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La grossesse sur cicatrice de césarienne (1) (1)

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grossesse sur cicatrice utérine

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La grossesse sur cicatrice de césarienne (1) (1)

  1. 1. BOUCHAHDA R, Dr AYACHI A, Pr. Ag MOURALI M CHU BIZERTE La Grossesse sur cicatrice utérine: un cas clinique de traitement conservateur
  2. 2. 2011 2013 GEU???
  3. 3. EXAMEN CLINIQUE
  4. 4. O βHCG: 40200 UI/ml O Échographie pelvienne couplée au doppler
  5. 5. ONEGATIV SLIDING ORGAN SIGN
  6. 6. Grossesse sur cicatrice d’hystérotomie Risque hémorragique!!!!
  7. 7. O Méthotrexate in situ (20mg) voie trans-vaginale échoguidée O Suivi clinique, biologique et échographique à J4, J7 puis hebdomadaire
  8. 8. AC+ La courbe de décroissance des HCG plasmatiques 2ème dose en IM MTX taux BHCG 0 50000 100000 J0 MTX1 J4 MTX1 J4 MTX2 J7 MTX2 S3 MTX1 S4 MTX1 S5 MTX1 taux BHCG taux BHCG Φsac gestationnel 0 50 Φsac gestationnel Φsac…
  9. 9. 5ème semaines post méthotrexate
  10. 10.  L’incidence: o 6% Ծesses ectopiques (JIAO 2008) o 1/1800 Ծesses. (Belinga E et al 2014 )
  11. 11.  Facteurs de risque: 2007 (FIROOZEH .2013)
  12. 12.  Physiopathologie: Micro-defect de la cicatrice utérine!! Microtraumatisme endomètre 2008
  13. 13. 2013
  14. 14.  Le diagnostic positif:
  15. 15. 2000 Signes directs: • Sac implanté sur la cicatrice • Disruption du sac sur le mur ant Signes indirects: • Vacuité utérine • Disparition ou diminution épaisseur myometre • Vascularisation peritrophoblastique • Canal cervical libre
  16. 16. 2014
  17. 17. Vascularisation peri-trophoblastique nourricière du sac
  18. 18.  Diagnostic différentiel échographique:
  19. 19. Grossesse
  20. 20. La grossesse cervicale
  21. 21. La fausse couche en cours:
  22. 22.  La prise en charge
  23. 23. Consensus?
  24. 24.  Taux de succés de 70 à 80%(MTX in situ)  Taux d’echec 64% (MTX systémique) (Timor-Tritsch et al 2012) complications 61,9% (Timer-Tritsch IE; Am J Obstet Gynecol 2012)
  25. 25. Rare Grave(rupture/accreta) Écho endovaginale( critères de Vial)+++ Prise en charge précoce ( préservation de la vie et de la fertilité)

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