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Accouchement avec utérus cicatriciel

Delivery after previous caesarean section

  • Article Original / Original Article
  • Published:
Revue de médecine périnatale

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.

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.

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Authors and Affiliations

  1. CHU de Clermont-Ferrand, pôle de gynéco-obstétrique-reproduction humaine, boulevard Léon-Malfreyt, Hôtel-Dieu, F-63058, Clermont-Ferrand cedex 01, France

    J. Niro, L. Velemir, F. Vendittelli, B. Jacquetin, D. Gallot & D. Lemery

  2. faculté de médecine, UMR CNRS6247 GReD, Clermont-Université, 28, place Henri-Dunant, F-63000, Clermont-Ferrand, France

    D. Gallot & D. Lemery

  3. Réseau de santé périnatale d’Auvergne, CHU de Clermont-Ferrand, boulevard Léon-Malfreyt, F-63058, Clermont-Ferrand cedex 01, France

    F. Vendittelli & D. Lemery

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  1. J. Niro
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  2. L. Velemir
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  3. F. Vendittelli
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Correspondence to J. Niro.

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Niro, J., Velemir, L., Vendittelli, F. et al. Accouchement avec utérus cicatriciel. Rev. med. perinat. 2, 12–18 (2010). https://doi.org/10.1007/s12611-010-0056-x

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  • DOI: https://doi.org/10.1007/s12611-010-0056-x

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