Pronostic obst étrical des patientes présentant un antécédent de césarienne réalisée avant 32 semaines d’aménorrhée

Conclusion Après une césarienne réalisée avant 32 SA, la TVBAC doit être encouragée sur conditions locales favorables, les taux de réussite étant comparables à une césarienne à terme. Le taux de rupture utérine (complète ou sous-péritonéale) semble cependant légèrement accru par rapport au risque après césarienne réalisée à terme, pouvant même survenir précocement et en dehors de tout travail. Objective To assess delivery mode, maternal morbidity including uterine rupture and scar dehiscence and neonatal outcome, during a pregnancy after a previous caesarean delivery before 32 weeks of amenorrhea. Methods A retrospective descriptive study was carried out at the Besançon University Hospital during an 8-year period. We identified 292 consecutive patients presenting a singleton pregnancy delivery before 32 weeks of amenorrhea. We analysed the next pregnancy. Patients presenting more than one caesarean section were excluded from this study. Results Out of the 292 patients, 62 met inclusion criteria. The average gestational age of the first caesarean section was 29 weeks and 3 days. Among these patients, 17 (27.4%) had a planned caesarean delivery after caesarean (CDAC) and 45 (72.6%) had a trial of vaginal delivery (TVD) with a success rate of 71.1%, that is a total of 51.6% of vaginal delivery after a previous early caesarean section. In case of a failed TVD, arterial pH (P <0.005), Apgar score at one minute (P <0.05) and at 10minutes (...

Source: Gynecologie Obstetrique and Fertilite - October 16, 2016 Category: OBGYN Source Type: research