La place de la sage-femme libérale dans la stratégie diagnostique de l’endométriose

Abstract : Introduction : Endometriosis is a chronic gynecologic disease affecting approximately one in ten women of reproductive age with a diagnostic delay of about 10 years. By virtue of the “HPST Act” of 21st July 2009, midwives can perform gynecological care of healthy women. The aim of our study is to study the knowledge of midwives who are in private practice, regarding endometriosis and what they propose to the patients when this disease is suspected.
Method : We carried out an observational quantitative study from September 23rd to December 18th 2017. It was conducted via an online questionnaire. Private practice midwives providing preventive gynecological care in three regions (Ile de France, Normandy and Alsace Lorraine Champagne-Ardenne) were interviewed. 748 questionnaires were sent and 337 responses were recorded, 327 of which were exploitable.
Results : The most common warning signs of endometriosis for private practice midwives are dysmenorrhea (92%) and dyspareunia (61.5%). When a woman has dysmenorrhea, they search for an average of 4 other symptoms suggestive of endometriosis, among which deep dyspareunia (86,5%) and pelvic pain in off-period (85.8%). The majority of private practice midwives refer patients to a specialist in case of suspicion of the disease.
Discussion : Private practice midwives are aware of the main symptoms of the disease and search for them in case of a patient presenting with pelvic pain. They also know how to carry out first-line examinations and they refer patient to a specialist if endometriosis is suspected. According to the results of our study, they have an important role in the diagnostic strategy of endometriosis.
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Laura Hornecker. La place de la sage-femme libérale dans la stratégie diagnostique de l’endométriose. Gynécologie et obstétrique. 2018. ⟨dumas-02091369⟩

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