PICO MID drainage cordon

DRAINAGE DU CORDON OMBILICAL
QUESTION: Est-ce que la drainage du cordon ombilical en ante-partum immédiat est
bénéfique pour la réduction des hémorragies utérines immédiates et facilite le
décollement placentaire?
AUTEUR:
Marie-Isabelle Desrosiers (Juillet 2008)
SUPERVISEUR :
Guylène Thériault
P
:
Patiente en ante-partum immédiat
I
:
Laisser drainer le sang du cordon ombilical
C
:
Versus le clamper
O
:
Facilitation du décollement placentaire et diminution du saignement postpartum immédiat
CONTEXTE: En faisant mon stage en obstétrique, certains médecins me disent qu'il
est préférable de faire drainer le sang du coron coupé en attendant la délivrance du
placenta car cela favoriserait le décollement placentaire et diminuerait possiblement les
risques de saignements utérins immédiats. Toutefois, un obstétricien m'a dit de ne pas
faire cela, de le clamper car il n'y aurait aucune évidence et que dans ce contexte, c'est
mieux de clamper pour diminuer le risque de contamination avec le sang du personnel.
RECHERCHE:
Pub Med: Umbilical cord drain*: 2/ 77 article intéressant, un sans traduction disponible
(portuguais) et l'autre est mentionné est la revue de Cochrane: "Placental cord drainage
after spontaneous vaginal delivery as part of the management of the third stage of
labour".
Clinical Evidence: placenta: 36 résultats dont 1. "Pregnancy and childbirth", section
"Post partum hemorrhage prevention". La revue systématique se fonde sur celle de
Cochrane (ci-bas), toutefois on ne spécifie pas bien l'effet du drainage seul, cela est
regroupé globalement dans le management actif.
Cochrane: umbilical cord drainage: 8 articles dont un est bon: Placental cord drainage
after spontaneous vaginal delivery as part of the management of the third stage of
labour (Review)
RÉSULTATS:
1) Pub Med:
Placental cord drainage after spontaneous vaginal delivery as part of the
management of the third stage of labour.
Drainage du cordon ombilical
2) Clinical Evidence: "Pregnancy and childbirth", section "Post partum hemorrhage
prevention", June 2005.
Leurs données viennent de la revue systématique de Cochrane.
One systematic review found that active management of the third stage of labour,
consisting of controlled cord traction, early cord clamping plus drainage, and a
prophylactic oxytocic agent, reduced postpartum haemorrhage of 500 or 1000 mL or
greater and related morbidities including mean blood loss, postpartum haemoglobin less
than 9 g/dL, blood transfusion, need for supplemental iron postpartum, and length of
third stage of labour. Although active management increased adverse effects such as
nausea, vomiting, and headache, one RCT identified by the review found that women
were less likely to be dissatisfied when their third stage of labour was actively managed.
3) Cochrane:
Placental cord drainage after spontaneous vaginal delivery as part of the management
of the third stage of labour. (Review)
The objective of this review was to assess the specific effects of placental cord drainage
on the third stage of labour, with or without the prophylactic use of oxytocics.
Two studies met our inclusion criteria in terms of quality and relevance. Cord drainage
could impact the third stage of labour as the results show a statistically significant
reduction in the length of third stage of labour (one trial, n = 147, weighted mean
difference (minutes) -5.46, 95% confidence interval (CI) -8.02 to -2.90). In the incidence
of retained placenta at 30 minutes after birth (one trial, n = 477, relative risk 0.28, 95%
CI 0.10 to 0.73) a significant difference was found, but this should be interpreted with
caution due to potential intervention bias.
AUTHORS' CONCLUSIONS: It is difficult to draw conclusions from such a small number
of studies, especially where the review outcomes were presented in a variety of formats.
However, there does appear to be some potential benefit from the use of placental cord
drainage in terms of reducing the length of the third stage of labour. More research is
required to investigate the impact of cord drainage on the management of the third stage
of labour.
CONCLUSION :
Il manque d'évidence sur l'impact du drainage du cordon ombilical en troisième stade.
Toutefois, les études démontrent des bénéfices sur la diminution de la durée du
troisième stage en gestion active. Pour ce qui est de la réduction des pertes sanguines
et de la réduction des rétention placentaire, cela demeure à étude à l'égard de ces
données, je vais continuer le drainage du cordon ombilical car il démontre des
bénéfices.