[ La césarienne : à propos de 147 cas au niveau de l'hôpital Mohamed V à Chefchaouen au Nord du Maroc ]
Volume 11, Issue 4, June 2015, Pages 855–862
Farid EL Khlifi1, Mohamed EL Bakkali2, El Houssain Bouhoussain3, Sekkouri Alaoui Salaheddine4, Amina Sallek5, Boudiab Abdelmajid6, and Ahmed Reda Daoud7
1 Doctorat sciences et techniques CED, Département de Biologie, Université Ibn Tofail, Kenitra, Morocco
2 Doctorat sciences et techniques CED, Département de Biologie, Université Ibn Tofail, Kénitra, Morocco
3 Hôpital Mohamed V, Chefchaouen, Morocco
4 Hôpital Mohamed V, Chefchaouen, Morocco
5 Hôpital Mohamed V, Chefchaouen, Morocco
6 Hôpital Mohamed V, Chefchaouen, Morocco
7 Hôpital Mohamed V, Chefchaouen, Morocco
Original language: French
Copyright © 2015 ISSR Journals. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Objective: Determine whether the existence of special clinical situations nursery (origin, gestational age, obesity and age) or fetal (breech presentation, and macrosomia term exceeded), associated with risks must include the completion of a C-section.
Patients and methods: cross type prospective study including singleton pregnancies who delivered at the Mohamed V Hospital in Chefchaouen in northern Morocco, from 1 September 2013 to 30 August 2014. The maternal and fetal factors were analyzed.
Results: Over the period studied, 305 were studied childbirth which 147 have given birth to a caesarean section. This population was from, about 53% rural, 26% of Chefchaouen Bab Taza 12% and 7.8% of Ouazzane. At significantly higher rates of caesarean section in patients at from Ouazzane (p <0.018). Analysis summit presentation is an interesting univariate prognostic factor acceptability of vaginal Exp (B) = 0.415 [0.244 to 0.708]. As against a presentation above is to the detriment of birth vaginally Exp (B) = 9.946 [1.225 to 80.720]. Three strong predictors of birth by natural means, term gestational age (Exp (B) = Gross 0.378 [0.178 to 0.799] a normal body mass index (Exp (B) = 0.389 [0.157 to 960 ]) and macrosomia (Exp (B) = Gross 0.536 [0.308 to 0.933]). While a term greater than 40 weeks of gestation was associated with a significantly increased risk of caesarean section (Exp (B) = 3.480 Gross [1.432 to 8.459]). Using multivariate models, it has been shown that in a patient from Ouazzane, presents a high risk of cesarean birth regardless of the type of presentation in these same patients but from another Ouazzane that the presentation of any seat remains a protective factor in favor of vaginal delivery (Exp (?)a between 0.14 and 0.46 Summit presentation to the top). But is increasing in If the extended term when the presentation is top type.
Discussion and conclusion: There is insufficient current data to systematically carry out a C-section for breech presentation. This is a much debated issue but this work has allowed us to identify a statistical model that should narrow down the choice, but still needs to be validated by a prospective study.
Author Keywords: childbirth, risk, breech presentation, caesarean section, vaginal.
Volume 11, Issue 4, June 2015, Pages 855–862
Farid EL Khlifi1, Mohamed EL Bakkali2, El Houssain Bouhoussain3, Sekkouri Alaoui Salaheddine4, Amina Sallek5, Boudiab Abdelmajid6, and Ahmed Reda Daoud7
1 Doctorat sciences et techniques CED, Département de Biologie, Université Ibn Tofail, Kenitra, Morocco
2 Doctorat sciences et techniques CED, Département de Biologie, Université Ibn Tofail, Kénitra, Morocco
3 Hôpital Mohamed V, Chefchaouen, Morocco
4 Hôpital Mohamed V, Chefchaouen, Morocco
5 Hôpital Mohamed V, Chefchaouen, Morocco
6 Hôpital Mohamed V, Chefchaouen, Morocco
7 Hôpital Mohamed V, Chefchaouen, Morocco
Original language: French
Copyright © 2015 ISSR Journals. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Objective: Determine whether the existence of special clinical situations nursery (origin, gestational age, obesity and age) or fetal (breech presentation, and macrosomia term exceeded), associated with risks must include the completion of a C-section.
Patients and methods: cross type prospective study including singleton pregnancies who delivered at the Mohamed V Hospital in Chefchaouen in northern Morocco, from 1 September 2013 to 30 August 2014. The maternal and fetal factors were analyzed.
