Devenir Obstétrical après Plicatures Utérines dans le Traitement de l’Hémorragie du Post –Partum Immédiat par Atonie Utérine : Une Étude de 81 Cas dans un Hôpital de Niveau 2 de Bamako- Mali.

Traoré SO, Ba Berthe, S Doumbia, A Samaké, J Koné, A Traoré, S Tall, RT Sangaré, OM Traoré, MA Traoré, M Diakité, I Teguete, Y Traoré, M Traoré

Abstract



RÉSUMÉ
Objectif. L’étude avait pour but d’évaluer le devenir obstétrical des patientes après plicature utérine dans le traitement de l’hémorragie du postpartum immédiat par atonie utérine. Patientes et méthodes. L’étude était transversale rétrospective et descriptive portant sur tous les cas de traitements de l’atonie utérine après césarienne et le devenir obstétrical de ces patientes. Nous avons étudié les variables socio démographiques et cliniques suivantes : l’âge, la parité, facteurs prédisposant à l’hémorragie du post-partum immédiat, les spécificités chirurgicales et les suites postopératoires. Résultats. L’atonie utérine a été retrouvée chez 1200 césariennes (5%). L’ocytocine a été la molécule la plus utilisée en première intention dans le traitement de l’atonie utérine avant la plicature utérine (68 patientes). La plicature a été pratiquée chez 81(6,75%) et a été efficace chez 74 (91,35%) patientes. Sept hystérectomies ont été réalisées pour échec de la procédure de plicature. Nous avons répertorié six cas d’infections puerpérales (7,40%) et trois décès (3,70%). Soixante-quatre femmes (79%) ont été perdues de vue. Trois ont été revues pour synéchies utérines et onze autres pour suivi de grossesses dont 8 (73%) ont accouché par césarienne avec six cas de récidives d’atonies. Conclusion. Le pronostic obstétrical après plicature utérine est réservé avec de nombreux cas de synéchies, de césariennes itératives et de récidives d’atonies utérines.
ABSTRACT
Objective. The objective of the study was to evaluate the obstetric outcome of women treated with uterine plication for early postpartum hemorrhage secondary to uterine atony. Patients and methods. The study was cross sectional descriptive and retrospective. All women treated for uterine atony after cesarean section were recruited. Our study variables were: age, parity, predisposing factors to early postpartum hemorrhage, surgical characteristics, immediate postoperative status and obstetric outcome. Results. Uterine atony was found in 1 200 caesareans (5%). Oxytocin was the most common first-line agent in the treatment of uterine atony before uterine plication (68 patients). Plication was performed in 81 women (6.75%) and was effective in 74 (91.35%). Seven hysterectomies were performed because of failure of the plication procedure. We recorded six cases of puerperal infections (7.40%) and three deaths (3.70%). Sixty-four women (79%) were lost to follow up. Three women were seen in the department for uterine synechiae and eleven came for follow-up of pregnancies of which eight women were delivered by caesarean section with six cases of atony recurrence. Conclusion. The obstetric outcome of women after uterine plication is marked by synechiae, iterative caesarian section and recurrence of uterine atony.


Keywords


délivrance, hémorragie, plicature, complications

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