Good dilatation, good breech’s delivery? Labor’s particularities of the podalic presentations compared to the cephalic presentations ; 'À bonne dilatation bon siège' ? Particularités du travail des présentations podaliques comparées aux présentations céphaliques

Objective: the objective is to compare the course of labor as well as the maternal and neonatal prognosis of the podalic presentations with the cephalic presentations. But also to know the elements that can influence it. Material and method: this is a retrospective two-center study carried out over 3 years. We analyzed the progress of labor and the impact of certain treatments on it. The maternal prognosis as well as the criteria of neonatal well-being were evaluated. Results: our study identifies 122 sites, each paired with a cephalic presentation. The progress of labor as a whole is comparable between our two populations with an average labor time of 9 hours for the breeches. Only the duration of stage 1 (496min vs. 414min p = 0.05) and the duration of expulsive efforts (17min vs. 14min p = 0.04) are significantly different. It is not affected by the water broken before labor, advanced labor on admission to the delivery room, or completion of induction. Professionals perform more episiotomy (22.1% vs. 4.1% p <0.001), although there is more intact perineum (54.9% vs. 41% p = 0.03). At the same time, the short-term neonatal state is more unfavorable for breeches, with significantly more respiratory distress (24 vs. 3 p <0.001) and pH <7.15 (28 vs. 5 p <0.001) which characterize a risk of neonatal anoxo-ischemia. However, this did not lead to more neonatal transfers (5 vs. 2 p = 0.33). Conclusion: the podalic presentation represents a neonatal risk only during the phase of adaptation to extra-uterine life. The progress of labor itself differs little from that of the cephalic presentations. We can therefore accept Lacomme's adage "Good dilation, good breech". ; Objectif : l’objectif est de comparer le déroulement du travail ainsi que le pronostic maternel et néonatal des présentations podaliques aux présentations céphaliques. Mais également de connaitre les éléments pouvant influencer celui-ci. Matériel et méthode : il s’agit d’une étude bi-centrique rétrospective réalisée sur 3 ans. Nous avons analysé ...