{"id":690,"date":"2025-06-11T13:18:21","date_gmt":"2025-06-11T10:18:21","guid":{"rendered":"https:\/\/wiki.voka.io\/diseases\/uncategorized\/placenta-previa\/"},"modified":"2026-06-22T18:50:26","modified_gmt":"2026-06-22T15:50:26","slug":"placenta-praevia","status":"publish","type":"diseases_post","link":"https:\/\/wiki.voka.io\/fr\/maladies\/obstetrique\/placenta-previa\/","title":{"rendered":"Placenta pr\u00e6via : classification, diagnostic, risques et tactique de suivi de la grossesse"},"content":{"rendered":"<p><?xml encoding=\"UTF-8\" ?><\/p>\n<p class=\"wp-block-paragraph\">Le placenta pr\u00e6via (<em>placenta previa<\/em>) est un \u00e9tat dans lequel l\u2019implantation du placenta se produit dans le segment inf\u00e9rieur de l\u2019ut\u00e9rus, mal vascularis\u00e9, en recouvrant l\u2019orifice interne du col de l\u2019ut\u00e9rus. Cet \u00e9tat survient dans 0,3 \u00e0 2 % des grossesses au troisi\u00e8me trimestre. \u00c0 des stades plus pr\u00e9coces, un \u00e9tat similaire est d\u00e9fini comme la pr\u00e9sentation du chorion, c\u2019est-\u00e0-dire de la membrane embryonnaire externe \u00e0 partir de laquelle le placenta se forme par la suite (jusqu\u2019\u00e0 16 semaines).<\/p>\n<h2 class=\"wp-block-heading\" id=\"etiologie\"><strong>\u00c9tiologie <\/strong><\/h2>\n<p class=\"wp-block-paragraph\">La cause fondamentale du d\u00e9veloppement du placenta pr\u00e6via n\u2019est pas \u00e9tablie. Il existe toutefois un lien entre la formation d\u2019un placenta pr\u00e6via et les l\u00e9sions de l\u2019endom\u00e8tre induites par diff\u00e9rents facteurs \u00e9tiologiques. <\/p>\n<p class=\"wp-block-paragraph\">C\u2019est pourquoi les <strong>facteurs de risque<\/strong>suivants, qui augmentent la probabilit\u00e9 de survenue d\u2019un placenta pr\u00e6via, ont \u00e9t\u00e9 identifi\u00e9s :<\/p>\n<ul class=\"wp-block-list\">\n<li>\u00c2ge de la m\u00e8re est sup\u00e9rieur \u00e0 35 ans ;<\/li>\n<li>Grossesse multiple ;<\/li>\n<li>Ant\u00e9c\u00e9dents d\u2019interruption de grossesse ;<\/li>\n<li>Interventions chirurgicales dans la cavit\u00e9 ut\u00e9rine (curetage, etc.) ;<\/li>\n<li>L\u00e9iomyome ut\u00e9rin de grande taille ;<\/li>\n<li>Utilisation de techniques de f\u00e9condation in vitro ;<\/li>\n<li>Ant\u00e9c\u00e9dents de chirurgie ut\u00e9rine ;<\/li>\n<li>ant\u00e9c\u00e9dent de <em>Placenta previa<\/em>  ;<\/li>\n<li>Tabagisme ;<\/li>\n<li>Race (un facteur de risque controvers\u00e9 ; certaines \u00e9tudes montrent que le risque est plus \u00e9lev\u00e9 chez les femmes originaires d\u2019Asie et d\u2019Afrique).<\/li>\n<\/ul>\n<p class=\"wp-block-paragraph\">L\u2019implantation n\u00e9cessite \u00e9galement un environnement avec une irrigation sanguine suffisante. Les cellules du trophoblaste de la couche externe du blastocyste se d\u00e9veloppent dans le placenta et les membranes f\u0153tales. Le trophoblaste s\u2019attache \u00e0 la caduque ut\u00e9rine. Le m\u00e9canisme d\u2019action des pathologies constituant ces facteurs de risque exerce un effet d\u00e9l\u00e9t\u00e8re