2023-12-18 11:20:25
The intervention called PRISMA led to a 48% reduction in serious complications in mothers and a 28% reduction in serious complications in babies, shows a study led by a team from Laval University.
“We wanted to show that the right intervention to the right patient at the right time would reduce complications,” said the first author of the study, Nils Chaillet, who is a professor at the Faculty of Medicine at Laval University and a researcher. at the Research Center of the CHU de Québec-Université Laval.
It is estimated that each year in Canada, some 45,000 women who have already had a cesarean section must decide whether their next birth will also be by cesarean section, or whether they will opt instead for a vaginal birth. The decision can be difficult, since each option carries its own set of risks.
Some patients who would benefit from a cesarean section may still be tempted by a vaginal birth, said Mr. Chaillet; Conversely, patients who are good candidates for vaginal delivery may be tempted by a cesarean section. The new tool will inform their decision.
Uterine rupture
Professor Chaillet and his collaborators from Quebec, the United States and France tested PRISMA on nearly 11,000 pregnant women who had previously given birth by cesarean section. The incidence of complications associated with the delivery of these women was compared to that of a group of comparable size composed of women who had also given birth by cesarean section previously, but who did not benefit from the procedure.
Study participants gave birth in 40 hospitals in Quebec between 2016 and 2019.
PRISMA uses an ultrasound examination to predict the risk of uterine rupture. This predictive tool was developed by Emmanuel Bujold, who is a professor at Laval University and co-author of the study. Another tool predicts the chances of a successful vaginal delivery.
All this information allows the woman, together with her doctor, to make a more informed decision.
These tools, assure the authors of the study, predict the risk of complications, while promoting a high level of care during childbirth.
“So first we detect the risks, and then we act on the quality of care so that the patient can receive optimal care,” summarized Professor Chaillet.
“The Sword of Damocles”
PRISMA could also remove what the researcher called “the sword of Damocles” that hangs over the heads of doctors who embark on a vaginal birth without knowing whether the patient’s uterus will hold up until the end. end. Thanks to this new data, “the doctor will be able to apply the standards of care that have been shown to him, without ulterior motives,” said Mr. Chaillet.
The data will also allow the healthcare team to better determine how patient they can be during delivery, he added: can we afford to let labor continue for a while longer? knowing that the uterus is strong, or should we instead consider a cesarean section more quickly than we would otherwise?
“The results showed that we are able to significantly reduce the baby’s severe complications without increasing the risk of cesarean section or uterine rupture,” underlined Mr. Chaillet. Complications decreased significantly because we gave the right intervention to the right patient at the right time.”
The PRISMA intervention is now implemented in hospitals that tested it as part of the study.
The conclusions of this study were published by the prestigious medical journal The Lancet.
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