[Obstetrical prognosis of breech presentation admitted in advanced first stage of labour]. / Pronostic obstétrical de la présentation du siège en cas d'admission en travail avancé.

AIM: Fear of dystocia during breech delivery brings obstetrical teams to choose elective caesarean sections. However, some patients with breech presentations will be in labour before the date scheduled and caesarean delivery during labour increases maternal morbidity. Therefore, this situation raises the question about the relevance of labour trial for breech presentations admitted in labour. Our study aimed to determine the obstetrical prognosis of breech presentations on admission in the labour ward following their degree of cervical dilation. MATERIALS AND METHODS: We conducted an observational retrospective study on 213 single breech presentations at ≥37 gestational weeks that delivered at our level 3 labour ward between1st January 2007 and 30th July 2013. Maternal, obstetrical and neonatal factors were analyzed. RESULTS: The total caesarean rate during labour was 23.4% and significantly less important (P<0.05) in patients with cervical dilation ≥5cm on admission (14% vs. 27%). Apgar scores, cordonal arterial pH and lactates, rate of transfer to intensive care were not significantly different between the two groups. CONCLUSION: In our study, any patient with a breech presentation at an advanced stage of labour on admission is of very good prognosis, although statistical power is insufficient.

[Obstetrical prognosis of breech presentations with premature rupture of membranes at term]. / Pronostic obstétrical des présentations podaliques à terme en cas de rupture des membranes avant travail.

OBJECTIVES: Breech delivery is still a controversial situation in literature. Added complexity exists when breech presentations are associated with premature rupture of membranes (PROM) as such cases are conventionally excluded in studies dealing with PROM and are often indications for elective caesarean section. Thus, the objective of this study was to evaluate the obstetrical prognosis of breech presentations after PROM at term. MATERIALS AND METHODS: We conducted a retrospective observational study at the Besançon University Medical Centre, between 1(st) January 2008 and 31(th) December 2012. Two groups of patients with breech presentations at term were constituted according to the existence or not of a PROM. The primary endpoint was the delivery mode: caesarean section or vaginal. Other endpoints were maternal characteristics, type of onset of labour and neonatal criterias. RESULTS: Two hundred and nine patients were included. In the control group, 67.9 % of vaginal deliveries occurred versus 60 % in the group with PROM (P=0.25). No difference was found on neonatal criterias such as pH, lactate and the Apgar score at 5 minutes. CONCLUSION: PROM at term in breech presentation doesn't seem to change the obstetrical prognosis and should therefore not be a systematic indication for elective caesarean section.

[Evaluation of satisfaction after hysteroscopic tubal ligation. About a study from the CHU of Besançon]. / Évaluation de la satisfaction après stérilisation tubaire par voie hystéroscopique sans anesthésie. À propos d'une étude au CHU de Besançon.

OBJECTIVE: The Essure(®) system is a hysteroscopic sterilization method. The purpose of our study was to retrospectively evaluate the sterilization procedure with Essure(®) devices without anesthesia. PATIENTS AND METHODS: The descriptive study included all tubal sterilizations with Essure(®) devices performed without anesthesia, with MEOPA, from January 1st, 2013 till February 28th, 2014 in the CHU of Besançon. The evaluation of the global satisfaction of the patients was collected by telephone survey. RESULTS: A hundred and forty-three patients benefited from Essure(®) without anesthesia during the period of study in the CHU of Besançon and among them, 120 patients answered the telephone survey questionnaire. The average age was of 41.3 years. As regards the satisfaction and the tolerance, 89.2% of the patients declared to be globally satisfied by this procedure and 95.8% would recommend it to a friend. Indeed, 66.6% of the patients declared to have felt no pain or moderate pain. Furthermore, the MEOPA was well tolerated at 79.9% of the patients. As regards the procedure of Essure(®) inserts without anesthesia the rate of failure was 9.2% and at 3 months the radiological control was satisfactory in 94.5% of the patients. DISCUSSION AND CONCLUSION: The tubaire sterilization by implants Essure(®) is a fast and effective procedure. Our study shows, that at present, this technique can be realized without anesthesia, during a dedicated consultation, with an important rate of global satisfaction of the patients. It thus allows to decrease the number of hospitalization in ambulatory surgery and to decrease the cost of this intervention.

[Obesity and primiparity: Risky delivery?]. / Obésité et primiparité: accouchement à risque ?

