Single-session visuospatial task procedure to prevent childbirth-related posttraumatic stress disorder: a multicentre double-blind randomised controlled trial.

Preventive evidence-based interventions for childbirth-related posttraumatic stress disorder (CB-PTSD) are lacking. Yet, 18.5% of women develop CB-PTSD symptoms following an unplanned caesarean section (UCS). This two-arm, multicentre, double-blind superiority trial tested the efficacy of an early single-session intervention including a visuospatial task on the prevention of maternal CB-PTSD symptoms. The intervention was delivered by trained maternity clinicians. Shortly after UCS, women were included if they gave birth to a live baby, provided consent, and perceived their childbirth as traumatic. Participants were randomly assigned to the intervention or attention-placebo group (allocation ratio 1:1). Assessments were done at birth, six weeks, and six months postpartum. Group differences in maternal CB-PTSD symptoms at six weeks (primary outcomes) and six months postpartum (secondary outcomes) were assessed with the self-report PTSD Checklist for DSM-5 (PCL-5) and by blinded research assessors with the Clinician-administered PTSD scale for DSM-5 (CAPS-5). Analysis was by intention-to-treat. The trial was prospectively registered (ClinicalTrials.gov, NCT03576586). Of the 2068 women assessed for eligibility, 166 were eligible and 146 were randomly assigned to the intervention (n = 74) or attention-placebo control group (n = 72). For the PCL-5, at six weeks, a marginally significant intervention effect was found on the total PCL-5 PTSD symptom count (ß = -0.43, S.E. = 0.23, z = -1.88, p < 0.06), and on the intrusions (ß = -0.73, S.E. = 0.38, z = -1.94, p < 0.0525) and arousal (ß = -0.55, S.E. = 0.29, z = -1.92, p < 0.0552) clusters. At six months, a significant intervention effect on the total PCL-5 PTSD symptom count (ß = -0.65, S.E. = 0.32, z = -2.04, p = 0.041, 95%CI[-1.27, -0.03]), on alterations in cognition and mood (ß = -0.85, S.E. = 0.27, z = -3.15, p = 0.0016) and arousal (ß = -0.56, S.E. = 0.26, z = -2.19, p < 0.0289, 95%CI[-1.07, -0.06]) clusters appeared. No group differences on the CAPS-5 emerged. Results provide evidence that this brief, single-session intervention carried out by trained clinicians can prevent the development of CB-PTSD symptoms up to six months postpartum.

The Potential Role of Wearable Inertial Sensors in Laboring Women with Walking Epidural Analgesia.

There is a growing interest in wearable inertial sensors to monitor and analyze the movements of pregnant women. The noninvasive and discrete nature of these sensors, integrated into devices accumulating large datasets, offers a unique opportunity to study the dynamic changes in movement patterns during the rapid physical transformations induced by pregnancy. However, the final cut of the third trimester of pregnancy, particularly the first stage of labor up to delivery, remains underexplored. The growing popularity of "walking epidural", a neuraxial analgesia method allowing motor function preservation, ambulation, and free movement throughout labor and during delivery, opens new opportunities to study the biomechanics of labor using inertial sensors. Critical research gaps exist in parturient fall prediction and detection during walking epidural and understanding pain dynamics during labor, particularly in the presence of pelvic girdle pain. The analysis of fetal descent, upright positions, and their relationship with dynamic pelvic movements facilitated by walking during labor is another area where inertial sensors can play an interesting role. Moreover, as contemporary obstetrics advocate for less restricted or non-restricted movements during labor, the role of inertial sensors in objectively measuring the quantity and quality of women's movements becomes increasingly important. This includes studying the impact of epidural analgesia on maternal mobility, walking patterns, and associated obstetrical outcomes. In this paper, the potential use of wearable inertial sensors for gait analysis in the first stage of labor is discussed.

Glomerular diseases in pregnancy: pragmatic recommendations for clinical management.

Our understanding of the various aspects of pregnancy in women with kidney diseases has significantly improved in the last decades. Nevertheless, little is known about specific kidney diseases. Glomerular diseases are not only a frequent cause of chronic kidney disease in young women, but combine many challenges in pregnancy: immunologic diseases, hypertension, proteinuria, and kidney tissue damage. An international working group undertook the review of available current literature and elicited expert opinions on glomerular diseases in pregnancy with the aim to provide pragmatic information for nephrologists according to the present state-of-the-art knowledge. This work also highlights areas of clinical uncertainty and emphasizes the need for further collaborative studies to improve maternal and fetal health.

