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Banco de dados - Alliance francophone pour l'accouchement respecté (AFAR)

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http://afar.info/id=851/pt

Criado em : 26 Jul 2004
Alterado em : 27 Oct 2018

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Nota bibliográfica (sem autor) :

The effect of fundal pressure manoeuvre on intrauterine pressure in the second stage of labour. BJOG. 2002 May;109(5):520-6.

Autores :

Buhimschi CS, Buhimschi IA, Malinow AM, Kopelman JN, Weiner CP.

Ano de publicação :

2003

URL(s) :

https://obgyn.onlinelibrary.wiley.com/doi/full/10.…
https://doi.org/10.1111/j.1471-0528.2002.01399.x

Résumé (français)  :

OBJECTIF : Etudier la relation entre la pression intra-utérine et l’application d’une manœuvre d’expression abdominale standardisée, et déterminer les caractéristiques maternelles, fœtales et du travail qui modulent la relation.

SCHÉMA : Mesure prospective de la pression intra-utérine au cours du deuxième stade du travail.

CONTEXTE : Hôpital universitaire nord-américain.

POPULATION : Quarante femmes en accouchement spontané à terme complet ont été étudiées au cours de la deuxième étape. Chaque femme agissait comme son propre contrôle. Toutes les femmes atteintes de l’analgésie péridurale demandée.

MÉTHODES : Une manœuvre d’expression abdominale a été réalisée afin de normaliser le niveau de force et la surface d’application. La pression intra-utérine a été mesurée à l’aide d’un cathéter à sonde. Cinq interventions ont été analysées: 1. Valsalva lors d’une contraction utérine; 2. expression abdominale et valsalva lors d’une contraction; 3. expression abdominale lors d’une contraction sans valsalva; 4. expression abdominale en l’absence de contractions utérines; et 5. valsalva en l’absence de contractions utérines.

RÉSULTATS : Les femmes au deuxième stade du travail ont augmenté de manière transitoire leur force expulsive (reflétée par la pression intra-utérine) de 86% de leur contraction de base en utilisant simultanément valsalva et l’expression abdominale. L’efficacité avec laquelle les deux manœuvres augmentant la contraction augmentaient la pression intra-utérine était directement liée à l’âge gestationnel et inversement à l’épaisseur du myomètre.

CONCLUSION : L’expression abdominale appliquée dans des conditions contrôlées augmente considérablement la pression intra-utérine chez certaines femmes, mais pas toutes. La mesure simultanée de la pression intra-utérine, afin de conserver les informations pendant l’application, créera un “environnement contrôlé“ pour l’obstétricien et assurera que cette manœuvre peut être appliquée de manière contrôlée. La délimitation future du groupe de femmes pouvant bénéficier de l’expression abdominale, ainsi que du groupe réfractaire, est essentielle pour éviter des interventions chirurgicales inutiles ou retardées.

Abstract (English)  :

OBJECTIVE: To investigate the relationship between intrauterine pressure and the application of a standardised fundal pressure manoeuvre, and to determine the maternal, fetal and labour characteristics that modulate the relationship.

DESIGN: Prospective measurement of intrauterine pressure during the second stage of labour.

SETTING: North American university hospital.

POPULATION: Forty full-term women in spontaneous labour were studied during the second stage. Each woman acted as her own control. All women laboured with requested epidural analgesia.

METHODS: A fundal pressure manoeuvre was performed so as to standardise the level of force and the surface area of application. Intrauterine pressure was measured using a sensor-tip catheter. Five interventions were analysed: 1. valsalva during a uterine contraction; 2. fundal pressure and valsalva during a contraction; 3. fundal pressure during a contraction without valsalva; 4. fundal pressure in the absence of uterine contractions; and 5. valsalva in the absence of uterine contractions.

RESULTS: Women in the second stage of labour transiently increased their expulsive force (as reflected by intrauterine pressure) by 86% of their baseline contraction using valsalva and fundal pressure simultaneously. The efficiency by which both contraction-enhancing manoeuvres increased intrauterine pressure was directly related to gestational age and inversely related to myometrial thickness.

CONCLUSION: Fundal pressure applied under controlled conditions significantly increases intrauterine pressure in some, but not all women. Simultaneous measurement of intrauterine pressure, to maintain feedback during application will create a ’controlled environment’ for the obstetrician and reassurance that this manoeuvre can be applied in a controlled fashion. Future delineation of the group of women that could benefit from fundal pressure, as well as the group that is refractory is essential to avoid unnecessary or delayed operative interventions.

Sumário (português)  :

Comentários :

Argument (français) :

L’expression abdominale appliquée dans des conditions contrôlées augmente considérablement la pression intra-utérine chez certaines femmes, mais pas toutes.

Argument (English):

Fundal pressure applied under controlled conditions significantly increases intrauterine pressure in some, but not all women.

Argumento (português):

A expressão abdominal sob condições controladas aumenta significativamente a pressão intra-uterina em algumas mulheres, mas não em todas.

Palavras-chaves :

➡ idade materna ; expressão abdominal

Autor da esta ficha :

Cécile Loup — 26 Jul 2004 ➡ última atualização : Bernard Bel — 27 Oct 2018


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filiados Collectif interassociatif autour de la naissance (CIANE, http://ciane.net).
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