Revue de médecine périnatale

, Volume 2, Issue 1, pp 12–18

Accouchement avec utérus cicatriciel

  • J. Niro
  • L. Velemir
  • F. Vendittelli
  • B. Jacquetin
  • D. Gallot
  • D. Lemery
Article Original / Original Article
  • 79 Downloads

Résumé

L’utérus cicatriciel est devenu le premier motif de césarienne itérative. Le risque de rupture utérine est estimé autour de 0,7 ‰, et environ 600 césariennes seraient nécessaires pour éviter une complication néonatale grave. Parallèlement, la morbidité maternelle a augmenté par les anomalies d’insertions placentaires, responsables de complications hémorragiques graves. Il convient de discuter avec le couple de la voie d’accouchement en cherchant d’abord à identifier d’emblée toute contre-indication à la voie basse, puis les arguments favorables au succès de celle-ci. En cas de césarienne prophylactique, on attendra 39 SA pour diminuer la morbidité respiratoire fœtale. En cas de déclenchement, il faudra respecter les recommandations de la Haute Autorité de Santé (HAS) et informer la patiente du risque majoré de rupture utérine.

Mots clés

Utérus cicatriciel Épreuve du travail Intention de voie basse Rupture utérine Déclenchement du travail 

Delivery after previous caesarean section

Abstract

Scarred uterus became the first motive for iterative cesarean. The risk of uterine break is considered near 0.7‰ and approximately 600 cesarians would be necessary to avoid a neonatal serious complication. At the same time, the maternal morbidity increased by the abnormalities of placental insertions is responsible for important haemorrhagic complications. It is advisable to discuss with the couple of the way of delivery by trying at first to identify at once any contraindication for trial of labor and then the favorable arguments for his success. In case of preventive cesarean, we shall wait for 39 weeks to decrease the fetal respiratory morbidity. In case of release, it will be necessary to respect official recommendations and to inform the patient of the risk increased by uterine break.

Keywords

Uterine scar Trial of labor Previous cesarean Uterine rupture Labor induction 

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Copyright information

© Springer 2010

Authors and Affiliations

  • J. Niro
    • 1
  • L. Velemir
    • 1
  • F. Vendittelli
    • 1
    • 3
  • B. Jacquetin
    • 1
  • D. Gallot
    • 1
    • 2
  • D. Lemery
    • 1
    • 2
    • 3
  1. 1.CHU de Clermont-Ferrand, pôle de gynéco-obstétrique-reproduction humaineClermont-Ferrand cedex 01France
  2. 2.faculté de médecineUMR CNRS6247 GReD, Clermont-UniversitéClermont-FerrandFrance
  3. 3.Réseau de santé périnatale d’AuvergneCHU de Clermont-FerrandClermont-Ferrand cedex 01France

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