Health 4:10PubMedCrossRefGoogle Scholar
  40. 40.
    Janssen PA, Ryan EM, Etches DJ, et al (2007) Outcomes of planned hospital birth attended by midwives compared with physicians in British Columbia. Birth 34(2):140–147PubMedCrossRefGoogle Scholar
  41. 41.
    Blondel B, Supernant K, Du Mazaubrun C, Breart G (2006) Trends in perinatal health in France between 1995 and 2003: results from the National Perinatal Surveys. J Gynecol Obstet Biol Reprod (Paris) 35(4):373–387Google Scholar
  42. 42.
    Hodnett ED, Gates S, Hofmeyr GJ, Sakala C (2007) Continuous support for women during childbirth. Cochrane Database Syst Rev (3):CD003766Google Scholar

Copyright information

© Springer 2009

Authors and Affiliations

  1. 1.Département d’obstétrique-gynécologie, CHU Sainte-Justineuniversité de MontréalMontréalCanada
  2. 2.Maternité de Port-Royal, hôpital Cochin-Saint-Vincent-de-Pauluniversité Paris-Descartes, Assistance publique-Hôpitaux de ParisParisFrance

Personalised recommendations