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JOGC

No 361 - Césarienne sur demande maternelle

      Résumé

      Une demande maternelle de césarienne planifiée en l'absence d'indication maternelle ou fœtale peut amener un fournisseur de soins de santé à évaluer les risques et les avantages et à se poser des questions éthiques. Il est essentiel de bien conseiller la patiente quant aux risques et aux avantages de la CDM sans indication médicale. Les fournisseurs devraient être en mesure d'offrir une comparaison des risques et des avantages de cette intervention et de ceux qui sont associés à une tentative d'accouchement par voie vaginale, afin que la patiente puisse prendre une décision éclairée. L'autonomie de la patiente devrait être respectée, mais d'autres principes éthiques (bienfaisance, non-malfaisance et justice) doivent aussi être pris en considération durant le processus de conseil. Il n'existe pas d'études estimant les risques de la CDM pour la mère et le nouveau-né. Souvent, on utilise des études sur la césarienne avant le déclenchement du travail comme substitut pour déterminer les risques et les avantages.
      Si, après avoir exploré les raisons de sa demande et discuté des risques et des avantages avec le médecin, la patiente est ferme dans son choix, le médecin peut opter pour une des deux options suivantes : 1) accepter de faire la césarienne à 39 + 0 semaines de grossesse; ou 2) refuser et aiguiller la patiente pour un deuxième avis médical.

      Mots clés

      Abbréviations:

      IC (Intervalle de confiance), CDM (Césarienne sur demande maternelle), FSM (Fournisseur de soins maternels), RC (Rapport de cotes)
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