Results: Over the period studied, 305 were studied childbirth which 147 have given birth to a caesarean section. This population was from, about 53% rural, 26% of Chefchaouen Bab Taza 12% and 7.8% of Ouazzane. At significantly higher rates of caesarean section in patients at from Ouazzane (p <0.018). Analysis summit presentation is an interesting univariate prognostic factor acceptability of vaginal Exp (B) = 0.415 [0.244 to 0.708]. As against a presentation above is to the detriment of birth vaginally Exp (B) = 9.946 [1.225 to 80.720]. Three strong predictors of birth by natural means, term gestational age (Exp (B) = Gross 0.378 [0.178 to 0.799] a normal body mass index (Exp (B) = 0.389 [0.157 to 960 ]) and macrosomia (Exp (B) = Gross 0.536 [0.308 to 0.933]). While a term greater than 40 weeks of gestation was associated with a significantly increased risk of caesarean section (Exp (B) = 3.480 Gross [1.432 to 8.459]). Using multivariate models, it has been shown that in a patient from Ouazzane, presents a high risk of cesarean birth regardless of the type of presentation in these same patients but from another Ouazzane that the presentation of any seat remains a protective factor in favor of vaginal delivery (Exp (?)a between 0.14 and 0.46 Summit presentation to the top). But is increasing in If the extended term when the presentation is top type.
Discussion and conclusion: There is insufficient current data to systematically carry out a C-section for breech presentation. This is a much debated issue but this work has allowed us to identify a statistical model that should narrow down the choice, but still needs to be validated by a prospective study.
Author Keywords: childbirth, risk, breech presentation, caesarean section, vaginal.
Abstract: (french)
But de l'étude : déterminer si l'existence de situations cliniques particulières, maternelles (provenance, age gestationnel, obésité et age) ou fœtale (présentation du siège, macrosomie et terme dépassé), associés à des risques doivent indiquer la réalisation d'une césarienne.
Patientes et méthodes : étude prospective de type transversale incluant les grossesses monofoetale ayant accouché au niveau de l'hôpital Mohamed V à Chefchaouen au Nord du Maroc, du 1er septembre 2013 au 30 aout 2014. Les facteurs maternels et fœtaux ont été analysés.
Résultats : Sur la période étudiée, 305 accouchement ont été étudiés dont 147 ont accouché d'une césarienne. Cette population était originaire, à environ de 53% du rural, 26% de Chefchaouen, 12% de Bab Taza et 7,8% de Ouazzane. Au taux de césarienne significativement élevé chez les patientes à provenance de Ouazzane (p <0,018). En analyse univarié la présentation en sommet est un facteur pronostique intéressant d'acceptabilité de la voie basse Exp(B) Brut = 0,415 [0,244–0,708]. Par contre une présentation en haut est en défaveur de l'accouchement voie basse Exp(B) Brut = 9,946[1,225–80,720]. Trois éléments fortement prédictifs de l'accouchement par les voies naturelles, un age gestationnel à terme (Exp(B) Brut =0,378[0,178–0,799], un indice de masse corporelle normale (Exp(B) Brut =0,389[0,157-960]) et une macrosomie (Exp(B) Brut =0,536[0,308–0,933]). Alors que un terme de supérieur de 40 semaine d'aménorrhée était associé à une augmentation substantielle du risque de césarienne (Exp(B) Brut =3,480[1,432–8,459]). En utilisant des modèles multivariés, il a été montré que chez une patiente à provenance de Ouazzane, présente un haut risque d'accoucher césarien quel que soit le type de la présentation chez ces mêmes patientes mais de provenance autre que Ouazzane, la présentation du siège quelconque demeure un facteur protecteur et en faveur d'accouchement par voie vaginale (Exp(β) ajusté entre 0,14 pour présentation en sommet et 0,46 pour celle en haut). Mais s'accentue en cas du terme prolongé quand la présentation est de type haut.
Discussion et conclusion : Il n'y a pas de données actuelles suffisantes pour réaliser systématiquement une césarienne en cas de présentation du siège. C'est une question très débattue mais ce travail nous a permis de déterminer un modèle statistique qui devrait affiner ce choix, mais qui demande encore à être validé par une étude prospective.
Author Keywords: accouchement, risque, présentation du siège, césarienne, voie basse.
How to Cite this Article
Farid EL Khlifi, Mohamed EL Bakkali, El Houssain Bouhoussain, Sekkouri Alaoui Salaheddine, Amina Sallek, Boudiab Abdelmajid, and Ahmed Reda Daoud, “Caesarean section: about 147 cases at the Mohamed V Hospital Chefchaouen in northern Morocco,” International Journal of Innovation and Applied Studies, vol. 11, no. 4, pp. 855–862, June 2015.
