Résumé
La césarienne concerne un grand nombre de patientes et de structures de soins. Grâce aux évolutions de la technique chirurgicale et du blocage efficace des afférences grâce à l’emploi de l’anesthésie locorégionale, l’agression tissulaire que représente la césarienne est bien moins importante qu’il y a quelques années encore. On peut même aujourd’hui considérer la césarienne comme une intervention chirurgicale mineure. Plus que dans d’autres domaines de la chirurgie, la restauration rapide de l’état physiologique est primordiale en raison de la création des liens mèreenfant. Pour restaurer le fonctionnement physiologique et accélérer le retour rapide à une vie normale, plusieurs actions sont possibles et méritent d’être mises en place rapidement dans toutes les structures. La limitation des soins invasifs (sonde urinaire, perfusion intraveineuse) représente le premier moyen simple. Ceci se traduit par une reprise précoce des boissons et de l’alimentation, tout en assurant une analgésie multimodale adéquate afin de réduire le recours aux antalgiques morphiniques et donc leurs effets secondaires. Prévenir de façon simple et efficace les hémorragies du postpartum grâce à l’administration d’une dose unique d’un ocytocique de longue durée d’action participe à la stratégie visant à raccourcir la durée du maintien de la voie veineuse.
Abstract
Caesarean delivery is more and more becoming a minor surgical procedure as present surgical techniques are associated with reduced trauma and because it is possible to return to normal life soon after surgery. Moreover, this surgical procedure is performed in numerous patients and institutions. More than in any other surgical procedure, rapid postoperative rehabilitation is essential to facilitate maternal and neonatal bonding. Improvement of present practice should be implemented rapidly in all institutions and may be obtained by modifying some simple but important strategies. Reducing invasiveness of care (postpartum avoidance of urinary catheter and of intravenous infusion) is the primary goal to achieve and is associated with rapid allowance of drinking in the post-anaesthesia care unit and oral feeding in the first hours after surgery. Adequate pain relief may be obtained by using multimodal strategies which allow a reduced use of opioids and their accompanying their side effects. Patient controlled oral analgesia can be combined with this strategy. Preventing postpartum haemorrhage by administration of an oxytocic drug, and choosing whenever possible carbetocin which is administered as a single injection also reduces the use of postoperative intravenous fluids. These simple and easy to implement recommendations should now be undertaken in every maternity unit by using multidisciplinary clinical pathways.
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Wyniecki, A., Benhamou, D. Réhabilitation précoce postopératoire après césarienne. Rev. med. perinat. 4, 119–125 (2012). https://doi.org/10.1007/s12611-012-0197-1
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DOI: https://doi.org/10.1007/s12611-012-0197-1