OBJECTIVES: To evaluate the risk of materno-foetal complications in obese primiparous women (Body Mass Index (BMI)≥30) MATERIALS AND METHODS: A retrospective study was conducted in our tertiary referral labour ward from 1st January 2009 to 31st December 2010, including primiparous women delivering living cephalic singleton pregnancies after 37 weeks of amenorrhea. Two groups were compared: obese patients (BMI≥30) and non-obese (BMI<30). Obstetrical and neonatal data were collected. RESULTS: Among 1636 primiparous women, 132 (8%) had a BMI≥30. Induction of labor, prolonged pregnancy and post-partum hemorrhage were significatively more frequent in obese group (P<0.001). Those patients have an increased risk of cesarean section (P<0.001). Mean birth weight of newborns from obese mothers is significatively higher (3493g vs 3265g, P<0.001), as is the frequency of macrosomia (16.7% vs 5.2%, P<0.001). CONCLUSION: Obesity is associated with obstetrical complications in primiparous obese women, who are to be considered risky patients at their arrival in the labour ward, and specific obstetrical management must be planned to improve maternal and neonatal outcomes.

[Fetal heart rate patterns of breech presentations during expulsion. A comparative study with cephalic presentations]. / L'analyse du rythme cardiaque fœtal au cours de l'expulsion des présentations podaliques. Analyse comparative dans une maternité de niveau III.

INTRODUCTION: Expulsion upon vaginal delivery is a period at risk for the foetus, especially in case of breech presentation. In fact, monitoring the fetal well-being is complex in this phase. The correct interpretation of fetal heart rate (FHR) during expulsion, using Melchior's classification, is important because it helps screen for fetal acidosis. The aim of this study was to determine if it was possible to tolerate an abnormal FHR during expulsion of breech presentations. MATERIAL AND METHODS: A retrospective study was conducted to compare FHR during expulsion and neonatal results between breech and cephalic presentations at Besançon's university hospital. RESULTS: We collected data from 118 breech presentations and 236 cephalic presentations. Melchior's FHR classification types were significantly different between breech and cephalic presentations with a majority of type 1. Neonatal results were significantly less favorable for breech presentations, but without any increase in mortality and in severe morbidity. DISCUSSION AND CONCLUSION: Melchior's expulsion FHR classification seems to be applicable for breech presentations with a different distribution of FHR types compared to cephalic presentations. Following the results of this study, it seems to be possible to tolerate an abnormal FHR during expulsion of breech presentation, so far as is reasonable.

[Active management of the second twin for vaginal delivery: ruptured versus intact membranes. Apropos a series of 182 patients]. / Accouchement manœuvrier du deuxième jumeau: membranes rompues versus membranes intactes. À propos d'une série de 182 patientes.

AIM: The vaginal management of the second twin (T2) differs throughout our country. In 2009, the French National College of Gynecologists and Obstetricians released practice guidelines, with low-level evidence, encouraging active management of the second twin, using maneuvers with intact membrane. PATIENTS AND METHODS: In our level III labour ward, these maneuvers are systematically performed when the second twin is in a breech or transverse presentation and after ruptured membranes in most cases. We studied 182 twin pregnancies with active management of the T2 at more than 28 weeks of gestation, from 1st January 1996 to 31st December 2010, by comparing the membrane status during delivery of T2. RESULTS: The results did not show any significant differences between the two groups of patients concerning the neonatal or maternal results. The technique is feasible, even by residents. Our results show that total breech extraction of the second twin with ruptured membranes is feasible, which allows for reappraisal of the national recommendations. CONCLUSION: In our practice, it is possible to actively deliver the T2 with ruptured membranes without altering maternal and fetal prognosis and thus simplifying learning for young doctors.

[Delayed necrotizing fasciitis: a complication of stress incontinence surgery by suburethral sling]. / Fasciite nécrosante tardive : une complication de la chirurgie de l'incontinence urinaire par bandelette sous-urétrale.

We report a 50-year-old woman case with an extensive necrotizing fasciitis (NF). The NF appeared 10 years after a tension free vaginal tape procedure for urinary stress incontinence. Vital prognosis was engaged due to the initial sepsis severity. This kind of complication is rare and could be under estimated. NF usually appear soon after surgery, whatever within the year following implantation. Anyway, NF are always related to a vaginal erosion of the tape.

[Impact of a major decrease in the use of episiotomy on perineal tears in a level III maternity ward]. / Influence d'une forte diminution du recours à l'épisiotomie sur le taux global de périnée intact et peu lésionnel dans une population d'une maternité de niveau III.

