État néonatal et durée des efforts expulsifs chez les primipares à bas risque : données observationnelles dans 138 maternités françaises

Abstract

In agreement with national guidelines published in 2007, limiting duration of expulsive efforts to 30 minutes is a common obstetrical practice in France. In many other countries, there is no fixed limit for pushing duration. The objective of our work is to analyze mode of delivery and neonatal issues according to duration of expulsive efforts. It is a secondary analysis of an observational prospective study, among low-risk primiparous women, in 138 French maternity units. According to duration of expulsive efforts, we determined proportions of spontaneous and instrumental vaginal deliveries. Then, we analyzed the risk of neonatal asphyxia (defined by pH <or=7.10 and/or 5-minute Apgar score <or=7) according to duration of expulsive efforts, with stratification on mode of delivery. Three thousand three hundred and thirty low-risk primiparous women were included. Median duration of expulsive efforts was 15 minutes and 18.5 % (n=602) of women pushed more than 30 minutes. Among women with a duration of expulsive efforts longer than 30 minutes, 57 % had a spontaneous vaginal delivery. In our population, 1.4 % of neonates had an arterial pH at birth <or=7.10 and 1.0 % a 5-minute Apgar score <or=7. We found no association between duration of expulsive efforts and risk of neonatal asphyxia in the spontaneous delivery group (p=0.38) as well as in the instrumental delivery group (p=0.21). Moreover, we found no association between duration of expulsive efforts and adverse neonatal outcomes. In a context of adequate surveillance of the fetal well-being during labor, a duration of expulsive efforts longer than 30 minutes does not increase the risk of neonatal asphyxia or adverse neonatal outcomes. Expulsive efforts could be continue beyond 30 minutes in case of normal FHR.