[Caesarean section at full dilatation: What are the risks to fear for the mother and child?] / Césarienne à dilatation complète : quels sont les risques à craindre pour la mère et l'enfant ?

OBJECTIVES: Caesarean section is associated with increased maternal morbidity compared to a vaginal delivery, especially if it occurs during labour. Little data on caesarean section performed at full dilatation is available. METHODS: This was a retrospective study done in University Hospital of type 3 over a period of ten years, including future primiparous patients who had a caesarean section performed at full dilatation, compared to a control group of patients whose caesarean section was conducted in first part of the labour. We collected different maternal data per- and postoperative and neonatal. RESULTS: In total, 824 patients were enrolled including 412 in each group. For caesarean section at full dilatation, foetal extraction required more manoeuvres (RR=3.05; 95% CI: 2.1; 4.39; P<0.001); we noted more extension of hysterotomy (RR=1.79; 95% CI: 1.30; 2.46; P<0.001). Postoperative and neonatal maternal morbidity was not different, except more frequent neonatal trauma for caesarean section at full dilatation. CONCLUSION: A caesarean section at full dilatation has an excess intraoperative risk and requires great caution. Nevertheless, no significant increase of postoperative and neonatal complications can be proved.

[Preterm breech before 35 weeks of gestation: What is the influence of the delivery route on neonatal condition?]. / Sièges prématurés avant 35 semaines d'aménorrhée: quelle influence de la voie d'accouchement sur l'état néonatal ?

OBJECTIVE: The mode of delivery for preterm breech is still controversial, while no randomized study has been completed. The question of a protective effect of cesarean section on neonatal outcome arises. The objective of this study was to compare mortality and neonatal morbidity for children born before 35 weeks of gestation in breech presentation, depending on the route of delivery. METHODS: This was a retrospective study done in University Hospital type 3 over five years, comparing neonatal mortality and different neonatal morbidity criteria for children born between 25 weeks of gestation and 34 weeks+6 days spread into two groups according to their mode of delivery: elective caesarean section before labor and vaginal delivery. Statistical analysis was performed with an adjustment for gestational age and weight of the newborn. RESULTS: No significant difference between the two groups was found with regard to neonatal mortality. Among the various morbidity criteria studied, only the head entrapment rate and serious traumatic injury occurrence were significantly increased in the "intent to vaginal delivery" group. pH at birth and Apgar scores at five minutes were not significantly different between the two groups. CONCLUSIONS: This work shows an increased risk of traumatic complications for vaginal delivery with no increase in other neonatal complications. It seems reasonable in this particular context to allow an attempt at vaginal delivery on condition of strict compliance with safety regulations relating to breech delivery.