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Les risques maternels et fœtaux de la césarienne programmée et en urgence

Maternal and foetal’s risks of planned and emergency cesarean delivery

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Pelvi-périnéologie

Résumé

L’augmentation du taux de césarienne a un impact probable sur la santé publique; même si cette intervention est actuellement banalisée et rapide. Les médecins et les patients doivent tenir compte de la balance risques/bénéfices de la césarienne par rapport à la voie basse. Cet article étudie la morbimortalité maternelle et foetale en cas d’accouchement par césarienne et recherche également des différences entre les césariennes en urgence et celles qui sont programmées en dehors du travail. Les données sur ce sujet sont limitées; il n’y a actuellement pas d’études randomisées permettant de comparer les deux voies d’accouchements. La césarienne en urgence semble liée à une augmentation de la mortalité et de la morbidité maternelle grave et minime, que ce soit par rapport à l’accouchement par voie basse ou par rapport à la césarienne programmée. Les risques d’hémorragie de la délivrance sont doublés et les complications peropératoires triplées en cas de césarienne en urgence. Le taux d’infection postnatale peut atteindre 10 % en cas de césarienne. Pour les risques foetaux associés à la naissance par césarienne, il y a peu de données; en particulier pour comparer les résultats entre césarienne programmée et en urgence. Il existe un excès de pathologies respiratoires néonatales en cas de césarienne en comparaison à la voie basse, pouvant être multiplié par un facteur dix. Un excès d’échecs d’allaitement maternel est également associé à l’accouchement par césarienne.

Abstract

Increased rate of cesarean section have the potential for a significant impact on public health, even if this intervention is now considered a routine procedure. Physicians and patients considering cesarean delivery may consider the balance between the risks and benefits of a cesarean section versus a planned vaginal delivery. This article aims to investigate the association between cesarean delivery and maternal and neonatal mortality and morbidity. Differences between emergency cesarean section and planned cesarean delivery were studied. Available data are subject to several limitations. There are no randomized trial data comparing outcomes among cesarean delivery versus planned vaginal birth. Emergency cesarean sections are associated with an increased maternal mortality as well as minor and severe maternal morbidity in comparison with vaginal delivery or planned cesarean section. The rate of respiratory morbidity is significantly higher in neonates delivered by c-section compared to those delivered vaginally. In addition, an excess of breastfeeding failure is associated with caesarean delivery.

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Authors and Affiliations

  1. Pôle d’obstétrique, hôpital Jeanne-de-Flandre, CHRU de Lille, avenue Eugène-Avinée, F-59000, Lille, France

    A. Ladaique, A. Leroch’ & P. Deruelle

  2. Faculté de médecine Henri-Warembourg, université de Lille, F-59045, Lille cedex, France

    P. Deruelle

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  1. A. Ladaique
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  2. A. Leroch’
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  3. P. Deruelle
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Correspondence to P. Deruelle.

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Ladaique, A., Leroch’, A. & Deruelle, P. Les risques maternels et fœtaux de la césarienne programmée et en urgence. Pelv Perineol 4, 200–206 (2009). https://doi.org/10.1007/s11608-009-0251-z

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  • DOI: https://doi.org/10.1007/s11608-009-0251-z

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