sur la formation des vaisseaux placentaires ; il perturbe la circulation placentaire, ce qui conduit \u00e0 l\u2019apparition d\u2019anomalies de la placentation. <\/p>\n<h2 class=\"wp-block-heading\" id=\"classification-du-placenta-praevia\"><strong>Classification du placenta pr\u00e6via<\/strong><\/h2>\n<p class=\"wp-block-paragraph\">Selon la classification, le placenta pr\u00e6via est diagnostiqu\u00e9 lorsque le bord du placenta se situe \u00e0 moins de 20 mm de l\u2019orifice interne. Le placenta pr\u00e6via se divise en placenta central (ou complet) \u2014 recouvrant la totalit\u00e9 du canal cervical \u2014 et en placenta lat\u00e9ral (ou partiel), o\u00f9 l\u2019axe du canal cervical n\u2019est obtur\u00e9 qu\u2019aux deux tiers \u2014 <a href=\"https:\/\/catalog.voka.io\/en\/models\/5d5e2bef-26af-4dc6-88b4-205ca36c1d80\/c1487f46-dc74-4de7-b3d2-b9ddee2fa713\/e7fcbf7c-42ed-4dc0-8c68-e2a3036c5422\/7759d1ce-5155-4720-97c2-adc503806ba8\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">mod\u00e8les 3D<\/a> :<\/p>\n<div class=\"carousel-block\">\n<div class=\"swiper carousel-swiper carousel-swiper-block_6a3d67dd140a8\">\n<div class=\"swiper-wrapper\">\n<div class=\"swiper-slide image-carousel-slide\"><img decoding=\"async\" class=\"carousel-image\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/ru\/akusherstvo\/predlezhanie-placenty\/polnoe-centralnoe-predlezhanie-placenty-vid-sboku-a-vid-sniezu-b.webp\" alt=\"Placenta pr\u00e6via complet (central) : vue lat\u00e9rale (\u00e0 gauche), vue inf\u00e9rieure (\u00e0 droite)\"><span class=\"small-text-article text-main-text-color\">Placenta pr\u00e6via complet (central) : vue lat\u00e9rale (\u00e0 gauche), vue inf\u00e9rieure (\u00e0 droite)<\/span><\/div>\n<div class=\"swiper-slide image-carousel-slide\"><img decoding=\"async\" class=\"carousel-image\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/ru\/akusherstvo\/predlezhanie-placenty\/placenta%20previa_central.webp\" alt=\"Placenta pr\u00e6via partiel (lat\u00e9ral)\"><span class=\"small-text-article text-main-text-color\">Placenta pr\u00e6via partiel (lat\u00e9ral)<\/span><\/div>\n<\/div>\n<\/div>\n<div class=\"swiper-article-carousel__controls\">\n<div class=\"swiper-article-carousel__pagination-container swiper-article-carousel__pagination-container-block_6a3d67dd140a8\"><\/div>\n<div class=\"swiper-article-carousel__arrows\"><button class=\"swiper__arrow swiper__arrow--prev carousel-swiper-button-prev swiper__arrow swiper__arrow--prev carousel-swiper-button-prev-block_6a3d67dd140a8\"><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"40\" viewbox=\"0 0 40 40\" fill=\"none\"><path d=\"M20 3.75C16.7861 3.75 13.6443 4.70305 10.972 6.48862C8.29969 8.27419 6.21689 10.8121 4.98696 13.7814C3.75704 16.7507 3.43524 20.018 4.06225 23.1702C4.68926 26.3224 6.23692 29.2179 8.50952 31.4905C10.7821 33.7631 13.6776 35.3107 16.8298 35.9378C19.982 36.5648 23.2493 36.243 26.2186 35.013C29.1879 33.7831 31.7258 31.7003 33.5114 29.028C35.297 26.3557 36.25 23.2139 36.25 20C36.2455 15.6916 34.5319 11.561 