OBJECTIVE: To evaluate the perineal outcome after a major decrease in episiotomy rate in a high-risk (level III) maternity ward. MATERIALS AND METHODS: This was a retrospective cohort study in a teaching high-risk maternity comparing perineal tears between 2003 and 2010. We included for analysis: pregnancies at 25 weeks or more, fetal birthweights of 500 g or more, vaginal deliveries in our maternity, singletons or multiple pregnancies, cephalic or breech presentations. RESULTS: The two populations were comparable. In 2003, we performed 18.8% of episiotomies and 1.3% in 2010. Between these years, our intact perineum rate increased from 28.8 to 37.5% (P<0.0001). We also report an increase in first and second degree perineum lesions (20.5% in 2003 and 40.2% in 2010, P<0.0001) and anterior perineal lesions (17.8% in 2003 and 30.3% in 2010, P<0.0001). We also report a significant decrease in perineal lesions with sphincter injuries (1% in 2003 and 0.3% in 2010 P<0.0001). DISCUSSION: Comparing 2003 to 2010, the majority of cases with no episiotomy (over 2/3) resulted in first degree perineum lesions which are today recognized as benign lesions without any systematic need for suturing. A restrictive use of episiotomy increases the rate of intact perineum and of "non-severe" perineal lesions.

[Term breech presentations in singleton pregnancies: a continuous series of 418 cases]. / La présentation du siège singleton à terme. À propos d'une série continue de 418 cas.

AIMS: The obstetrical management of term breech presentations in singleton pregnancies usually opposes the advocates of elective caesarean section to vaginal birth. Twelve years after the Term Breech Trial and 6 years after the PREMODA study, the aims of this work are to analyze neonatal results according to route of delivery chosen before labour and to evaluate professional practices in an important continuous series of cases. PATIENTS AND METHODS: This is a retrospective study including all breech singleton pregnancies that delivered at our level III labour ward at 37 weeks of amenorrhea, from 1st January 2005 to 31st December 2011. All data were analyzed in intention to treat. RESULTS: Of the 418 patients included during the study period, 52% of them delivered vaginally. In 81% of cases, a vaginal birth trial was accepted and 64% of these patients delivered vaginally. Severe morbidity and neonatal mortality judgement criteria were not significantly different between the vaginal birth trial and the elective caesarean groups. Our obstetrical department continues to provide residents with specific training in the management of breech presentations. In this study, 60% of breech deliveries were performed by residents. CONCLUSION: Although a limited statistical power, this study did not bring any proof in favour of elective caesarean for singleton term breech presentations. Training residents in the management of vaginal breech deliveries is feasible and highly recommended.

[Breech delivery and scarred uterus: a special obstetrical situation?]. / Accouchement du siège et utérus cicatriciel : une situation obstétricale particulière ?

AIM: The management of breech delivery in patients with a history of caesarean section is a special situation requiring to anticipate the delivery route if the usual prerequisites for the acceptance of vaginal breech delivery are present. Does a history of caesarean section imply a systematic refusal of vaginal delivery in case of breech presentation or an alternative to an iterative caesarean still exists? MATERIALS AND METHODS: An observational study was undertaken in our level III labour ward from January 1st 1994 to June 30th 2010 on 91 patients with a history of caesarean section and who had breech deliveries of singleton pregnancies at more than 35weeks of amenorrhea. Maternal, obstetrical and neonatal parameters were collected. Patients were divided into three groups: vaginal delivery, caesarean section after an accepted vaginal birth trial, elective caesarean section. RESULTS: The rate of an accepted vaginal birth trial was 24.2% (22 cases) with a 36.4% (eight patients) success rate in this group. There were two (2.9%) unplanned vaginal births. Fourteen patients (15.4%) had caesarian sections after an accepted vaginal birth trial: ten before labour and four during labour for dynamic dystocia or non-reassuring fetal status. Most caesarean sections before labour in case of an accepted vaginal birth trial were justified by an intercurrent factor requiring induction of labour. Neonatal factors did not show any increased morbidity or mortality in the vaginal birth group. No Apgar score was found to be less than or equal to 7 at 5minutes. Umbilical arterial pH and lactate measured as from 2001 were similar between the groups. Indeed, the mean arterial pH after vaginal birth was 7.19 as compared to 7.22 in case of caesarean section after an accepted vaginal birth trial, and 7.26 after elective caesarean section. Likewise, the mean lactate measurement was at 4.71mmol/L after vaginal birth versus 4.54 and 3.07 in the other two groups. Only neonates born after elective caesarean sections were transferred to intensive care (four cases). CONCLUSION: Vaginal breech delivery in case of a scarred uterus is possible, if each obstetrical situation is correctly studied to authorize a vaginal birth trial after a careful selection of patients and a strict management of labour. Vaginal birth does not seem to increase maternal and neonatal morbidity and mortality in this situation.

