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Master Thesis

Cerclages cervicaux des grossesses multiples : analyse des pratiques bordelaises, résultats et étude des facteurs pronostiques

Abstract : Introduction: cervical insufficiency is a term describing a woman's inability to maintain pregnancy in the second trimester and before the term. Cervical strapping is widely used and recommended to combat late miscarriages and premature births induced by this deficiency for simple pregnancies; in contrast, it has not proved effective for multiple pregnancies. Materials and methods: this is a monocentric, descriptive retrospective study of 62 patients with multiple pregnancies strapped before 26 SA from January 2000 to December 2016 at the maternity of CHU in Bordeaux. The objective is to take stock of the situation of cervical stich on multiple pregnancies at the maternity center of the CHU in Bordeaux, in order to know if the stich is real benefit to the unborn child by reducing the complications associated with secondary preterm birth cervical insufficiency, or if, on the contrary, strapping engenders maternal complications such that it was preferable not to do so. Results: twenty-two patients, including 3 triple and 59 twin pregnancies, who received emergency cerclage (n = 25), echo-indicated cerclage (n = 26) or an antecedent = 10), and a patient whose indication of cerclage was unknown were included in the study. The occurrence of prematured rupture of membranes was slightly increased in our sample, while chorioamnionitis was comparable to that of patients not enrolled in the literature. The average gestational age was 33.2 SA for hot strapping, 32.5 SA for the echo-indicated strapping and 34.2 SA for the cerclage on antecedent. The prognostic factors detrimental to the stich were tobacco, cervical dilatation greater than or equal to 2 cm, cervical length less than 25 mm, protrusion of the membranes and the low level of experience of the operator. Fifty-five neonates presented at least one neonatal complication during the first 28 days of life. Discussion and conclusion: echo-indicated cerclage has a worse prognosis than hot strapping, and it may be asked whether this is not done too late to be beneficial. On the other hand, the influence of the operator's experience is not negligible as is the cervical changes. Finally, even if the data from the literature are discordant, strapping on twin pregnancies is a way of restoring hope to the patients.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01628626
Contributor : Bu Carreire Université de Bordeaux <>
Submitted on : Friday, November 3, 2017 - 6:00:17 PM
Last modification on : Thursday, December 7, 2017 - 1:16:13 AM
Long-term archiving on: : Sunday, February 4, 2018 - 2:42:52 PM

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Marine Lasserre. Cerclages cervicaux des grossesses multiples : analyse des pratiques bordelaises, résultats et étude des facteurs pronostiques. Médecine humaine et pathologie. 2017. ⟨dumas-01628626⟩

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