[Pregnancy and chronic renal failure: what is new in 2023?] / Grossesse et insuffisance rénale chronique : quelle prise en charge en 2023 ?

Chronic renal failure (CRF) during pregnancy increases the risk of fetomaternal complications such as preeclampsia, premature delivery and, above all, a deterioration of renal function. A multidisciplinary preconceptional assessment is necessary in this complex clinical situation. Progress in neonatal resuscitation and a better understanding of the pathophysiological mechanisms of autoimmune nephropathy have improved the prognosis of these high-risk pregnancies. This article provides an overview of the issues related to the follow-up of pregnant women with renal disease. It summarizes the glomerular and hemodynamic physiological changes during pregnancy, the fetal and maternal risk, and the adaptation of antihypertensive and immunosuppressive drug treatments.

La présence d'une insuffisance rénale chronique (IRC) lors d'une grossesse augmente le risque de complications fœto-maternelles, comme une prééclampsie, un accouchement prématuré et surtout une péjoration de la fonction rénale. Un bilan préconceptionnel multidisciplinaire permet d'optimiser une situation clinique complexe. Les progrès de la réanimation néonatale et une meilleure compréhension des mécanismes physiopathologiques des néphropathies auto-immunes permettent une amélioration du pronostic de ces grossesses à risque. Cet article donne une vue d'ensemble des problématiques liées au suivi des femmes enceintes souffrant d'une maladie rénale. Il résume les modifications physiologiques glomérulaires et hémodynamiques durant la grossesse, le risque fœto-maternel ainsi que l'adaptation des traitements médicamenteux antihypertenseurs et immunosuppresseurs.

Temporary cervical sling and uterine twist before B-Lynch for massive uterine bleeding after delivery.

Massive uterine bleeding occurring after delivery is in most cases unpredictable and can have fatal consequences. This article presents the technique of combining the twisting of uterus on a 90° rotation on its axis and positioning a sling around the cervix, allowing to decrease incoming blood flow from uterine and ovarian arteries. The aim of this easy-to-use procedure is to enable surgeons and anaesthesiologists to respectively ensure the presence of an experienced surgeon and to stabilise the haemodynamic of the patient. It is a modus operandi of particular interest in resources' challenged environments.

[Hypersensitivity reactions to intravenous iron: an allergist' perspective]. / Réactions d'hypersensibilité au fer intraveineux : le point de vue de l'allergologue.

Intravenous iron infusions rarely result in severe hypersensitivity reactions. The primary suspected hypersensitivity mechanism is an abnormal complement activation by non-IgE antibodies to the carbohydrate moieties stabilizing iron formulations. A major risk factor for hypersensitivity reactions is related to the infusion speed. Fishbane-like reactions usually resolve after pausing the infusion, which can be resumed under medical surveillance and at a lower infusion rate. Yet, anaphylactic reactions require emergency first aid and subsequent strict avoidance of intravenous iron. Desensitization protocols can be implemented in selected cases and under strict medical surveillance to reduce the risks of severe reactions upon re-exposure.

L'administration de fer intraveineux (IV) peut rarement se compliquer de réactions d'hypersensibilités sévères, parfois fatales. Le mécanisme supposé est celui d'une activation anormale du complément, possiblement liée à des anticorps non-IgE (immunoglobuline E) dirigés contre les groupements carbohydrates qui stabilisent la formulation de fer. Un débit de perfusion trop rapide est un facteur important de réaction d'hypersensibilité. En effet, les réactions légères se résolvent généralement après mise en pause de la perfusion, qui peut ensuite être reprise à un débit réduit. Les réactions anaphylactiques nécessitent en revanche un traitement d'urgence et une éviction stricte. Le recours à un protocole de désensibilisation sous surveillance médicale étroite permet, dans certaines situations, de limiter le risque de réaction lors d'une réadministration de fer IV.

[Trial of labour after c-section in 2022: a narrative review of the literature]. / Accouchement vaginal après une césarienne en 2022 : revue narrative de la littérature.

One in three women in Switzerland gives birth by c-section. This high incidence of c-section frequently exposes obstetricians and midwives to the management of women and their deliveries with a scarred uterus. The decision of couples is multifactorial, but the information that will be delivered by their gynaecologist will necessarily influence the delivery route choice. We propose to review the international recommendations and the literature on the subject, to provide the couple and the attending physician with elements of reflection to guide the choice of delivery route or to monitor adequately when attempting vaginal delivery after a caesarean section.

