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Master Thesis

Interruption médicale de grossesse : indications et analyse des pratiques obstétricales sur trois ans au CHU de Bordeaux

Abstract : Objective: Analyze the different methods of termination of pregnancy (TOP) and their complications according to the term. Our secondary aim is to analyze patient’s health care and TOPs management. Study Design We conducted a descriptive retrospective unicentric study in a French department: “Maternité Alienor d’Aquitaine” in Bordeaux hospital. We included all TOPs between 01/01/2012 and 12/31/2014. We analyzed the general characteristics of patients with their postpartum data, circumstances of discovery of the anomalies, complementary examinations and different TOP technics. Results 324 patients were listed (2 % of the births of the Bordeaux department). There was a fetal indication in 94 % of the TOPs. The main reason for termination was malformation discovery by ultrasound screening in the first and the second trimesters of pregnancy. Maternal indications of TOPs were rare. The choriocentesis was most used for the caryotypique analysis in our center. 18 % of the TOPs were made during the third trimester with one month of delay for the management at this length of gestation. We found a global rate of 69 % of vaginal deliveries, 29 % by curettage (16 % of them were done after 15 weeks of amenorrhea) and 2 % by caesarian. We performed a fœticide in 75 % of the cases between 22 and 27+6 weeks of amenorrhea. An additional cervical preparation was often necessary for the TOP between 28 and 31+6 weeks of amenorrhea. We noted an almost exclusive use of Misoprostol (even after 32 weeks of amenorrhea) causing an induction/expulsion delay averaging of 8.9 hou! rs. 75 % of the retentions concerned the vaginal deliveries in the second trimester and 76.7 % of the postpartum hemorrhages concerned the curettages (performed up to 16 weeks). The prevention of postpartum hemorrhage was done for half of the TOPs after 32weeks of amenorrhea. Conclusion: This study is the largest carried out in France, which analyzed at the same time indications, complications and obstetric practices of the TOPs, between the first and the third trimesters. In spite of some differences our practices remain with the literature and the national obstetric recommendations. Keywords: Termination of pregnancy, choriocentesis, misoprostol, fœticide.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01381868
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Submitted on : Friday, October 14, 2016 - 6:58:51 PM
Last modification on : Wednesday, August 23, 2017 - 4:40:57 PM

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Charlotte Mothe. Interruption médicale de grossesse : indications et analyse des pratiques obstétricales sur trois ans au CHU de Bordeaux. Médecine humaine et pathologie. 2016. ⟨dumas-01381868⟩

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