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Contre la césarienne systématique pour la naissance des grands prématurés

  • Conference paper
41es Journées nationales de la Société Française de Médecine Périnatale (Grenoble 12–14 octobre 2011)

  • 258 Accesses

Résumé

La grande prématurité se définit comme la survenue d’un accouchement avant 32 SA. Cette situation dont la hausse constante est générée par notre pratique médicale représente aujourd’hui plus de 1 % des naissances. Après une période où la naissance des grands prématurés s’envisageait généralement par césarienne, afin de ne pas exposer ces fœtus fragiles aux contractions du travail et aux aléas de l’expulsion, est venu le temps de la remise en question. La pertinence des données de la littérature dont nous disposons est fragile. Les essais contrôlés randomisés sont quasi inexistants. Seules des études observationnelles de cohorte sont disponibles. Elles n’ont pour la plupart pas réussi à démontrer un intérêt, en termes d’amélioration du pronostic périnatal, d’une politique de césarienne systématique vis-à-vis de la grande prématurité isolée. Quel que soit le mode d’accouchement, la mortalité néonatale et la morbidité neurologique semblent identiques. La morbidité respiratoire est plutôt en défaveur de la césarienne. Par ailleurs, la morbidité maternelle imputable à la césarienne est bien connue. Elle semble plus importante dans le cadre de la grande prématurité du fait de la nature corporéale plutôt que segmentaire de la cicatrice.

Si bien qu’au total, il n’y a plus lieu de recommander une césarienne systématique pour l’accouchement d’un grand prématuré. Néanmoins, la fragilité du grand prématuré impose de réagir sans retard à une situation d’hypoxie fœtale en cours de travail et ce, dès que celle-ci est repérée. Une politique libérale de césarienne facile demeure nécessaire pour toutes les situations pathologiques qui compliquent la grande prématurité pendant ou en dehors du travail.

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Authors
  1. F. Sergent
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  2. V. Equy
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  3. P. Hoffmann
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  4. J.-C. Pons
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  5. J.-P. Schaal
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Sergent, F., Equy, V., Hoffmann, P., Pons, JC., Schaal, JP. (2011). Contre la césarienne systématique pour la naissance des grands prématurés. In: 41es Journées nationales de la Société Française de Médecine Périnatale (Grenoble 12–14 octobre 2011). Springer, Paris. https://doi.org/10.1007/978-2-8178-0257-2_19

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  • DOI: https://doi.org/10.1007/978-2-8178-0257-2_19

  • Publisher Name: Springer, Paris

  • Print ISBN: 978-2-8178-0256-5

  • Online ISBN: 978-2-8178-0257-2

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