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Master Thesis

Prise en charge du placenta praevia hémorragique. Évaluation des pratiques professionnelles à la maternité de Port Royal

Abstract : Placenta previa is a variety of placental insertion particulary feared in obstetric because of its main risk: haemorrhage, especially in the second half of pregnancy and until delivery. Objectives Our study focused on women with a placenta previa until delivery and who have been hospitalized at least once beyond 24 weeks for bleeding. One purpose of this study was to assess the conduct and outcome of these pregnancies to obtain evidences about maternal and perinatal prognosis associated. We also intended to analyse the management of these women in case of bleeding placenta previa, and examine the relation between this management and the occurrence of maternal and/or perinatal severe complications. Materials and methods A retrospective study was performed at the maternity of Port Royal (type III) between January and May 2009, including a total of 79 patients. Results The average number of antepartum bleeding episodes was 3.2. Furthermore, the rate of postpartum haemorrhage was 41%, higher in cases of accreta associated: 93% vs 29% without accreta. Overall, bleeding associated with placenta previa were responsible for: 5% of women transfused in antepartum and 25% in postpartum, hysterectomy for 8% of women, and a postpartum hemoglobin level less than 9g/dl for 48% of women. In case of not covering placenta, the rate of caesarean sections was 56%. Whatever type of placenta, the rate of emergency caesarean section for bleeding was 43% in 82% of cases before 37 weeks. The prematurity rate was 66%, and the average gestational age at delivrery was 34.5 weeks. For 68% of women affected by severe maternal and/or perinatal complications, it has not been highlighted links with practices conducted. The protocol of Port Royal was generally respected. Differentials focused on the contraindication to vaginal examination in cases of covering placenta, and the modalities for tocolysis. The main difficulties in management were to assess as fairly as possible when a caesarean was necessary due to too heavy or persistent bleeding. Conclusion Bleeding placenta previa is associated with a high maternal and perinatal morbidity. In most cases, severe associated complications are difficult to prevent.
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Dorine Ley. Prise en charge du placenta praevia hémorragique. Évaluation des pratiques professionnelles à la maternité de Port Royal. Gynécologie et obstétrique. 2010. ⟨dumas-00566252⟩

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