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Master Thesis

Présentation du siège et utérus uni-cicatriciel Quelle voie d'accouchement proposer ?

Abstract : Objective: To determine the obstetrics, maternal and fetal criteria which orient the choice of obstetricians to vaginal delivery or elective cesarean before labor for women with breech presentation and scarred uterus. From this objective, two secondary objectives have been defined: - identify, when the vaginal delivery is accepted, the modality of surveillance of labor, and medical care of patients during the labor. - identify, if there are, the specific complications to this association. Methods: Literature review accompanied by a study of 118 cases of association with fetuses in breech presentation and scarred uterus in the maternity of Saint Joseph (grade 2B) and Hôpital Nord (grade 3) during January 2014 at June 2019. Results: Obstetrics criteria identified were : first cesarean indication, type of incision of previous cesarean, time between the first cesarean and the date of conception of the current pregnancy, vaginal delivery after previous cesarean, realization of radio pelvimetry, realization of fetal biometrics, verification of absence of hyperflexion of the head fetuses, spontaneous labor or not. Fetal criteria identified were gestational age and presence of fetopathy. Maternal criteria identified were the choice of delivery route, maternal age (> 40 years old), BMC (> 30 kg/m2), absence of maternal or placental contra indication concerning vaginal delivery. Concerning the study of cases, there are 3 patients with breech presentation and scarred uterus with a vaginal delivery and 115 with cesarean section. 28 cases of vaginal delivery have been accepted but 18 patients refused. Among the 3 vaginal delivery, any maternal or fetal complications were observed. Among the patients which have a cesarean section, 3 scar disunities, 3 scar infections, 1 thrombophlebitis and 16 anemias of post partum were observed. Conclusion: In the literature, studies about breech presentation and scarred uterus don’t found any augmentation of maternal and neonatal morbidity in case of vaginal delivery compared to elective cesarean. In case of strict selection of women, it should be possible to accept a vaginal delivery with breech presentation and scarred uterus.
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https://dumas.ccsd.cnrs.fr/dumas-02987118
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Submitted on : Tuesday, November 3, 2020 - 3:34:14 PM
Last modification on : Thursday, November 5, 2020 - 3:24:51 AM

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Léa Basile. Présentation du siège et utérus uni-cicatriciel Quelle voie d'accouchement proposer ?. Gynécologie et obstétrique. 2020. ⟨dumas-02987118⟩

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