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La femme enceinte obèse : le point de vue de l’anesthésiste

Obese pregnant woman: The anaesthesist point of view

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Revue de médecine périnatale

Résumé

La parturiente obèse est à haut risque de morbimortalité péripartum par l’association des modifications physiologiques de l’obésité et d’éventuelles comorbidités associées aux modifications physiologiques de la grossesse. La prise en charge anesthésique doit privilégier l’anesthésie locorégionale afin d’éviter le recours à l’anesthésie générale et les risques auxquels elle expose. L’analgésie péridurale obstétricale est une indication médicale pour l’accouchement par voie basse et la rachianesthésie avec péridurale combinée est la technique à recommander pour la césarienne. L’antibioprophylaxie pour la césarienne devra utiliser des posologies adaptées à l’IMC, certains recommandant même une bithérapie. La thromboprophylaxie pourra être indiquée même en cas d’accouchement par voie basse et sera dans tous les cas adaptée à l’IMC.

Abstract

The obese parturient is a high risk patient by the combination of obesity and pregnancy physiological changes. Regional anesthesia is recommended to avoid general anaesthesia. Epidural analgesia is a medical indication for vaginal delivery and spinal combined spinal and epidural anaesthesia is recommended for caesarean section. Antibiotic prophylaxis for cesarean section should use dosages correlated with BMI, some even recommending combination therapy. Thromboprophylaxis may be indicated even if vaginal delivery and will be correlated with BMI.

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Authors and Affiliations

  1. Pôle femme et enfant, hôpital Estaing, CHU Clermont-Ferrand, 1 place Lucie Aubrac, F-63000, Clermont-Ferrand, France

    M. Bonnin & B. Storme

  2. Club d’anesthésie réanimation obstétricale, MK communication secrétariat logistique CARO, 52 avenue de Cournon, F-63170, Aubière, France

    M. Bonnin, D. Chassard, A. S. Ducloy-Bouthors, H. Keita-Meyer & E. Moreau

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  1. M. Bonnin
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  2. B. Storme
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  3. D. Chassard
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  4. A. S. Ducloy-Bouthors
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  5. H. Keita-Meyer
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  6. E. Moreau
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Correspondence to M. Bonnin.

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Bonnin, M., Storme, B., Chassard, D. et al. La femme enceinte obèse : le point de vue de l’anesthésiste. Rev. med. perinat. 8, 187–191 (2016). https://doi.org/10.1007/s12611-016-0387-3

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  • DOI: https://doi.org/10.1007/s12611-016-0387-3

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