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No 214-Directive clinique sur la prise en charge de la grossesse entre la 41e+0 et la 42e+0 semaine de gestation

  • Martina Delaney
    Affiliations
    St. John’s (T.-N.-L.)
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  • Anne Roggensack
    Correspondence
    Auteur-Ressource : Dr. Anne Roggensack, University of Calgary, Calgary, Alberta.
    Affiliations
    Toronto (Ont.)
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  • Author Footnotes
    ∗ Le Comité de pratique clinique - obstétrique : Dean C. Leduc, MD (président), Ottawa (Ont.); Charlotte Ballermann, MD, Edmonton (Alb.); Anne Biringer, MD, Toronto (Ont.); Martina Delaney, MD, St. John's (T.-N.-L.); Loraine Dontigny, MD, Lasalle (Québec); Thomas P. Gleason, MD, Edmonton (Alb.); Lily Shek-Yn Lee, inf. aut., Vancouver (C.-B.); Marie-Jocelyne Martel, MD, Saskatoon (Sask.); Valérin Morin, MD, Cap-Rouge (Québec); Joshua Nathan Polsky, MD, Windsor (Ont.); Carol Rowntree, MD, Sundre (Alb.); Debra-Jo Shepherd, MD, Regina (Sask.); Kathi Wilson, sage-femme aut., Ilderton (Ont.). Tous les membres du comité nous ont fait parvenir une déclaration de divulgation.

      Résumé

      Objectif

      Fournir une directive clinique factuelle sur la prise en charge de la grossesse entre la 41e+0 et la 42e+0 semaine de gestation.

      Issues

      Baisse de la mortalité périnatale associée à la césarienne effectuée entre la 41e+0 et la 42e+0 semaine de gestation.

      Résultat

      Des recherches ont été menées dans la base de données Medline, la Cochrane Library, ainsi qu’auprès du American College of Obstetricians and Gynecologists et du Royal College of Obstetricians and Gynecologists, afin d’en tirer les articles publiés en anglais entre 1966 et mars 2007, au moyen des mots clés suivants : prolonged pregnancy, post-term pregnancy et postdates pregnancy. La qualité des résultats a été évaluée et les recommandations ont été formulées conformément aux lignes directrices élaborées par le Groupe d’étude canadien sur les soins de santé préventifs.

      Recommandations

      • 1.
        L’exécution d’une échographie devrait être offerte au cours du premier trimestre (idéalement, entre la 11e et la 14e semaine de gestation) à toutes les femmes, puisqu’il s’agit d’un moyen de déterminer l’âge gestationnel plus précis que le recours à la date des dernières règles; l’utilisation de l’échographie du premier trimestre à cette fin donne, en effet, lieu à un nombre moindre de grossesses prolongées au-delà de 41+0 semaines (I-A).
      • 2.
        Lorsque plus de cinq jours séparent l’âge gestationnel déterminé au moyen de la date des dernières règles et l’âge gestationnel déterminé au moyen de l’échographie du premier trimestre, la date prévue de l’accouchement devrait être modifiée en fonction de résultats de l’échographie du premier trimestre (I-A).
      • 3.
        Lorsque plus de dix jours séparent l’âge gestationnel déterminé au moyen de la date des dernières règles et l’âge gestationnel déterminé au moyen de l’échographie du deuxième trimestre, la date prévue de l’accouchement devrait être modifiée en fonction de résultats de l’échographie du deuxième trimestre (I-A).
      • 4.
        Lorsque l’on dispose d’échographies tant du premier que du deuxième trimestre, l’âge gestationnel devrait être déterminé en fonction des résultats de la première échographie (I-A).
      • 5.
        Les femmes devraient se voir offrir l’option du décollement des membranes à partir de la période se situant entre la 38e; et la 41e semaine de gestation, à la suite d’une discussion sur les risques; et avantages d’une telle intervention (I-A).
      • 6.
        Les femmes devraient se voir offrir un déclenchement entre la 41e+0 et la 42e+0 semaine de gestation, puisque les données actuelles indiquent que cette pratique entraîne une baisse du taux de mortalité périnatale sans hausse du risque de césarienne (I-A).
      • 7.
        Le dépistage prénatal utilisé dans le cadre de la surveillance des grossesses se situant entre la 41e et la 42e semaine de gestation devrait comprendre au moins un examen de réactivité fœtale et une évaluation du volume de liquide amniotique (I-A).
      • 8.
        Tous les services d’obstétrique devraient, en fonction de leurs ressources locales, formuler des lignes directrices quant à la planification du déclenchement du travail (I-A).

      Mots clés

      Abréviations:

      DEC (date estimative de conception), DR (dernières règles), DVC (distance vertex-coccyx), ECR (essai comparatif randomisé), ERF (examen de réactivité fœtale), IC (intervalle de confiance), RC (rapport de cotes), RR (risque relatif), TMP (taux de mortalité périnatale)
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