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Bibliographical entry (without author) : | Complications maternelles des extractions instrumentales Maternal morbidity after operative vaginal delivery Journal de Gynécologie Obstétrique et Biologie de la Reproduction Vol 37, N° 8S1 - décembre 2008 pp. 244-259 |
Author(s) : | G. Beucher |
Year of publication : | 2008 |
URL(s) : | http://www.em-consulte.com/article/194988 |
Résumé (français) : | L’extraction instrumentale majore significativement le risque de déchirure du sphincter anal par rapport à la voie basse spontanée, notamment lorsqu’une application haute de l’instrument, une présentation en variété postérieure et/ou une macrosomie sont associées (NP2). Les risques de déchirure vaginale, d’hémorragie du post-partum et de rétention urinaire aiguë semblent être augmentés par rapport à la voie basse spontanée (NP3). Il n’existe pas de preuve qu’un type de forceps soit plus délétère qu’un autre. Les différentes ventouses (souples, rigides et à usage unique) comportent les mêmes risques maternels (NP2). Le risque d’incontinence anale dans l’année qui suit un accouchement par voie basse est associé à la réalisation d’une extraction instrumentale, notamment d’un forceps (NP2). De même, celle-ci semble majorer le risque de lésion occulte du sphincter anal, quel que soit l’instrument (NP2). L’extraction instrumentale ne semble pas être associée au risque d’incontinence urinaire du post-partum ou à la survenue d’un prolapsus génital par rapport à la voie basse spontanée (NP2). Par contre, elle majore les risques de douleurs périnéales, de dyspareunie et de troubles sexuels du post-partum par rapport à la voie basse spontanée, et ce d’autant plus qu’il existe des déchirures périnéales (NP3). |
Abstract (English) : | Operative vaginal delivery significantly increases the risk of anal sphincter injury compared with spontaneous vaginal delivery, particularly when an instrumental application at high station, persistent occipital posterior presentation and/or macrosomia are associated. Risks of vaginal tears, postpartum haemorrhage and urinary retention appear to be increased compared with spontaneous vaginal delivery. There is no evidence that one type of forceps is less safe than another. Different vacuum extractors (soft, rigid and single-use instruments) have similar maternal outcomes. A risk of anal incontinence in the first year postpartum is associated with operative vaginal delivery, particularly forceps. Operative vaginal delivery also appears to increase the risk of occult anal sphincter injury regardless of the instrument used, but does not appear to be associated with the risk of postpartum urinary incontinence and genital prolapse compared with spontaneous vaginal delivery. It does, however, increase the risks of perineal pain, postpartum dyspareunia and sexual disorders compared with spontaneous vaginal delivery, particularly in cases of perineal tears. |
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Author of this record : | Emmanuelle Phan — 24 Mar 2010 |
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