[A look into the past: improves in obstetrical and neonatal outcome in maternity since the 19th century]. / Un regard dans le passé : évolution du devenir materno-fœtal en maternité depuis le xixe siècle.

OBJECTIVE: Evaluate changes in obstetrical and neonatal outcome of women who delivered in maternity hospital since the 19(th) century. MATERIALS AND METHODS: Data from a historic cohort of 1022 women who delivered between 1871 and 1874 in the hôtel Dieu hospital of Marseille were compared to those from 1159 women who delivered from 2005 to 2006 in the level 3 maternity of Nord hospital of Marseille (contemporary cohort). Deliveries that had occured before 22 weeks and/or with a foetal birth weight of less than 500 g were excluded. RESULTS: A total of 2131 pregnancies were included: 1011 and 1120 in historic and contemporary cohort, respectively. Despite comparable mean term of delivery, mean birth weight of neonates from historic cohort were significantly lower: 2971 g (550-4900 g) vs 3250 g (500-5375 g), respectively (p<0.001). Stillbirths were reported in 72 (7.1%) cases in historic cohort compared to nine (0.8%) in contemporary cohort (p<0.001). Neonatal mortality was 3.7% in historic cohort and 1.9% in contemporary cohort (p=0.012). A total of 99 (9.8%) maternal deaths were reported in historic cohort, while none in contemporary cohort (p<0.001). A wide majority of maternal deaths were caused by maternal infection (72.9%); 5.2% were caused by postpartum haemorrhage. CONCLUSION: Our results illustrate the tremendous impact on maternal and neonatal outcome of advances in obstetrical management. The significant increase in the median foetal birth weight is likely to be related to wide changes in environmental conditions and behaviour.

[Modality of fetal heart monitoring during labor (continuous or intermittent), telemetry and central fetal monitoring]. / Surveillance foetale continue ou discontinue, télémétrie et centrale d'analyse.

Fetal heart monitoring during labor is almost systematic today. Continuous monitoring decreases neonatal convulsions, but increases caesarean section and forceps deliveries without impact on long term neonatal prognosis. Overall, there is no proved impact of cardiac fetal monitoring (continuous or intermittent) on perinatal mortality. The most recent study shows neonatal benefits of continuous monitoring associated with an overall increase of caesarean section rate. Continuous fetal monitoring has a better sensitivity to detect acidosis. Many arguments for continuous fetal monitoring will be reported in this review. In specific conditions, intermittent fetal auscultation can be realised, but in current practice such conditions can rarely be applied. Telemetry has been poorly evaluated to date but experiences are currently undertaken. Central fetal monitoring does not improve neonatal issue but could increase caesarean section rate. Central of fetal monitoring could help in the organisation and the conservation of fetal heart monitoring.

[Comparative evaluation of the Joel-Cohen cesarean section versus the transrectal incision]. / Etude prospective comparative entre les techniques de césarienne de Joël-Cohen et de Mouchel.

OBJECTIVE: The aim of this study was to compare the Joel-Cohen method for cesarean section to the traditional transrectal incision. METHOD: Fifty-two patients requiring a caesarean section were enrolled in this prospective study. Overall morbidity and post-operative pain was assessed. Four surgeons participated to this study, each included 13 patients. The main judgement criterion was post-operative pain on the first day. RESULTS: Post-operative pain on the first day was less important (50 vs 23% p=0.04) in Joel-Cohen's. This method was shorter compared to the transrectal incision (33.6+6.4 min vs 51.2+8 min p<0.0001). There was no difference in overall morbidity between the two groups. CONCLUSION: Joel-Cohen's method decrease post-operative pain and is a shorter procedure compared to the transrectal incision.