En Suisse, une femme sur trois donne naissance à son enfant par césarienne. Cette forte incidence de la césarienne expose régulièrement les obstétriciens et les sages-femmes à la gestion de femmes et de leur accouchement avec un utérus cicatriciel. La décision des couples est multifactorielle, mais l'information qui sera délivrée par leur gynécologue va nettement influencer le choix de la voie d'accouchement. Nous proposons ici de passer en revue les recommandations internationales et la littérature sur le sujet, afin de procurer les éléments de réflexion au couple et au médecin traitant afin de guider le choix de la voie d'accouchement et de monitorer adéquatement au cours d'une tentative d'accouchement par voie basse.

[Contribution of the use of virtual reality in childbirth: A narrative review of the literature]. / Apport de l'utilisation de la réalité virtuelle lors de l'accouchement - Revue narrative de la littérature.

The current use of virtual reality (VR) in medicine is expanding rapidly. This non-pharmacological option is increasingly proposed as primary or complementary/multimodal analgesic or anxiolytic management. The role of VR in obstetrics remains to be defined. We propose a narrative review of the literature on the role of VR in obstetrics during childbirth, which shows promise. If used properly, this technique could help improve the experience of childbirth.

L'usage actuel de la réalité virtuelle (RV) en médecine est en pleine expansion. Cette option non pharmacologique est de plus en plus proposée comme prise en charge antalgique ou anxiolytique principale ou complémentaire/multimodale. La place de la RV en obstétrique reste à définir. Nous proposons ici une revue narrative de la littérature sur la place de la RV en obstétrique lors de l'accouchement, qui se révèle prometteuse. Avec une utilisation bien encadrée, cette technique pourrait avoir sa place dans l'amélioration du vécu de l'accouchement.

Does the McRoberts' manoeuvre need to start with thigh abduction? An innovative biomechanical study.

BACKGROUND: Guidelines and description about the achievement of the McRoberts manoeuvre are discordant, particularly concerning the need for abduction before the beginning of the manoeuvre. We sought to compare the biomechanical efficiency of the McRoberts' manoeuvre, with and without thigh abduction. METHODS: In a postural comparative study, twenty-three gravidas > 32 weeks of gestational age and not in labour were assessed during three repetitions of two McRoberts' manoeuvre that differed in terms of starting position. For the (i) McRoberts, the legs were initially placed in stirrups; for the (m) McRoberts, the legs were resting on the bed, with thighs in wide abduction. For each manoeuvre, flexion of the plane of the external conjugate of the pelvis on the spine (ANGce), hip flexion and abduction, were assessed using an optoelectronic motion capture system. Lumbar curve were assessed with Epionics Spine® system. Temporal parameters including movement duration or acceleration of the external conjugate were also computed. All values ​​obtained for the two types of manoeuvres were compared using a Wilcoxon matched-pairs signed-ranks test. The significance level was defined as p < 0.05. RESULTS: The starting position of McRoberts' otherwise had no effect on the maximum ANGce (p = 0.199), the minimal lordosis of the lumbar curve (p = 0.474), or the maximal hip flexion (p = 0.057). The other parameters were not statistically different according to the starting position (p > 0.005). CONCLUSION: Regardless of the starting position, the McRoberts' manoeuvre allows ascension of the pubic symphysis and reduction of the lumbar lordosis. This results imply that the McRoberts' manoeuvre could be performed with the legs initially placed in the stirrups.

Early clindamycin for bacterial vaginosis in pregnancy (PREMEVA): a multicentre, double-blind, randomised controlled trial.

