Objectif : évaluation des risques et bénéfices de la position à quatre pattes pendant le second stade du travail et comparaison avec la position en décubitus dorsal Méthodes : étude effectuée à Karachi (Pakistan) entre le 1er janvier 1999 et le 31 janvier 2000. 200 patientes présentant des conditions ante partum, intrapartum et socio-économiques semblables ont été sélectionnées. On a retenu uniquement les patientes qui se sont présentées à plus de 37 semaines de gestation avec un travail démarré et en position céphalique. Ont été exclues les patientes à gestations multiples, avec des présentations anormales [malprsentations], antécédent de cicatrice, fièvre maternelle, malformation foetale diagnostiquée en prénatal. [à finir]
OBJECTIVE: To assess the risks and benefits of squatting position during second stage of labour and its comparison with the supine position.
METHODS: The study was conducted at the Department of Obstetrics and Gynaecology, Jinnah Postgraduate Medical Centre, Karachi from 1st January 1999 to 31st January 2000. A total of two hundred patients of similar ante partum, intrapartum and socio-economic conditions were selected. Only patients of gestation more than 37 weeks, presenting in active labour with cephalic presentation were included. Patients with multiple gestation, malpresentation, previous scar, maternal fever and prenatal diagnosed fetal malformation were excluded from the study. Random selection was done after informed consent and alternately divided into two groups A and B. Both groups were ambulatory during first stage of labour. In second stage, group-A adopted the squatting position, while group-B remained supine in lithotomy position. The third stage of labour in both the groups was conducted in the supine position.
RESULTS: There was no difference in the application of episiotomies in both groups, however extension of the episiotomy occurred in 7% patients of the non-squatting group (P < 0.05). Para urethral tears occurred in 5% patients in squatting group, but all occurred in patients who were not given an episiotomy. Second degree, and third degree perineal tears occurred in 9% patients in the non-squatting group but none in the squatting group (P < 0.05). Forceps application was also significantly less in group-A 11% and 24% in group-B (P < 0.05).There were two cases of shoulder dystocia in group B but none in the group-A. During the Third stage of labour there were no cases of retained placenta in group A but there were 4% cases of retained placenta and 1% case of postpartum haemorrhage of more than 500 ml due to atony of the uterus in group-B. One patient in the non-squatting position had to have a caesarean section due to persistent occipito posterior position. There was no significant difference in the apgar scores, foetal heart rate patterns or requirement of neonatal resuscitation.
CONCLUSION: It appears that squatting position may result in less instrumental deliveries, extension of episiotomies and perineal tears
Comparaison entre accouchement allongé et accroupi : moins d’extractions instrumentales, de [ extention of episiotomies = déchirures sur épisiotomie?] et de déchirures périnéales dans le groupe accroupi.
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