[Secondary psoas actinomycosis: a complication of an intra-uterine contraceptive device]. / Actinomycose secondaire du psoas : une complication du dispositif intra-utérin.

Genital-pelvic actinomycosis is an uncommon disease which often arises on women with long term use of intrauterine device. Its diagnostic remains difficult. Even if different clinical locations has been reported, location to the psoas muscle is exceptional. We report such a case, diagnosed on a 53 years old woman. Both a tumoral and a severe infectious syndrome appeared three months after an intra-uterine device removal. The septic syndrome led to a laparotomic approach. Unusual clinical presentation, delay between device removal and septic syndrome and lack of genital infection explain the issues to reach the final diagnosis.

[Umbilical cord prolapse: a case study over 23 years]. / La procidence du cordon : à propos d'une série sur 23 années d'activité

AIM: To determine the incidence of umbilical cord prolapse, the characteristics of the population, and to evaluate its management and the neonatal prognosis. MATERIAL AND METHODS: Ninety-three cases of cord prolapse that occurred between January 1986 and December 2009 at our level III labour ward were studied retrospectively. RESULTS: The incidence of cord prolapse was 0.18%. It occurred in 66.7% of cases in multiparous patients, in 19.4% of cases in twin pregnancies, and in 41.9% of cases in breech presentations. In 34.4% of cases, the gestational age was less than 37 weeks. Birth occurred vaginally in 33.3% of cases with a delivery time interval significantly less than for caesarean sections (P<0.001). At complete cervical dilation, more than three quarter of patients delivered vaginally. Vaginal birth was significantly more frequent in case of breech (P=0.009) and second twin (P=0.03). Parity did not influence birth route. Neonates with a birth weight less than 2500 g (30.1%) had significantly more frequently an Apgar score less than 7 at 5 min (P=0.02), a higher rate of transfer to intensive care (P<0.001) and a longer hospital stay (P=0.002). We report six neonatal deaths (6.5%). Neonatal status was not influenced by the time interval for delivery. CONCLUSION: Umbilical cord prolapse is still nowadays a serious complication of pregnancy, responsible for a significant rate of neonatal mortality. The aim in case of cord prolapse is to obtain fetal delivery the quickest way possible so as to improve the neonatal outcome. In some particular obstetrical situations such as breech presentations and second twin deliveries, birth occurs faster if performed vaginally as shown by our case study.

[Twin delivery with the first twin in breech position. A study of 137 continuous cases]. / L'accouchement gémellaire en cas de premier jumeau en présentation podalique. Étude d'une série continue de 137 cas.

AIM: The first twin (T1) in breech position is at risk of complications during vaginal delivery, making the choice of the appropriate delivery route highly important. Although British and American practice guidelines recommend the cesarean section, the French National College of Obstetricians and Gynecologists concluded that there was not enough data to choose one delivery route or the other. In this context, we set out to describe practices in our centre. MATERIAL AND METHODS: Our retrospective study was conducted at a level III labor ward between January 1st, 1995 and December 31st, 2006. One hundred and thirty-seven twin pregnancies at more than 26 gestational weeks (GW), with T1 in breech and T2 in any position, were included. RESULTS: A cesarean section was performed before labor in 60.6 % cases. Among the 54 (39.4 %) cases where a trial of labor was accepted, 29 patients (53.7 % success rate) delivered vaginally and 25 (46.3 %) had a cesarean section during labor. No statistical difference was observed between the neonatal outcomes after cesarean section as compared to vaginal birth. However, a significant relationship was found between delivery route and parity. Less than one-third of nulliparas versus two-third of patients with a history of at least one delivery, having trials of labor, ultimately gave birth vaginally. Thus, we observed a high rate of cesarean section during labor in nulliparas (68 % of the initially accepted trials of labor). CONCLUSION: Our study is the first one that clearly shows that the success rate of the trial of labor is closely related to a history of vaginal birth. Following these results and because of more than two-third of cesarean section during labor in nulliparas, we subsequently plan an elective cesarean section at the 38th GW for nulliparas with twin pregnancies and T1 in breech position. Nevertheless, if any of these patients go in labor before the cesearean section, a careful trial of labor is offered.

