achoengagement · 2011. 4. 26. · Title: achoengagement.pdf Author: dr00728 Created Date:...
Transcript of achoengagement · 2011. 4. 26. · Title: achoengagement.pdf Author: dr00728 Created Date:...
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Echographie d’engagement au cours du travail
Jean-baptiste Haumonté, Raha Shojai,Léon Boubli
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Bassin des obstétriciens
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Définition
• « franchissement du détroit supérieur par le plus grand diamètre de la présentation »
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• Evaluation clinique de la hauteur de la tête fœtale subjective
• �Notion d’engagement est fondamantale
• De cette expertise– Possibilité d’accouchement par les voies naturelles
• Voie basse spontanée• Extraction instrumentale• Césarienne
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• mannequin de pratique obstétricale
• 32 résidents et 25 spécialistes
• Résultats
• erreur «moyenne»
• 30% (95% CI, 25-35%) pour les résidents
• 34 % (95% CI, 27-41%) pour les spécialistes
• 12% d’erreus concernant l’engagement de la tête foetale
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Traumatisme crânien fœtal du per partum
• 37/700 cas lésions intracérébrales• 24 cas (64%) : changement d’instruments
– Forceps / ventouses• 11 cas (30%) : césarienne après échec
d’extraction instrumentale
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Hémorragie intra crânienne à terme
Incidence OR
Accouchement normal 1/1900 1
Césarienne pdt le travail 1/954 2
Ventouse/forceps 1/860 2.7
Echec ventouse/forceps 1/334 5.7
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Diagnostic echographique
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L’idée de l’échographie translabiale
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Engagement et descente de la présentation fœtale
Detroit supérieur
Excavation pelvienneDetroit moyen
Présentation engagéeAngle < 45°
Présentation non engagéeAngle > 45°
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Probabilité inverse de succès de
ventouse
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Etude hôpital nord 40 patientes à terme
Présentation céphalique OP
Dilatation complète
Mesure angle tête fœtale-symphyse
Mode d’accouchement
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Etude hopital Nord
Effort expulsif Repos
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conclusions
• L’échographie a révolutionné l’obstétrique• Corrélation entre échographie et
progression du travail• Méthode reproductible• Avantage de visualiser la descente de la
tête fœtale• Outils complémentaires et non un
remplacement du sens clinique