Objectif. - La prise en charge des menaces d'accouchement premature (MAP) est une activite quotidienne des perinatologues des maternites de type I et II. L'objectif de cette etude est de determiner la frequence des appels pour MAP, et d'evaluer l'algorithme utilise.Patientes et methode. - Enquete prospective et suivi a trois mois de tous les cas de MAP transferes, durant une periode de huit mois, a la cellule des transferts perinataux de la region Rhone-Alpes.Resultats. - Le taux de TIU en Rhone-Alpes est de 10,5/10 000 naissances en 2002. Les appels pour MAP representent 40 % des appels pour transfert in utero. Deux cent soixante-cinq appels ont ete recus, dont 201 pour des MAP isolees. Vingt-six pour cent des patientes transferees presentaient une grossesse gemellaire. Aucune des 176 femmes transferees n'a accouche pendant le transport. Vingt-huit patientes etaient a plus de 4 cm de dilatation tandis que 173 etait a moins de 4 cm de dilatation. Parmi ces dernieres, 26 % ont eu une echographie du col avant le transfert et 71 % n'ont pas accouche sept jours apres l'appel. Aucune des femmes dont le col mesurait plus de 27 mm n'a accouche dans les sept jours suivant l'appel. Cinquante pour cent des femmes qui etaient a 4 cm ou plus de dilatation lors de l'appel ont accouche plus de quatre heures apres l'appel.Discussion et conclusion. - La MAP est la premiere cause de transfert in utero de la region Rhone-Alpes. L'algorithme utilise par la cellule valide les places respectives de l'echographie du col et de l'examen clinique avant TIU. Une dilatation avancee lors de l'appel n'est qu'une contre-indication relative au TIU. La realisation d'une echographie du col avant le transfert permet d'annuler le transfert si le col mesure 27 mm ou plus. L'utilisation de cet algorithme permet de distinguer des MAP << pediatriques >> ou << non pediatriques >> selon l'imminence de l'accouchement.
Objective. - Preterm labor is one of the major causes of concern for level I and II obstetricians. The purpose of this study was to determine the incidence of in utero transfer performed for preterm labor. We also aimed to evaluate the algorithm we used in case of call for preterm labor. This algorithm allowed us to study the rate of endovaginal sonography use prior to in utero transfer, to calculate its predictive value and to evaluate the risk of delivery during transfer.Patients and method. - We conducted an 8-months prospective study of all calls for preterm labor received at a regional call center in France (EU). All obstetrical data were entered in a computerized anonymous database. Three months after the first call midwives collected data from the receiving hospital.Results. - Calls for preterm labor account for 40% of calls for in utero transfer. Two hundred and sixty-five calls have been received for preterm labor; among them 50 cases were associated with a preterm rupture of membrane, a maternal or fetal pathology and 14 cases were lost for follow-up. Those 64 cases were excluded leaving 201 cases for analysis. Twenty-eight had a cervix dilated 4 cm, or more,, while 173 had a cervix dilated less than 4 cm.Fifty percent of woman that had a cervical dilatation of 4 cm or more delivered more than 4 h after the call. Among the 173 patients that had a cervix dilated less than 4 cm, 71% had not delivered 7 days after the hotline call and 26% had an endovaginal ultrasonography performed before the transfer. None of the women that had a cervical length longer than 27 mm delivered in the 7 following days. None of the 176 women that were transferred delivered during the transfer.Discussion and conclusion. - In utero transfer for preterm labor is the leading cause of in utero transfer. Endovaginal ultrasonography prior to transfer should be performed in order to avoid unnecessary transfer. Women who have a preterm labor with a cervical dilatation of 4 cm or more are not an absolute contra-indication to in utero transfer. In those cases the transfer indication should be discussed on a case-to-case basis including the actual term and the distance between hospitals.