[Spontaneous hepatic rupture during an uncomplicated twin pregnancy]. / Rupture hépatique spontanée au cours d'une grossesse gémellaire non compliquée.

Liver subcapsular haematoma and its consequence, spontaneous hepatic rupture, are very rare complications of pregnancy. They are mainly associated with pre-eclampsia. The diagnosis is difficult and the maternal and fetal mortality rates are high. We report the case of a spontaneous hepatic rupture on a normal liver during an uncomplicated twin pregnancy with a favorable outcome for both the mother and the newborns.

[Operative delivery data in France for 2007: results of a national survey within teaching hospitals]. / Données 2007 de l'extraction instrumentale en France: résultats d'une enquête nationale auprès de l'ensemble des centres hospitalo-universitaires.

AIM: Clinical Practice Guidelines of the French College of Gynecologists and Obstetricians concerning operative deliveries were published in December 2008. That is why a national survey was performed for the year 2007 so as to obtain an inventory of obstetrical practices regarding the geographical distribution of the type of instrument used for operative deliveries following the level of each teaching hospital concerned. MATERIAL AND METHODS: We included in our study 49 teaching hospitals from metropolitan France and the overseas departments and territories. For the year 2007, we noted the number of operative deliveries, the type of instrument used, as well as the level of the maternity concerned with its total number of patients, births, cesarean sections, vaginal deliveries, and episiotomies. RESULTS: We obtained data from all 49 centres. The mean number of deliveries per year was 2203 for level I teaching hospitals, 2060 for level II and 2720 for level III, respectively. The rate of operative delivery was quite different from one centre to the other, ranging from 5.3 to 34.1% of all births. Similarly, for the type of instrument used, there existed clear geographical disparities although the notion of "School's instrument" was not as preeminent as before since most centres used at least two instruments. Moreover, the rate of cesarean varied from 9 to 29.5% (all levels concerned) with a national mean rate of 20.7% for teaching hospitals. Finally, mean rate of episiotomies ranged from 3.6 to 60%. DISCUSSION: This study showed that important differences existed between teaching hospitals in the use of instruments and that obstetrical practices are far from being uniform. However, in 2007, the routine use of more than one instrument in each centre was most usual, as opposed to the situation some decades ago. The use of obstetrical vacuum extractors has been largely disseminated. Each of the three types of instruments has specific indications and mastering at least two instruments seems more secure in the management of the numerous obstetrical situations. It is up to teaching hospitals to make sure that the use of at least two instruments is taught for operative deliveries. The recent publication of Clinical Practice Guidelines would probably help in standardizing operative deliveries in years to come.

[Radiation-induced breast angiosarcoma following breast-conserving therapy. Report of two cases]. / Angiosarcome mammaire radio-induit après traitement conservateur du cancer du sein. A propos de deux cas.

Breast angiosarcoma is a rare but serious complication of radiotherapy. We report two cases of radiation-induced breast angiosarcoma in two patients having benefited from breast conserving surgery with radiation. We shall put emphasis on the etiopathogeny of these tumours and their clinical and therapeutic aspects.

[Evaluating a policy of restrictive episiotomy before and after practice guidelines by the French College of Obstetricians and Gynecologists]. / Evaluation d'une politique restrictive d'épisiotomie avant et après les recommandations du Collège national des gynécologues obstétriciens français.

AIM: To evaluate our practice following Clinical Practice Guidelines (CPG) of the French College of Obstetricians and Gynecologists (CNGOF) in 2005 advocating a policy of restrictive episiotomy and to show that a significative decrease in the rate of episiotomy does not increase the number of third and fourth degree perineal tears. MATERIAL AND METHODS: A retrospective study of episiotomies and third/fourth degree perineal tears of the year 2003 (before the CPG) was compared with the year 2007 (after the CPG). We analyzed the indications of episiotomies and compared the rate of episiotomies and severe perineal tears between the two periods. RESULTS: In 2003, the rate of episiotomies was 18.8% (upon 1755 vaginal deliveries). We observed 16 (9 per thousand) third-degree perineal tears, five of which was associated with episiotomies; and two (1 per thousand) fourth-degree perineal tears. In 2007, the rate of episiotomies was 3.4% (upon 1940 vaginal deliveries). There were eight (4 per thousand) third-degree and four (2 per thousand) fourth-degree perineal tears. The two periods of study were similar in terms of age, parity, gestational age, birthweight, rate of spontaneous deliveries, breech and instrumental deliveries. There were a difference regarding deliveries in the occipitoposterior position (5.8% vs 13.8% ; p=0.02). No significant difference was found between the rates of third degree (9 per thousand vs 4 per thousand ; p=0.059) and fourth degree perineal tears (1 per thousand vs 2 per thousand ; p=0.487). However, there was a significant decrease in the rate of episiotomies between the two periods (18.8% vs 3.4% ; p<0.001). CONCLUSION: An episiotomy rate of 3.4% is much lower than the threshold rate of 30% recommanded. A policy of restrictive episiotomy is possible without increasing the rate of severe perineal tears. Aknowledging the risks and benefits of each obstetrical procedure might decrease the number of episiotomies, whose practice should be evaluated in every labour ward.

