[A look into the past: improves in obstetrical and neonatal outcome in maternity since the 19th century]. / Un regard dans le passé : évolution du devenir materno-fœtal en maternité depuis le xixe siècle.

OBJECTIVE: Evaluate changes in obstetrical and neonatal outcome of women who delivered in maternity hospital since the 19(th) century. MATERIALS AND METHODS: Data from a historic cohort of 1022 women who delivered between 1871 and 1874 in the hôtel Dieu hospital of Marseille were compared to those from 1159 women who delivered from 2005 to 2006 in the level 3 maternity of Nord hospital of Marseille (contemporary cohort). Deliveries that had occured before 22 weeks and/or with a foetal birth weight of less than 500 g were excluded. RESULTS: A total of 2131 pregnancies were included: 1011 and 1120 in historic and contemporary cohort, respectively. Despite comparable mean term of delivery, mean birth weight of neonates from historic cohort were significantly lower: 2971 g (550-4900 g) vs 3250 g (500-5375 g), respectively (p<0.001). Stillbirths were reported in 72 (7.1%) cases in historic cohort compared to nine (0.8%) in contemporary cohort (p<0.001). Neonatal mortality was 3.7% in historic cohort and 1.9% in contemporary cohort (p=0.012). A total of 99 (9.8%) maternal deaths were reported in historic cohort, while none in contemporary cohort (p<0.001). A wide majority of maternal deaths were caused by maternal infection (72.9%); 5.2% were caused by postpartum haemorrhage. CONCLUSION: Our results illustrate the tremendous impact on maternal and neonatal outcome of advances in obstetrical management. The significant increase in the median foetal birth weight is likely to be related to wide changes in environmental conditions and behaviour.