Extraction instrumentale sur une hauteur de présentation supérieur à 55mm à l’échographie transpérinéale

Conclusion Malgré un taux d’échec plus élevé des extractions instrumentales sur des présentations à une distance entre 45 et 55mm et≥55mm, les tentatives d’extraction ne devraient pas être contre-indiquées de manière formelle mais être laissées libres à l’appréciation de l’obstétricien. Objective Compare the issue of an operative vaginal delivery associated to the fetal presentation diagnosed by transperineal ultrasound. Three groups were formed: ≥55mm, between 45 and 55mm, and <45mm. Methods A monocentric prospective study on 108 patients has been conducted between April 2011 and August 2014. The distance between perinea and skull has been analyzed to compare the success of operative vaginal delivery considering the level of the fetal presentation in the pelvic cavity. Results The failed operative vaginal deliveries are more frequent while the fetal head is above 55mm (16.7%) or while the fetal head is between 45 and 55mm (9.1%) than while the fetal skull is under 45mm (1.8%) (P =0.04). However there is no significant difference for the fetal shoulder dystocia (5.6% vs 3.0% vs 3.5%, P =0.5), nor for the newborn outcomes (16.7 vs 15.2 vs 14; P =0.9). Conclusion Despite the high rate of failed operative vaginal delivery above 55mm, it should be considered not to prohibit but send free to the obstetrician appreciation.
Source: Gynecologie Obstetrique and Fertilite - Category: OBGYN Source Type: research