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Directive clinique No 394 - Investigation sur la mortinaissance

      Résumé

      Objectifs

      Fournir un protocole d'investigation pour aider les fournisseurs de soins de santé à déterminer la cause d'une mort fœtale.

      Options

      Une attention particulière a été portée aux protocoles d'investigation sur la mort fœtale disponibles au Canada et dans d'autres pays à l'heure actuelle.

      Résultats

      Déterminer les causes possibles d'une mortinaissance et leur incidence sur les grossesses subséquentes.

      Données probantes

      Afin de retenir des articles relatifs à l’étiologie de la mort fœtale, des recherches ont été effectuées dans les bases de données PubMed (juin 2006 à septembre 2018) et Cochrane Library, et dans les protocoles d'investigation de l'American College of Obstetricians and Gynecologists, de l'International Stillbirth Alliance Collaborative for Improving Classification of Perinatal Deaths, du Royal College of Obstetricians and Gynaecologists, des Queensland Clinical Guidelines et du Reproductive Care Program of Nova Scotia.

      Avantages

      Offrir les meilleurs conseils aux femmes quant aux causes possibles d'une mort fœtale et de leurs incidences sur des grossesses subséquentes.

      Méthodes de validation

      Le comité de médecine fœto-maternelle et le comité de pratique clinique – obstétrique de la Société des obstétriciens et gynécologues du Canada ont analysé et évalué les données probantes obtenues. La qualité des données et des recommandations a été déterminée à l'aide des critères d’évaluation des données du Groupe d'étude canadien sur les soins de santé préventifs.

      RECOMMANDATIONS

      • 1
        Il y a lieu d'utiliser un protocole pour enquêter sur la cause possible d'une mort fœtale (II-2A).
      • 2
        Il convient de réaliser un bilan diagnostic après une mortinaissance en fonction des caractéristiques cliniques précises de chaque cas (II-2A).
      • 3
        Il faut informer les parents du fait qu'aucune cause précise n'est déterminée dans près de la moitié des cas de mortinaissance (II-2B).
      • 4
        Il y a lieu de recommander l'examen du cordon ombilical et du placenta, l'autopsie et l’évaluation cytogénétique à tous les parents, sans égard à leur héritage culturel, pour tenter d'expliquer la cause de la mort fœtale (II-2B).
      • 5
        L'autopsie ne peut pas être réalisée sans le consentement éclairé des parents (III-A).
      • 6
        Dans les cas où les parents ne consentent pas à l'autopsie, il y a lieu d'offrir un examen post mortem minimalement invasif au moyen de l'imagerie par résonance magnétique, lorsque disponible, combinée à un prélèvement histologique moins effractif que l'autopsie (III-B).

      Mots clés

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