BACKGROUND: Preterm delivery during pregnancy (<37 weeks' gestation) is a leading cause of perinatal mortality and morbidity. Treating bacterial vaginosis during pregnancy can reduce poor outcomes, such as preterm birth. We aimed to investigate whether treatment of bacterial vaginosis decreases late miscarriages or spontaneous very preterm birth. METHODS: PREMEVA was a double-blind randomised controlled trial done in 40 French centres. Women aged 18 years or older with bacterial vaginosis and low-risk pregnancy were eligible for inclusion and were randomly assigned (2:1) to three parallel groups: single-course or triple-course 300 mg clindamycin twice-daily for 4 days, or placebo. Women with high-risk pregnancy outcomes were eligible for inclusion in a high-risk subtrial and were randomly assigned (1:1) to either single-course or triple-course clindamycin. The primary outcome was a composite of late miscarriage (16-21 weeks) or spontaneous very preterm birth (22-32 weeks), which we assessed in all patients with delivery data (modified intention to treat). Adverse events were systematically reported. This study is registered with ClinicalTrials.gov, number NCT00642980. FINDINGS: Between April 1, 2006, and June 30, 2011, we screened 84 530 pregnant women before 14 weeks' gestation. 5630 had bacterial vaginosis, of whom 3105 were randomly assigned to groups in the low-risk trial (n=943 to receive single-course clindamycin, n=968 to receive triple-course clindamycin, and n=958 to receive placebo) or high-risk subtrial (n=122 to receive single-course clindamycin and n=114 to receive triple-course clindamycin). In 2869 low-risk pregnancies, the primary outcome occurred in 22 (1·2%) of 1904 participants receiving clindamycin and 10 (1·0%) of 956 participants receiving placebo (relative risk [RR] 1·10, 95% CI 0·53-2·32; p=0·82). In 236 high-risk pregnancies, the primary outcome occurred in 5 (4·4%) participants in the triple-course clindamycin group and 8 (6·0%) participants in the single-course clindamycin group (RR 0·67, 95% CI 0·23-2·00; p=0·47). In the low-risk trial, adverse events were more common in the clindamycin groups than in the placebo group (58 [3·0%] of 1904 vs 12 [1·3%] of 956; p=0·0035). The most commonly reported adverse event was diarrhoea (30 [1·6%] in the clindamycin groups vs 4 [0·4%] in the placebo group; p=0·0071); abdominal pain was also observed in the clindamycin groups (9 [0·6%] participants) versus none in the placebo group (p=0·034). No severe adverse event was reported in any group. Adverse fetal and neonatal outcomes did not differ significantly between groups in the high-risk subtrial. INTERPRETATION: Systematic screening and subsequent treatment for bacterial vaginosis in women with low-risk pregnancies shows no evidence of risk reduction of late miscarriage or spontaneous very preterm birth. Use of antibiotics to prevent preterm delivery in this patient population should be reconsidered. FUNDING: French Ministry of Health.

In vivo assessment of the levator ani muscles using shear wave elastography: a feasibility study in women.

INTRODUCTION AND HYPOTHESIS: We hypothesized that shear wave elastography (SWE) technology might be useful for assessing the elastic properties of the pelvic floor in women. Our primary objective was to evaluate the feasibility of assessing the levator ani muscles using SWE in women. Our secondary aim was to investigate the changes in their elastic properties from rest to Valsalva maneuver. METHODS: During this prospective feasibility study in nonpregnant female volunteers, we collected data on participant age, body mass index (BMI), parity, and time since the delivery. The levator ani muscles of each participant were assessed using SWE technology at rest and during a Valsalva maneuver by measuring the shear modulus (in kilopascals). We then assessed the changes in the shear modulus at rest and during the Valsalva maneuver using a Wilcoxon test. RESULTS: Twelve parous women participated in this study. The mean time since the last delivery was 14 months, the mean age was 31 years, and mean BMI was 28 kg.m-2. All the assessments performed at rest were successfully completed, but we encountered two failures during the Valsalva maneuver. The mean shear modulus increased by a factor of more than 2 from rest to the Valsalva maneuver for both the right (16.0 vs 35.4 kPa) and left side (17.1 vs 37.6 kPa). CONCLUSIONS: An assessment of the elastic properties of the levator ani muscles is feasible for nonpregnant women. The reproducibility of the technique and its application in pregnant women and women with pelvic floor disorders must be investigated.

Is there an impact of feet position on squatting birth position? An innovative biomechanical pilot study.

