Facteurs prédictifs de l'issue de l'accouchement sur utérus cicatriciel, service de gynécologie obstétrique EHS Batna, Algérie / Predictive factors of the outcome of delivery on scar uterus in the department of obstetrics - gynecology EHS Batna, Algeria

Introduction. La pratique de césariennes est en augmentation constante dans le monde, soulevant la problématique de la gestion des femmes enceintes ayant un utérus cicatriciel. L'objectif de notre travail était d'identifier les facteurs significativement associés au succès de l'épreuve utérine au sein de notre service, afin de réaliser une sélection rigoureuse des candidates à la tentative de voie basse. Méthodes. Nous avons mené une étude épidémiologique descriptive, rétrospective, mono centrique au niveau de l'EHS mère ­ enfant Batna du 1er janvier 2018 au 31 décembre 2019 ayant intéressé les femmees porteuses d'un utérus cicatriciel d'origine obstétricale avec un âge de grossesse supérieur à 22 SA. Résultats. Au cours de notre étude nous avons recensé 3002 accouchements sur utérus cicatriciel. Le taux de tentatives de voie basse après césarienne était de 46,84 % avec un taux de succès de 89,19 %. Les principaux facteurs qui favorisent le succès de la tentative de voie basse après césarienne étaient : un antécédent d'accouchement par voie vaginale après la césarienne (p <0,001) la multiparité (p=0,0002), une césarienne précédente pour présentation podalique (p<0,001), un intervalle inter génésique de 12 mois et plus (p <0,001), des conditions locales favorables (dilatation du col supérieure à 4 cm ; p=0,02 et la p=0,02 et la rupture artificielle des membranes ; p =0,02 et la rupture artificielle des membranes ; p=0,03). Les facteurs qui défavorisent le succès de la TVBAC étaient : un antécédent de césarienne pour stagnation ou non-engagement à dilatation complète (p<0,001), un terme d'accouchement supérieur à 40 SA (p=0,002), un poids de naissance supérieur à 4000 g (p<0,001). Les facteurs qui ne semblent pas influencer l'issue de l'épreuve utérine étaient : l'âge maternel, l'âge de réalisation de la première césarienne, la présence de pathologies maternelles et la réalisation de radiopelvimétrie Conclusion. Les facteurs de succès et d'échec d'une TVBAC sur utérus cicatriciel sont importants à relever pour les décisions ultérieures de la voie d'accouchement, la situation obstétricale doit être soigneusement évaluée et en cas de doute, faire appel à une décision collégiale.

Neonatal outcomes in twin pregnancies with the first twin in breech presentation according to the mode of delivery: A cohort study from Dakar Senegal

The objectives of this study were to compare perinatal outcomes in twin pregnancies where the first twin was in the breech presentation. To do so, we performed a 10-year retrospective cohort study in a single university center. All patients with a twin pregnancy with the first twin in breech presentation, a gestational age greater than or equal to 34 weeks' gestation, and a birth weight >= 1500 g were included. The main outcome measures were 5-minute Apgar score <7 and perinatal mortality. We included 353 pairs of twins which complied with the inclusion criteria. One hundred and fifty (150) patients delivered vaginally while 203 pairs of twins were delivered by caesarean section. Patients who delivered abdominally were similar to those who delivered vaginally with regard to age, parity, and gestational age. Six twins A delivered vaginally and 2 delivered by caesarean section had an Apgar score < 7 (p = 0.76) whereas 12 twins B delivered vaginally and 2 delivered abdominally had an Apgar score <7 (p = 0.001). Perinatal mortality did not differ significantly between twins delivered abdominally and those delivered vaginally. There was no evidence that vaginal delivery was risky with regards to depressed Apgar scores for Twin A and neonatal mortality for breech first twins that weighed at least 1500 g. However, Twin B delivered vaginally were more likely to present with a low 5-minute Apgar score. Along with the literature, the findings of this study do not currently allow to define a consensual obstetric attitude towards management of breech first twin deliveries. Until more prospective multicenter randomized controlled studies shed light on this problem, the skills, experience and judgment of the obstetrician will play a major role in the decision-making process. (Afr J Reprod Health 2022; 26[5]: 50-56).

Pregnancy Outcome and Factors Affecting Vaginal Delivery of Twins at University of Nigeria Teaching Hospital; Enugu

Objective: The study aims to determine the differences in maternal and perinatal outcomes between caesarean and vaginal deliveries and the factors affecting vaginal delivery in twin pregnancy.Materials and Methods: An observational study to audit twin pregnancies delivered at the University of Nigeria Teaching Hospital between 2002 and 2008. Clinical observations were entered into a questionnaire immediately after the delivery of the women and the mothers and their babies were followed up until the end of the puerperium.Results: There were 5298 deliveries within the study period; out of which 117 were twin deliveries. This gives a twinning rate of 22 per 1000 deliveries. The mean age of the mothers was 30 } 5.9 years. Twenty.five (21.4) women were admitted into the hospital for preterm labor. The average gestational age of admission was 32 } 5.8 weeks and the average duration of hospital stay for preterm labor was 12.6 } 9.1 days. Other pregnancy complications observed were severe hypertension (14.5; anemia (9.4); postpartum hemorrhage (8.5); puerperal fever (5.1); abruptio placentae; and diabetic mellitus (2.7). Fifty.nine women (50.4) had vaginal deliveries; 5 (4.3) had vaginal delivery of the leading twin and caesarean delivery of the retained second twin while 53 women (45.3) were delivered by caesarean section. Forty.eight (41) women had preterm delivery. Vaginal deliveries were more common than caesarean section among patients that were unbooked than booked P = 0.047 (OR 2.26; 95CI:0.93.5.53) and those that had cephalic presentation of the leading twin; P = 0.0002 (OR = 4.7 95 CI:2.6.8.2). Vaginal delivery tended toward statistical significance when the fetal weight of the leading twin was 1.5 to 2.5 kg; P = 0.09. The commonest indications for caesarean section were abnormal lies and presentations and hypertension in pregnancy.Two.hundred and seventeen (92.7) out of a total of 234 fetuses that were delivered in this study were live births and 17 (7.3) still births. The rate of new born admissions in twin 1 was however higher in those delivered by Caesarean section (39.6) than those delivered vaginally (29.7). Indications for admissions into the special baby care units were; prematurity 33 (40.2); birth asphyxia 15 (18.3); low birth weight 12 (14.6); neonatal jaundice 10 (12.2); and twin-twin transfusion 4 (4.9). There was a higher rate of early neonatal death in both vaginally delivered twin 1 (9.4) and twin 2 (11.9) than those delivered by Caesarean section; 3.8 and 3.5; respectively.Conclusion: Cephalic presentation of the leading twin; birth weight less than 2.5 kg; and unbooked women presenting in advanced labor predisposed to vaginal delivery in twin pregnancies. There was however increased risk of still birth and early neonatal deaths especially for the leading twin in vaginal deliveries in unbooked women