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Petitprez K, Guillaume S, Mattuizzi A, Arnal M, Artzner F, Bernard C, Bonnin M, Bouvet L, Caron FM, Chevalier I, Daussy-Urvoy C, Ducloy-Bouthorsc AS, Garnier JM, Keita-Meyer H, Lavillonnière J, Lejeune-Sadaa V, Leray C, Morandeau A, Morau E, Nadjafizade M, Pizzagalli F, Schantz C, Schmitz T, Shojai R, Hédon B, Sentilhes L. [Normal childbirth: physiologic labor support and medical procedures. Guidelines of the French National Authority for Health (HAS) with the collaboration of the French College of Gynaecologists and Obstetricians (CNGOF) and the French College of Midwives (CNSF) -- Text of the Guidelines (short text)]. Gynecol Obstet Fertil Senol 2020; 48:873-882. [PMID: 33011381 DOI: 10.1016/j.gofs.2020.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The objective of these guidelines is to define for women at low obstetric risk modalities that respect the physiology of delivery and guarantee the quality and safety of maternal and newborn care. METHODS These guidelines were made by a consensus of experts based on an analysis of the scientific literature and the French and international recommendations available on the subject. RESULTS It is recommended to conduct a complete initial examination of the woman in labor at admission (consensus agreement). The labor will be monitored using a partogram that is a useful traceability tool (consensus agreement). A transvaginal examination may be offered every two to four hours during the first stage of labor and every hour during the second stage of labor or before if the patient requests it, or in case of a warning sign. It is recommended that if anesthesia is required, epidural or spinal anesthesia should be used to prevent bronchial inhalation (grade A). The consumption of clear fluids is permitted throughout labor in patients with a low risk of general anesthesia (grade B). It is recommended to carry out a "low dose" epidural analgesia that respects the experience of delivery (grade A). It is recommended to maintain the epidural analgesia through a woman's self-administration pump (grade A). It is recommended to give the woman the choice of continuous (by cardiotocography) or discontinuous (by cardiotocography or intermittent auscultation) monitoring if the conditions of maternity organization and the permanent availability of staff allow it and, after having informed the woman of the benefits and risks of each technique (consensus agreement). In the active phase of the first stage of labor, the dilation rate is considered abnormal if it is less than 1cm/4h between 5 and 7cm or less than 1cm/2h above 7cm (level of Evidence 2). It is then recommended to propose an amniotomy if the membranes are intact or an oxytocin administration if the membranes are already ruptured, and the uterine contractions considered insufficient (consensus agreement). It is recommended not to start expulsive efforts as soon as complete dilation is identified, but to let the presentation of the fetus drop (grade A). It is recommended to inform the gynecologist-obstetrician in case of nonprogression of the fetus after two hours of complete dilation with sufficient uterine dynamics (consensus agreement). It is recommended not to use abdominal expression (grade B). It is recommended to carry out preventive administration of oxytocin at 5 or 10 IU to prevent PPH after vaginal delivery (grade A). In the case of placental retention, it is recommended to perform a manual removal of the placenta (grade A). In the absence of bleeding, it should be performed 30minutes but not more than 60minutes after delivery (consensus agreement). It is recommended to assess at birth the breathing or screaming, and tone of the newborn to quickly determine if resuscitation is required (consensus agreement). If the parameters are satisfactory (breathing present, screaming frankly, and normal tonicity), it is recommended to propose to the mother that she immediately place the newborn skin-to-skin with her mother if she wishes, with a monitoring protocol (grade B). Delayed cord clamping is recommended beyond the first 30seconds in neonates, not requiring resuscitation (grade C). It is recommended that the first oral dose (2mg) of vitamin K (consensus agreement) be given systematically within two hours of birth. CONCLUSION These guidelines allow women at low obstetric risk to benefit from a better quality of care and optimal safety conditions while respecting the physiology of delivery.
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Affiliation(s)
- K Petitprez
- Service des bonnes pratiques professionnelles, Haute Autorité de santé, 93218 Saint-Denis, France
| | - S Guillaume
- Service de gynécologie-obstétrique, hôpital Necker-Enfants-Malades, Assistance publique des Hôpitaux de Paris, 75015 Paris, France
| | - A Mattuizzi
- Service de gynécologie-obstétrique, maternité Aliénor d'Aquitaine, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | | | - F Artzner
- Collectif inter-associatif autour de la naissance (CIANE), 93100 Montreuil, France
| | - C Bernard
- Collectif inter-associatif autour de la naissance (CIANE), 75011 Paris, France
| | - M Bonnin
- Service d'anesthésie-réanimation, hôpital d'Estaing, centre hospitalier universitaire de Clermont-Ferrand, 63100 Clermont-Ferrand, France
| | - L Bouvet
- Service d'anesthésie-réanimation, hôpital Femme-Mère-Enfant, hospices civils de Lyon, 69000 Lyon, France
| | - F-M Caron
- Pôle femme enfant Victor-Pauchet, centre hospitalier universitaire d'Amiens, 80080 Amiens, France
| | | | | | - A-S Ducloy-Bouthorsc
- Service d'anesthésie-réanimation, maternité Jeanne-de-Flandre, centre hospitalier régional universitaire de Lille, 59000 Lille, France
| | | | - H Keita-Meyer
- Service d'anesthésie-réanimation, hôpital Necker-Enfants-Malades, Assistance publique des Hôpitaux de Paris, 75015 Paris, France
| | | | - V Lejeune-Sadaa
- Service de gynécologie-obstétrique, centre hospitalier d'Auch, 32008 Auch, France
| | - C Leray
- Service de gynécologie-obstétrique, hôpital Cochin, maternité Port-Royal, Assistance publique des Hôpitaux de Paris, 75014 Paris, France
| | | | - E Morau
- Service d'anesthésie-réanimation, centre hospitalier de Narbonne, 11100 Narbonne, France
| | - M Nadjafizade
- École de sages-femmes, centre hospitalier régional universitaire de Nancy, 54035 Nancy, France
| | - F Pizzagalli
- Service de gynécologie-obstétrique, hôpital Antoine-Béclère, 92140 Clamart, France
| | - C Schantz
- CEPED, IRD, université Paris Descartes, Inserm, équipe SAGESUD, 75006 Paris, France
| | - T Schmitz
- Service de gynécologie-obstétrique, hôpital Robert-Debré, Assistance publique des Hôpitaux de Paris, 75019 Paris, France
| | - R Shojai
- Service de gynécologie-obstétrique, clinique de l'étoile, 13100 Aix-en-Provence, France
| | - B Hédon
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Montpellier, 34295 Montpellier, France
| | - L Sentilhes
- Service de gynécologie-obstétrique, maternité Aliénor d'Aquitaine, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France.
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