RESUMEN
OBJECTIVE: To assess professional practices of prolonged and post-term pregnancies in accordance to French guidelines. The secondary outcome was to evaluate neonatal and maternal morbidity during prolonged pregnancy. METHODS: Descriptive retrospective study was conducted in the 23 maternity hospitals of perinatal network between September and December 2018. The inclusion criterion was a birth term of≥41+0 weeks of gestation. Primary outcome was conformity to the national guidelines based on 10 items (conformity score≥80%). The secondary outcome was a composite criteria of neonatal morbidity (ventilation, resuscitation and/or Apgar score<7 at 5minutes) and maternal morbidity (obstetrical anal sphincter injury and/or postpartum hemorrhage). RESULTS: A total of 596 patients were included and the conformity was obtained in 65.3% of cases. Inconsistent criteria were amniotic fluid evaluation by the deepest vertical pocket (46.8%, n=279), and information of patients on prolonged pregnancy management (14.8%, n=88). Adverse perinatal outcome occurred for 40 newborns (6.0%) with shoulder dystocia (OR=5.2; CI 95%: 1.4-19.7) as a principal risk factor. Maternal morbidity outcome occurred in 70 cases (10.6%) primarily with increase in labour duration (OR=1.1 by hour of labour; CI 95%: 1.02-1.24) and prior caesarian section (OR=4.4; CI 95%: 1.8-11.0). CONCLUSIONS: Management of prolonged and post-term pregnancies matching with the French national guidelines. Points of improvement are amniotic fluid evaluation at term by a single deepest vertical pocket, and the information about induction of labour at term.
Asunto(s)
Trabajo de Parto , Hemorragia Posparto , Embarazo Prolongado , Cesárea , Femenino , Humanos , Recién Nacido , Embarazo , Embarazo Prolongado/epidemiología , Embarazo Prolongado/terapia , Estudios RetrospectivosRESUMEN
OBJECTIVES: Evaluate the incidence of perinatal mortality and evaluate the percentage of non optimal care management of fatal pregnancies between 2005 and 2011 in the Rhone-Alpes region in France, by the use of the Aurore network. Evaluate the development of morbi-mortality revues (MMR) in this region. METHODS: Retrospective study of perinatal mortality in the Aurore network, from 2005 to 2011. Systematic analysis of care management (adapted, non adapted, non evaluable), of each perinatal death that occurred in the Aurore network, by a multidisciplinary committee during regional MMR. RESULTS: The incidence of perinatal mortality has diminished from 2005 to 2011 (8,4 vs. 6,4, P<0.07) as well as the percentage of non adapted care management (13% vs. 5,6%, P<0.001). An underestimation of irregularities in the fetal heart rate was described in 34% of per partum deaths. The percentage of optimal care management was significantly higher when the obstetrician was in the maternity rather than on call at home (P<0.03) and in type 3 maternities compared to type 1 and 2 maternities (P<0.04). The attendance of the MMR organized in the AURORE network progressed between 2006 and 2011. CONCLUSION: Since 2005, a decrease in perinatal mortality and in non-adapted care management was observed. More studies are necessary to evaluate the link between the development of MMR in this network and the amelioration of these two indicators.
Asunto(s)
Redes Comunitarias/organización & administración , Educación , Maternidades/organización & administración , Mortalidad Perinatal , Complicaciones del Embarazo , Calidad de la Atención de Salud , Redes Comunitarias/normas , Educación/organización & administración , Educación/normas , Femenino , Francia/epidemiología , Implementación de Plan de Salud , Maternidades/normas , Humanos , Incidencia , Recién Nacido , Morbilidad , Embarazo , Complicaciones del Embarazo/epidemiología , Complicaciones del Embarazo/prevención & control , Calidad de la Atención de Salud/normas , Calidad de la Atención de Salud/tendencias , Estudios RetrospectivosRESUMEN
OBJECTIVES: French policy in terms of screening for Down Syndrome has been modified in 2010. It is presently based on combined screening based on maternal age, serum markers, and ultrasound measurement of fetal nuchal translucency between 11 and 13+6 weeks of gestation. The objective of this study was to observe the consequences of this new policy on the professional practices, using as example the professionals working in the healthcare network (Perinat 92-Sud). MATERIALS AND METHODS: A semi-quantitative survey was conducted between December 2010 and April 2011. A questionnaire on screening for Down Syndrome in the first trimester was sent to 110 ultrasound professionals performing on the territory of the network. RESULTS: Seventy-eight sonographers returned the questionnaire. Among them, 73.1% of sonographers who answered had an identifying number required for Down syndrome screening in France. Practitioners engaged in a private or mixed private/public practice or those over 40years had more often an identifying number. Among sonographers who do not have identifying number, 55% said they will perform an evaluation of professional practices, including a majority of hospital practitioners. CONCLUSION: The implementation of evaluations of professional practices brings the focus on perinatal networks. It modified the organization of the network Perinat 92-Sud and required the creation of a sonographer network.