BACKGROUND: The squatting birth position is widely used for "natural" birth or in countries where childbirth occurs in non-medical facilities. Squatting birth positions, like others, are roughly defined so a biomechanical assessment is required with the availability of noninvasive technology in pregnant women. In practice, we can observe spontaneously two kinds of squatting birth position: on tiptoes and with feet flat. OBJECTIVE: To compare the impact of foot posture on biomechanical parameters considered essential in obstetrical biomechanics during a squatting birth position: on tiptoes versus with feet flat on the floor. STUDY DESIGN: Thirteen pregnant women beyond 32 weeks of gestational age who were not in labor were assessed during squatting birth position firstly spontaneously and secondly with the foot posture that was not taken spontaneously (on the tiptoes vs with feet flat). For each position, ANGle of flexion on the spine of the plane of the pelvis external conjugate (ANGec), hip flexion and abduction, and lumbar curve were assessed using an optoelectronic motion capture system and a biomechanical model adapted from the conventional gait model as well as a measuring system of the lumbar curve. RESULTS: Spontaneously, 11 out of 13 women squatted on tiptoe at the first test. On tiptoes the hip flexion was lower than with feet flat (p < 0.02), whereas hip abduction was not significantly different (p = 0.28). A lower ANGec angle (p = 0.003) was noticed for the tiptoe position than feet flat. The lumbar curve (lordosis) was more marked for the squatting position on tiptoes than for the position with feet flat (p < 0.001). On tiptoes no woman had a pelvic inlet plane perpendicular to the spine and none had a flat back or kyphosis. No woman on tiptoes fulfilled the two conditions necessary for the position that we consider optimal. CONCLUSION: In squatting birth position, foot posture has a biomechanical impact on lumbar curve and pelvic orientation. When comparing squatting positions (on tiptoes vs feet flat), feet flat on the ground is closer to optimal birth conditions than on tiptoes.

Is increased peripheral ligamentous laxity in term pregnant women associated with obstetric anal sphincter injury?

INTRODUCTION AND HYPOTHESIS: Increased ligamentous laxity is associated with pelvic floor distension in pregnant women. This considered, it may also be related to the risk of obstetric anal sphincter injury (OASI). Our objective was to assess the association among increased ligamentous laxity, perineal tear severity, and OASI occurrence. METHODS: This is a prospective study. We assessed ligamentous laxity between the 36th week of pregnancy and the onset of labor, by measuring the passive extension of the nondominant index finger for a 0.26 N.m torque applied to the second metacarpophalangeal joint (MCP laxity). We collected perineal tear occurrence and classification (Royal College of Obstetricians and Gynecologists). We investigated the MCP laxity distribution according to the stage of perineal tears, and then we looked for a predictive level of MCP laxity for OASI. RESULTS: A total of 272 of the 300 pregnant women included had a vaginal delivery and were considered for the analysis. Mean age was 29 years, mean body mass index was 24.5 kg/m2 and 39.2% of women were nulliparous. We reported 12 cases of OASI. MCP laxity significantly increased with the stage of perineal tears from 58° in stage 0 to 69° and 66° for stages 3a and 3b respectively. An MCP laxity higher than 64° was associated with OASI with sensitivity of 75%, specificity of 56%, and an area under the curve of 0.65. CONCLUSION: Increased ligamentous laxity seems associated with OASI occurrence, which is the opposite of the initial hypothesis. This suggests that the stiffest tissues might be at a lower risk of injury.

[The breech comeback : implementation of a vaginal delivery protocol in the CHUV]. / Le retour du siège : mise en place d'un protocole d'accouchement par voie basse au CHUV.

Choosing between vaginal delivery and caesarean section in cases of breech presentation is still a matter of controversy. In this article, we present the Lausanne University Hospital's protocol following the introduction of an institutional vaginal breech delivery policy. Vaginal breech delivery is a viable alternative to caesarean section in the presence of an experienced obstetrician and rigorous patient-selection criteria.

Le choix entre un accouchement par voie basse et une césarienne reste controversé lors de présentation en siège. Nous présentons dans cet article le protocole de la Maternité du Centre hospitalier universitaire vaudois suite à l'introduction d'une politique favorisant les accouchements en siège. L'accouchement par voie basse du siège est désormais une alternative possible à la césarienne en présence d'obstétriciens expérimentés et de critères de sélection rigoureux des patientes.

Cultural adaptation of the female pelvic floor questionnaire (FPFQ) into French.

