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Master Thesis

Placentocentèse et amniocentèse aux deuxième et troisième trimestres : étude prospective portant sur 546 patientes à la maternité du centre Aliénor d'Aquitaine, CHU de Bordeaux pendant un an

Abstract : Introduction: International Guidelines (ACOG, RCOG and SOGC) usually recommend chorionic villous sampling (CVS) before 13+6 weeks of gestation (WG) and amniocentesis (A) after 15 WG. In France, it is consensually admitted not to perform invasive tests between 14 and 14+6 WG. The goal was to report the outcome of pregnancy when a placentocentesis (P) is performed after 14 WG. Material and methods: Unicentric prospective study at Bordeaux University Hospital including all the patients who underwent an invasive test after 14 WG between February 2015 and February 2016 after agreement of the South West and Overseas III Committee for the protection of persons (réf: DC 2015/11). Results: A total of 1030 invasive tests were performed: 318 CVS (n=317) before 13+6 WG and 712 invasive tests (n=707) after 14 WG (576 P and 136 A). Among the later, 453 P (n=452) and 98 A (n=98) were included. The mean gestational age at the time of the invasive test was respectively 19 + 6 WG in the P group and 25 WG in the A group. There were respectively 6.2 % (28/453) terminations of pregnancy (TOP) and 7.7 % (35/453) lost to follow-up in the P group and 8,2% (8/98) TOP et 7,1% (7/98) lost to follow-up in the A group. In the P group, excluding the 35 lost to follow up, the rate of fetal losses was 0.7% (3/418): 2 late losses (i.e. miscarriage before 24 WG) and 1 intrauterine fetal death (IUFD) observed at 31+6 WG secondary to a placental abruption in a context of preeclampsia, 3 months after the P, i.e. unrelated to the invasive test. Among the later and excluding the TOP, the rate of preterm delivery including the IUFD between 24 and 28 WG, before 32 WG and 3! 7 WG was respectively of 0.5 % (2/390), 1.3 % (5/390) and 10.2 % (40/390). In the A group, the rate of preterm delivery before 37 WG was 6% (5/83), no fetal loss was reported. Conclusion: The rate of fetal loss related to P was respectively 0,5 % (2/418) in the P group and 1,1 % (2/187) in the subgroup of patients who underwent the P between 14 and 15+6 WG. Placentocentesis seems a reasonnable option all through pregnancy to discuss with the patient case by case.
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Master Thesis
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Submitted on : Wednesday, February 15, 2017 - 5:12:08 PM
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Marie Sarrau. Placentocentèse et amniocentèse aux deuxième et troisième trimestres : étude prospective portant sur 546 patientes à la maternité du centre Aliénor d'Aquitaine, CHU de Bordeaux pendant un an. Médecine humaine et pathologie. 2016. ⟨dumas-01468775⟩

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