Investigation of factors associated with instrumental delivery at the maternity of Gabriel Martin Hospital in Reunion. Study of a retrospective observational cohort ; Recherche de facteurs associés à l’accouchement instrumental à la maternité du centre hospitalier Gabriel Martin à La Réunion. Étude d’une cohorte observationnelle rétrospective

Objective: in 2016, there was a disparity in the rates of instrumental deliveries (ID) in the maternities in La Reunion. The objective of study was to look for factors associated to ID in the Gabriel Martin hospital center (CHGM). Methods: the study was about a single-center retrospective observational group on patients giving birth to a singleton in a cephalic presentation after 34 weeks in 2017. The maternal and obstetric, and the labour characteristics of the patients having given spontaneous childbirth by vaginal delivery and those having an ID have been compared on both univariate and multivariate analysis. Results: the study counted 1287 patients: 1000 having given spontaneous childbirth by vaginal delivery, 227 instrumental deliveries and 60 cesareans at least 6cm of dilatation. The rate of ID among the vaginal deliveries was of 18,2%. Concerning the maternal and obstetrics characteristics, 3 factors were associated: primiparity in a vaginal delivery (OR=6,35 (IC95% 3,71-11,3)), a preceding in ID (OR=2,93 (IC95% 1,34-6,31)) and the existence of prenatal follow-up at the “Maison de naissance de l’Ouest” (MANAO) (OR =4,66 (IC95% 1,70- 13,09)). The factors associated linked to the labour were the existence of peridural anesthesia (OR =2 (IC95% 1,13-3,63)), a complete dilatation latency duration before the beginning of the expulsion labor superior to 2 hours (OR=1,82 (IC95% 1,04-3,15)). The factors associated to the beginning of the expulsion labor were a fetal presentation in posterior or a transverse variety (OR=3,56 (IC95% 2,21-5,75)), a non-engaged fetal presentation or a fetal presentation at upper strait (OR=2,95 (IC95% 1,89-4,63)) and an abnormal analysis of the fetal heart rate (OR=3,06 (IC95% 2,05-4,59)). Conclusion: the factors associated to ID were especially linked to the characteristics of the second part of the labour, appearing as a key period influencing the way of delivering. ; Objectif : il existe en 2016 une disparité des taux d’accouchement instrumental (AI) entre les maternités publiques ...