31.4855 8.51454C28.439 5.46806 24.3084 3.75455 20 3.75ZM23.3844 25.3656C23.5005 25.4818 23.5926 25.6196 23.6555 25.7714C23.7184 25.9231 23.7507 26.0858 23.7507 26.25C23.7507 26.4142 23.7184 26.5769 23.6555 26.7286C23.5926 26.8804 23.5005 27.0182 23.3844 27.1344C23.2682 27.2505 23.1304 27.3426 22.9786 27.4055C22.8269 27.4683 22.6643 27.5007 22.5 27.5007C22.3358 27.5007 22.1731 27.4683 22.0214 27.4055C21.8696 27.3426 21.7318 27.2505 21.6156 27.1344L15.3656 20.8844C15.2494 20.7683 15.1572 20.6304 15.0943 20.4787C15.0314 20.3269 14.999 20.1643 14.999 20C14.999 19.8357 15.0314 19.6731 15.0943 19.5213C15.1572 19.3696 15.2494 19.2317 15.3656 19.1156L21.6156 12.8656C21.7318 12.7495 21.8696 12.6574 22.0214 12.5945C22.1731 12.5317 22.3358 12.4993 22.5 12.4993C22.6643 12.4993 22.8269 12.5317 22.9786 12.5945C23.1304 12.6574 23.2682 12.7495 23.3844 12.8656C23.5005 12.9818 23.5926 13.1196 23.6555 13.2714C23.7184 13.4231 23.7507 13.5858 23.7507 13.75C23.7507 13.9142 23.7184 14.0769 23.6555 14.2286C23.5926 14.3804 23.5005 14.5182 23.3844 14.6344L18.0172 20L23.3844 25.3656Z\" fill=\"#B5C0CD\"><\/path><\/svg><\/button><button class=\"swiper__arrow swiper__arrow--next carousel-swiper-button-next swiper__arrow swiper__arrow--next carousel-swiper-button-next-block_6a3d67dd140a8\" tabindex=\"0\" aria-label=\"Next slide\"><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"40\" viewbox=\"0 0 40 40\" fill=\"none\"><path d=\"M20 3.75C16.7861 3.75 13.6443 4.70305 10.972 6.48862C8.29969 8.27419 6.21689 10.8121 4.98696 13.7814C3.75704 16.7507 3.43524 20.018 4.06225 23.1702C4.68926 26.3224 6.23692 29.2179 8.50952 31.4905C10.7821 33.7631 13.6776 35.3107 16.8298 35.9378C19.982 36.5648 23.2493 36.243 26.2186 35.013C29.1879 33.7831 31.7258 31.7003 33.5114 29.028C35.297 26.3557 36.25 23.2139 36.25 20C36.2455 15.6916 34.5319 11.561 31.4855 8.51454C28.439 5.46806 24.3084 3.75455 20 3.75ZM23.3844 25.3656C23.5005 25.4818 23.5926 25.6196 23.6555 25.7714C23.7184 25.9231 23.7507 26.0858 23.7507 26.25C23.7507 26.4142 23.7184 26.5769 23.6555 26.7286C23.5926 26.8804 23.5005 27.0182 23.3844 27.1344C23.2682 27.2505 23.1304 27.3426 22.9786 27.4055C22.8269 27.4683 22.6643 27.5007 22.5 27.5007C22.3358 27.5007 22.1731 27.4683 22.0214 27.4055C21.8696 27.3426 21.7318 27.2505 21.6156 27.1344L15.3656 20.8844C15.2494 20.7683 15.1572 20.6304 15.0943 20.4787C15.0314 20.3269 14.999 20.1643 14.999 20C14.999 19.8357 15.0314 19.6731 15.0943 19.5213C15.1572 19.3696 15.2494 19.2317 15.3656 19.1156L21.6156 12.8656C21.7318 12.7495 21.8696 12.6574 22.0214 12.5945C22.1731 12.5317 22.3358 12.4993 22.5 12.4993C22.6643 12.4993 22.8269 12.5317 22.9786 12.5945C23.1304 12.6574 23.2682 12.7495 23.3844 12.8656C23.5005 12.9818 23.5926 13.1196 23.6555 13.2714C23.7184 13.4231 23.7507 13.5858 23.7507 13.75C23.7507 13.9142 23.7184 14.0769 23.6555 14.2286C23.5926 14.3804 23.5005 14.5182 23.3844 14.6344L18.0172 20L23.3844 25.3656Z\" fill=\"#B5C0CD\"><\/path><\/svg><\/button><\/div>\n<\/div>\n<\/div>\n<p><script defer>\n    document.addEventListener('DOMContentLoaded', function() {\n        