État des lieux des ruptures utérines à la maternité de Bordeaux sur 21 ans : étude de cohorte rétrospective

Abstract : Scarred uterus is the main risk factor for uterine rupture. But according to the professional recommendations in 2012, trial of labour after cesarean section is the solution to privilege. It is important to select patients to whom trial of labour must be proposed and to identify risk factors in order to avoid uterine rupture. In order to carry out an evaluation of our practices, we wanted to highlight the risk factors, the clinical aspect and the materno-fetal consequences of this clinical situation. This is a mono-centric observational retrospective cohort analysis, performed in the maternity of Alienor d’Aquitaine, in Bordeaux, from January 1st, 1995 to December 31st, 2016. All the patients with a diagnosis of uterine rupture during pregnancy are included in our study. Data collection is performed retrospect ively from obstetric records of patients from digital sa welle as pepar sources. There were 92 194 deliveries between 1st January 1995 and 31st December 2016 in Bordeaux University Hospital .There were 74 uterine ruptures in our population (8/10,000 births). The rupture occurred on unscarred safe uterus in 10 cases (1.2/10,000 births); on scarred uterus in 64 cases (74/10,000 births). Among the 21 delivery triggers, labour was induced with prostaglandins for 3 women with scarred uterus (14.3%) and with trans-cervical balloons for 6 women (28.6%).In the overall population, the average labour lasts 8 hours, the average total oxytocic dose is 12,9 IU and the maximum dose is 3,5 IU per hour. Hemostasis hysterectomy occurs at a rate of 6.8% and neonatal deaths at a rate of 3%. In case of IMG/MFIU labour lasts 20 hours. In case of an unscarred uterus, hemostasis hysterectomy occurs at a rate of 30% and neonatal deaths at a rate of 16,7%. Induction with prostaglandins highly increases the risk of uterine rupture for scarred uterus. Consequently this situation rarely happens in the birth room today. Particular attention should be paid when doses of oxytocic are high and when labour is long, especially in the case of scarred uterus. However, unscarred uterus or IMG/MFIU situations should also be an alert. Although these situations are rare, their complications are major.
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Master Thesis
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Marion Bedoucha. État des lieux des ruptures utérines à la maternité de Bordeaux sur 21 ans : étude de cohorte rétrospective. Médecine humaine et pathologie. 2018. ⟨dumas-01977312⟩

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