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Master Thesis

Y a-t-il un intérêt à la pratique du toucher vaginal en systématique dans le suivi des grossesses à bas risque ?

Abstract : INTRODUCTION Is not reducing mortality and morbidity the common goal of obstetrics and pediatrics ? And yet, preterm birth is, at the moment, the first cause of these morbid-mortalities in France. Consequently, the screening of pregnancies exposed to a threatened preterm labor is of a certain interest. The evaluation of the cervix through cervical examination seems to be the first method used to diagnose this risk. Moreover, resorting to the latter seems to be frequent during the steady of pregnancy. However, many European countries did not choose a routine cervical examination during prenatal consultations. And yet, some of them present an equal, even an inferior, rate of preterm birth to ours. Is there an interest in the practice of routine cervical examinations during low-risk pregnancies ?

OBJECTIVE In order to work out a reflection about our methods, it seemed essential to turn to the goals and consequences of this examination. Thus, the interest of our work was both on practitioners and patients.

METHODS An analysis of the professional practices in Angers was made between September and December 2009 through a written and anonymous questionnaire. Among the liberal field (in town) and the hospital field, gynecologists-obstetricians, midwives and general practitioners were interrogated. The number of questionnaires which could be used was up to 133. A survey was given to patients in the postpartum period from October to December 2009 in the hospital of Angers through a written and anonymous questionnaire. The number of them which could be used was up to 137.

RESULTS A majority of professionals surveyed seemed to use cervical examinations for each pregnancy consultation. However, there were a lot who would be ready to change their methods to use a targeted one for the exam. Finally, the profession and the professional experiment seemed primordial in this type of practice. The patients, were for most, willing to be informed on their cervix during obstetrical examinations. Thus, this exam seemed reassuring for the majority of pregnant women. Eventually, there would exist a link between parity and this desire to be informed, and also between the type of practice of the practitioner and this same desire.

CONCLUSION Nothing seems to oppose a changing in the French methods, as regards cervical examination, for various reasons. First, the young professionals, who have just been graduated, seem to use this examination less often. Second, the patients consulting a practitioner who use a targeted one for the exam are less willing to be informed about their cervix. Thirdly, literature exposes the uselessness of the routine cervical examination during a low-risk pregnancy, for the prevention of preterm deliveries. What's more, no recommendation of practice, seems, in France, to indicate the use of this method for each obstetric consultation. Finally, there is no legislative law about the attitude to adopt as far as cervical examinations are concerned.

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Submitted on : Tuesday, January 10, 2012 - 11:46:29 AM
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Romain Lorioux. Y a-t-il un intérêt à la pratique du toucher vaginal en systématique dans le suivi des grossesses à bas risque ?. Gynécologie et obstétrique. 2010. ⟨dumas-00658331⟩



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