AIMS: The Female pelvic floor questionnaire (FPFQ) is a self-administered tool on pelvic floor function. Our aim was to carry out a cultural adaptation of the FPFQ into French and to assess its psychometric properties. METHODS: After cross-cultural adaptation into French, acceptability and reliability of the questionnaire were assessed through a sample of 56 women in a test-retest. Discriminative construct validity was evaluated by comparing the results obtained by the FPFQ to those of other validated questionnaires. Longitudinal follow-up of the 282 pregnant women included in the PreNatal Pelvic floor Prevention trial (3PN) was used to analyze responsiveness. RESULTS: The proportion of missing data did not exceed 4% for questions about bladder function, bowel function, and pelvic organ prolapse; 10% for issues related to sexual function. Question 9 was considered difficult to understand by 14% of women. After rewriting, this issue was retested in a new sample of 52 women and presented no further problems. The intra-class correlation coefficient was greater than or equal to 0.7 for all domains during the test-retest. The FPFQ was strongly and significantly correlated (Spearman r > 0.5) with the other validated questionnaires. The French version of FPFQ recorded changes in urinary and sexual symptoms for the women involved in 3PN trial with a standardized response mean equal to 0.83 and 0.44, respectively. CONCLUSION: The French version of the FPFQ is self-administered, reliable, valid, and can detect a change in symptoms during follow-up. Neurourol. Urodynam. 36:253-258, 2017. © 2015 Wiley Periodicals, Inc.

Is levator hiatus distension associated with peripheral ligamentous laxity during pregnancy?

INTRODUCTION AND HYPOTHESIS: The impact of pregnancy on pelvic floor disorders remains poorly understood. During pregnancy, an increase in ligamentous laxity and pelvic organ mobility is often reported. Our main objective was to investigate a possible association between peripheral ligamentous laxity and levator hiatus (LH) distension during pregnancy. METHODS: This was a prospective longitudinal study of 26 pregnant women followed up from the first to the third trimester. We collected the following information: occurrence of pelvic organ prolapse (POP) symptoms (score higher than 0 for the POP section of the Pelvic Floor Distress Inventory 20 questions score), 4D perineal ultrasound scan results with LH distension assessment and measurement of metacarpophalangeal joint mobility (MCP laxity). The association between MCP laxity and LH distension was estimated by mixed multilevel linear regression. The associations between MCP laxity and categorical parameters were estimated in a multivariate analysis using a generalized estimating equation model. RESULTS: MCP laxity and LH distension were correlated with a correlation coefficient of 0.26 (p = 0.02), and 6.8% of the LH distension variance was explained by MCP laxity. In the multivariate analysis, MCP laxity was associated with POP symptoms with an odds ratio at 1.05 (95% CI 1.01-1.11) for an increase of 1° in MCP laxity. CONCLUSION: LH distension and peripheral ligamentous laxity are significantly associated during pregnancy. However, the relationship is weak, and the results need to be confirmed in larger populations and with more specific techniques such as elastography to directly assess the elastic properties of the pelvic floor muscles.

[Evolution of cesarean section rates according to Robson classification in a swiss maternity hospital]. / Evolution du taux de césariennes dans une maternité universitaire suisse selon la classification de Robson.

We conducted a retrospective study was conducted in the Centre Hospitalier Universitaire Vaudois (CHUV) including all births between the 1st January 1997 and 31st December 2011 to analyze the cesarean section (CS) rate using the different groups of the Robson classification in a Swiss maternity hospital. The overall CS rate was 29 %, mainly related to group 5 (multiparous with previous CS) and group 2 (nulliparous women induced or who had CS before labor). The study also shows that induction of labor on maternal request in nulliparous at term (group 2a) increased significantly the risk of CS compared to induction of labor for medical reason (p<0.001). The Robson classification system appears as a simple tool for monitoring CS rates. The main strategies for reducing CS rates will be through better selection of women for VBAC (vaginal birth after caesarean) and limitation of induction of labor, especially in nulliparous women.

Afin d'analyser le taux de césariennes (CS) selon les différents groupes de la classification de Robson dans une maternité universitaire suisse, nous avons mené une étude rétrospective au Centre hospitalier universitaire vaudois (CHUV) incluant les accouchements survenus entre le 1er janvier 1997 et le 31 décembre 2011. Le taux global de CS s'élève à 29 %, principalement dans le groupe 5 (patientes avec antécédents de CS) et le groupe 2 (nullipares à terme provoquées ou ayant une CS élective). L'étude montre également que le déclenchement du travail sur demande maternelle chez la nullipare à terme (groupe 2a) augmente le risque de CS par rapport à une induction médicale (p < 0,001). La classification de Robson apparaît comme un outil simple d'évaluation et de surveillance des taux de CS. Limiter les inductions chez la nullipare et promouvoir la voie basse après CS pourraient constituer un point de départ pour infléchir le taux global de CS.