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.