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Master Thesis

Le cerclage prophylactique : état des lieux à la maternité de Robert-Debré entre janvier 2003 et décembre 2013

Abstract : Background: Prior preterm birth (PTB) or second trimester loss (STL) are risks factors of preterm delivery. Patients often require care after such an event. Even if few interventions have improved outcomes, the management of patients with prior PTB or STL pregnanci(es) remains an important challenge in modern obstetric. Cervical cerclage is the cornerstone of the treatment of women with a cervical insufficiency history, but it is still performed despite the lack of a targeted population for whom the evidence of a benefit is well established. Objective: The aim of the study is to evaluate prophylactic cerclage efficacy when its indication is based on obstetrical history according to different levels of risk. We want to suggest answers to patients in demand of care in the time of pre-conceptual or early-pregnancy consultations. Study design: A retrospective cohort study was conducted at the tertiary unit of Robert Debré in Paris between January 2003 and December 2013. Patients included had a prophylactic cerclage based on their obstetrical history with the McDonald procedure. Multiple pregnancies and induced preterm births were excluded from the analysis. The primary outcome was cerclage’s efficacy defined as a gestational age at delivery more or equal to 37 weeks’ gestation. Main results: Of the 208 patients who met inclusion criteria, 31,2 % had a preterm delivery (< 37 SA). Patients with one or 2 prior STL or PTB or those with prior successful prophylactic cerclage had a success rate of 76,5 % whereas patients with at least 3 prior STL or PTB or those with prior failure had a success rate of 49,2%. Conclusion: Patients with one or 2 prior STL or PTB or prior successful prophylactic cerclage are good candidates for the cerclage studied. By contrast alternative methods should be proposed to women with at least 3 prior STL or PTB or those with prior failure.
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https://dumas.ccsd.cnrs.fr/dumas-01194751
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Submitted on : Tuesday, November 3, 2015 - 2:26:16 PM
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  • HAL Id : dumas-01194751, version 1

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Juliette Deu. Le cerclage prophylactique : état des lieux à la maternité de Robert-Debré entre janvier 2003 et décembre 2013 . Gynécologie et obstétrique. 2015. ⟨dumas-01194751⟩

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