const imagesCarouselSwiper = new Swiper('.carousel-swiper-block_6a3d67dd140a8', {\n            slidesPerView: 1,\n            spaceBetween: 20,\n            loop: true,\n            pagination: {\n                el: '.swiper-article-carousel__pagination-container-block_6a3d67dd140a8',\n                clickable: true,\n            },\n            navigation: {\n                nextEl: '.carousel-swiper-button-next-block_6a3d67dd140a8',\n                prevEl: '.carousel-swiper-button-prev-block_6a3d67dd140a8',\n            },\n        })\n    })\n<\/script><\/p>\n<p class=\"wp-block-paragraph\">Il existe \u00e9galement un \u00e9tat appel\u00e9 placenta bas ins\u00e9r\u00e9. Dans ce cas, le bord du placenta se situe \u00e0 une distance comprise entre 20 et 35 mm.<\/p>\n<h3 class=\"wp-block-heading\" id=\"types-de-placenta-praevia\">Types de placenta pr\u00e6via<\/h3>\n<figure class=\"wp-block-table table-to-cards table-accents\">\n<table>\n<thead>\n<tr>\n<th class=\"has-text-align-center\" data-align=\"center\">Type d\u2019insertion du placenta<\/th>\n<th class=\"has-text-align-center\" data-align=\"center\">Distance entre le bord du placenta et l\u2019orifice interne<\/th>\n<th class=\"has-text-align-center\" data-align=\"center\">Degr\u00e9 de recouvrement du canal cervical<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td class=\"has-text-align-center\" data-align=\"center\">Placenta bas ins\u00e9r\u00e9<\/td>\n<td class=\"has-text-align-center\" data-align=\"center\">20-35 mm<\/td>\n<td class=\"has-text-align-center\" data-align=\"center\">Ne recouvre pas l\u2019orifice interne<\/td>\n<\/tr>\n<tr>\n<td class=\"has-text-align-center\" data-align=\"center\">Placenta pr\u00e6via<\/td>\n<td class=\"has-text-align-center\" data-align=\"center\"><20 mm<\/td>\n<td class=\"has-text-align-center\" data-align=\"center\">Recouvrement partiel ou total<\/td>\n<\/tr>\n<tr>\n<td class=\"has-text-align-center\" data-align=\"center\">Placenta pr\u00e6via partiel (lat\u00e9ral)<\/td>\n<td class=\"has-text-align-center\" data-align=\"center\"><20 mm<\/td>\n<td class=\"has-text-align-center\" data-align=\"center\">Recouvre \u2248 2\/3 du canal cervical<\/td>\n<\/tr>\n<tr>\n<td class=\"has-text-align-center\" data-align=\"center\">Placenta pr\u00e6via complet (central)<\/td>\n<td class=\"has-text-align-center\" data-align=\"center\"><20 mm<\/td>\n<td class=\"has-text-align-center\" data-align=\"center\">Recouvrement total de l\u2019ensemble du canal cervical<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/figure>\n<div class=\"videos-carousel-block\">\n<div class=\"swiper video-carousel-swiper video-carousel-swiper-block_6a3d67dd491e0\">\n<div class=\"swiper-wrapper\">\n<div class=\"swiper-slide\"><video controls class=\"carousel-video\"><source data-src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/en\/%20%20obstetrics\/placenta-previa\/central-placental-presentation.webm\" type=\"video\/webm\"><\/source><\/video><span class=\"small-text-article text-main-text-color\">Animation 3D \u2014 placenta pr\u00e6via