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JOGC

No 375 – Directive clinique sur l'utilisation de l’échographie au premier trimestre

      RÉSUMÉ

      Objectif

      Révision des indications cliniques de l’échographie du premier trimestre.

      Résultats

      L’échographie au premier trimestre offre des avantages cliniques démontrés.

      Données probantes

      Les données probantes ont été révisées au moyen de recherche dans Medline et selon la bibliographie des articles pertinents.

      Valeurs

      Le contenu et les recommandations ont été évalués par les auteurs principaux et le Comité d'imagerie diagnostique de la Société des obstétriciens et gynécologues du Canada. Le niveau d’évidence a été défini en fonction des critères du Groupe d’étude canadien sur les soins de santé préventifs.

      Recommandations

      • 1
        Une échographie au premier trimestre est recommandée pour l’évaluation et la documentation de la viabilité fœtale en cas de menace d'avortement (II-2B) ainsi que pour la détection de produits de conception retenus en cas d'avortement incomplet (II-2B).
      • 2
        L’échographie au premier trimestre n'est pas recommandée pour l’établissement d'un diagnostic de grossesse, mais elle est recommandée aux fins de datation, idéalement entre 7 et 12 semaines. Si la datation en fonction des dernières menstruations est fiable et qu'un examen échographique exhaustif précoce est prévu entre 11 et 14 semaines, la datation devrait être confirmée au cours de cet examen (III-A).
      • 3
        Une échographie est recommandée avant la réalisation d'une interruption de grossesse au premier trimestre (II-2B).
      • 4
        Une échographie au premier trimestre est recommandée lorsque des interventions diagnostiques ou thérapeutiques nécessitant un guidage visuel sont effectuées (p. ex., prélèvement de villosités choriales) ou avant un cerclage cervical prophylactique (I-A).
      • 5
        Une échographie au premier trimestre est recommandée lorsqu'une grossesse multiple est soupçonnée pour une détermination adéquate de la chorionicité et de l'amnionicité ainsi qu’un dépistage précoce d'anomalies génétiques ou anatomiques fœtales (II-2A).
      • 6
        Une échographie au premier trimestre est recommandée dans le cadre de l’évaluation d'une possible grossesse extra-utérine, môlaire ou de masses pelviennes suspectées (II-1A).
      • 7
        Une échographie effectuée entre 11 et 14 semaines de grossesse devrait systématiquement comprendre un examen de base de l'anatomie fœtale; les femmes qui courent un risque accru d'anomalies fœtales structurelles ou génétiques peuvent se voir offrir un dépistage approfondi, s'il est réalisé par des échographistes ayant l'expertise appropriée (II-3C).
      • 8
        Une évaluation de la clarté nucale devrait être offerte dans le cadre d'un programme prénatal de dépistage génétique et de counseling, et devrait être effectuée par des échographistes chevronnés suivant des processus d'assurance de la qualité adéquats. Toute patiente dont le fœtus présente une clarté nucale supérieure à 3,5 mm devrait se voir offrir une consultation en médecine fœtomaternelle (II-2A).
      • 9
        Une échographie au premier trimestre est recommandée en tant qu’élément important d'un protocole d’évaluation du risque de prééclampsie suivi par des professionnels ayant l'expertise appropriée et ayant accès à des ressources appropriées (I-A).

      Mots clés

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