[CAESAREAN DELIVERY: STANDARDIZING THE PRACTICES]. / Césariennes: uniformiser les pratiques.

Caesarean delivery was performed in 20% of all deliveries in France in 2010 and this rate has remained unchanged during the last 10 years. Indications to perform this procedure are well defined, especially in case of scarred uterus, twin pregnancies, macrosomia or breech presentation. Surgical (haemorrhage, urinary or intestinal tract injury) and anaesthetic (hypotension after regional anaesthesia, difficult intubation and aspiration after general anaesthesia) complications may occur during the procedure. Complications may also be encountered in the early postoperative period (haemorrhage, infection, venous thromboembolism) but also on the long-term, such as placenta accreta or uterine rupture which may significantly impact obstetric outcomes. Enhanced recovery after surgery promotes early recovery and rapid convalescence. It simplifies nursing practice after surgery and is the first important step toward a patient- and family-centred care.

NAITRE study on the impact of conditional cash transfer on poor pregnancy outcomes in underprivileged women: protocol for a nationwide pragmatic cluster-randomised superiority clinical trial in France.

INTRODUCTION: Prenatal care is recommended during pregnancy to improve neonatal and maternal outcomes. Women of lower socioeconomic status (SES) are less compliant to recommended prenatal care and suffer a higher risk of adverse perinatal outcomes. Several attempts to encourage optimal pregnancy follow-up have shown controversial results, particularly in high-income countries. Few studies have assessed financial incentives to encourage prenatal care, and none reported materno-fetal events as the primary outcome. Our study aims to determine whether financial incentives could improve pregnancy outcomes in women with low SES in a high-income country. METHODS AND ANALYSIS: This pragmatic cluster-randomised clinical trial includes pregnant women with the following criteria: (1) age above 18 years, (2) first pregnancy visit before 26 weeks of gestation and (3) belonging to a socioeconomically disadvantaged group. The intervention consists in offering financial incentives conditional on attending scheduled pregnancy follow-up consultations. Clusters are 2-month periods with random turnover across centres. A composite outcome of maternal and neonatal morbidity and mortality is the primary endpoint. Secondary endpoints include maternal or neonatal outcomes assessed separately, qualitative assessment of the perception of the intervention and cost-effectiveness analysis for which children will be followed to the end of their first year through the French health insurance database. The study started in June 2016, and based on an expected decrease in the primary endpoint from 18% to 14% in the intervention group, we plan to include 2000 women in each group. ETHICS AND DISSEMINATION: Ethics approval was first gained on 28 September 2014. An independent data security and monitoring committee has been established. Results of the main trial and each of the secondary analyses will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: NCT02402855; pre-results.