[Comparing fetal and maternal morbidities between operative deliveries by Teissier's spatulas and Minicup vacuum extractor]. / Morbidité materno-foetale liée à l'extraction instrumentale par spatules de Teissier. Etude comparative à la ventouse obstétricale de type Minicup.

OBJECTIVE: To compare fetal and maternal morbidities between operative deliveries by long Teissier's spatulas and Minicup vacuum extractor. MATERIAL AND METHODS: A retrospective study was conducted from January 2003 to July 2008 at the maternity ward, Besançon teaching hospital. Operative deliveries in term cephalic singleton pregnancies performed by Teissier's spatulas (case group) were compared to previous deliveries by vacuum extractor Minicup (control group). RESULTS: During the study period, 69 operative deliveries by Teissier's spatulas have been performed. No significant difference was found between the two groups in terms of maternal characteristics. Two third-degree perineal tears occurred following delivery by Teissier's spatulas with no third-degree tear in the vacuum extractor group (p = ns). The episiotomy rate in the Teissier's spatulas group was 15,9% compared to 11.6% in the vacuum extractor group (p = ns). Duration of operative delivery was significantly shorter in the Teissier's spatulas group (3.4 min vs 4.95 min; p = 0.007). Fetal morbidity was identical in the two groups. CONCLUSION: This study found no significant difference in terms of fetal and maternal morbidities between operative deliveries by Teissier's spatulas and vacuum extractor. Moreover, as opposed to Thierry's spatulas, the long Tessier spatulas can be adequately used in accordance with patient's wish and practice guidelines recommending a policy of restrictive episiotomy. However, a larger study is needed to confirm these preliminary results.

[Very preterm birth: is maternal anesthesia a risk factor for neonatal intubation in the delivery room?]. / Le risque d'intubation des grands prématurés en salle de naissance est-il lié au type d'anesthésie maternelle ? Expérience des réseaux périnatals Poitou-Charentes et Franche-Comté

OBJECTIVE: To assess the risk of tracheal intubation at birth in very premature neonates related to the type of maternal anesthesia in case of elective cesarean. POPULATION AND METHODS: All 219 live-born very premature neonates (28-32 weeks of gestation), delivered after an elective cesarean in the 27 maternity wards of 2 French semi-rural neonatal networks. Eighty-three percent (182/219) were delivered in level III maternity wards in university hospitals. RESULTS: Of the very preterm neonates, 33.3% (73/219) were intubated in the delivery room, either for respiratory distress syndrome or a low APGAR score. Very preterm neonates delivered after maternal general anesthesia were more often intubated than those delivered after spinal anesthesia (48.7% vs 25.2%; OR: 2.8; 95% CI: 1.8-5.1). The risk of intubation related to maternal general anesthesia remained statistically significant after an adjustment for gestational age, fetal growth retardation, respiratory distress syndrome, type of maternity ward, and a propensity score that took into account maternal sociodemographic characteristics and the causes of very preterm birth (aOR: 3.4; 95% CI: 1.4-8.2). The risk of intubation related to general anesthesia was lower after adjusting for the 5-min APGAR score (aOR: 2.8; 95% CI: 1.0-7.3). CONCLUSION: Very preterm neonates delivered after cesarean with general anesthesia require tracheal intubation in the delivery room more often than those delivered with spinal anesthesia. This study cannot assess a causal link between anesthesia and the need for neonatal intubation. However, neonatologists have to be aware of the type of maternal anesthesia because it may interfere with the non-invasive ventilation support policy of the very preterm neonate.