central<\/span><\/div>\n<div class=\"swiper-slide\"><video controls class=\"carousel-video\"><source data-src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/en\/%20%20obstetrics\/placenta-previa\/lateral-placental-presentation.webm\" type=\"video\/webm\"><\/source><\/video><span class=\"small-text-article text-main-text-color\">Animation 3D \u2014 placenta pr\u00e6via lat\u00e9ral<\/span><\/div>\n<\/div>\n<\/div>\n<div class=\"swiper-article-video-carousel__controls\">\n<div class=\"swiper-article-video-carousel__pagination-container swiper-article-video-carousel__pagination-container-block_6a3d67dd491e0\"><\/div>\n<div class=\"swiper-article-video-carousel__arrows\"><button class=\"swiper__arrow swiper__arrow--prev video-carousel-swiper-button-prev swiper__arrow swiper__arrow--prev video-carousel-swiper-button-prev-block_6a3d67dd491e0\"><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"40\" viewbox=\"0 0 40 40\" fill=\"none\"><path d=\"M20 3.75C16.7861 3.75 13.6443 4.70305 10.972 6.48862C8.29969 8.27419 6.21689 10.8121 4.98696 13.7814C3.75704 16.7507 3.43524 20.018 4.06225 23.1702C4.68926 26.3224 6.23692 29.2179 8.50952 31.4905C10.7821 33.7631 13.6776 35.3107 16.8298 35.9378C19.982 36.5648 23.2493 36.243 26.2186 35.013C29.1879 33.7831 31.7258 31.7003 33.5114 29.028C35.297 26.3557 36.25 23.2139 36.25 20C36.2455 15.6916 34.5319 11.561 31.4855 8.51454C28.439 5.46806 24.3084 3.75455 20 3.75ZM23.3844 25.3656C23.5005 25.4818 23.5926 25.6196 23.6555 25.7714C23.7184 25.9231 23.7507 26.0858 23.7507 26.25C23.7507 26.4142 23.7184 26.5769 23.6555 26.7286C23.5926 26.8804 23.5005 27.0182 23.3844 27.1344C23.2682 27.2505 23.1304 27.3426 22.9786 27.4055C22.8269 27.4683 22.6643 27.5007 22.5 27.5007C22.3358 27.5007 22.1731 27.4683 22.0214 27.4055C21.8696 27.3426 21.7318 27.2505 21.6156 27.1344L15.3656 20.8844C15.2494 20.7683 15.1572 20.6304 15.0943 20.4787C15.0314 20.3269 14.999 20.1643 14.999 20C14.999 19.8357 15.0314 19.6731 15.0943 19.5213C15.1572 19.3696 15.2494 19.2317 15.3656 19.1156L21.6156 12.8656C21.7318 12.7495 21.8696 12.6574 22.0214 12.5945C22.1731 12.5317 22.3358 12.4993 22.5 12.4993C22.6643 12.4993 22.8269 12.5317 22.9786 12.5945C23.1304 12.6574 23.2682 12.7495 23.3844 12.8656C23.5005 12.9818 23.5926 13.1196 23.6555 13.2714C23.7184 13.4231 23.7507 13.5858 23.7507 13.75C23.7507 13.9142 23.7184 14.0769 23.6555 14.2286C23.5926 14.3804 23.5005 14.5182 23.3844 14.6344L18.0172 20L23.3844 25.3656Z\" fill=\"#B5C0CD\"><\/path><\/svg><\/button><button class=\"swiper__arrow swiper__arrow--next video-carousel-swiper-button-next swiper__arrow swiper__arrow--next video-carousel-swiper-button-next-block_6a3d67dd491e0\" tabindex=\"0\" aria-label=\"Next slide\"><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"40\" viewbox=\"0 0 40 40\" fill=\"none\"><path d=\"M20 3.75C16.7861 3.75 13.6443 4.70305 10.972 6.48862C8.29969 8.27419 6.21689 10.8121 4.98696 13.7814C3.75704 16.7507 3.43524 20.018 4.06225 23.1702C4.68926 26.3224 6.23692 29.2179 8.50952 31.4905C10.7821 33.7631 13.6776 35.3107 16.8298 35.9378C19.982 36.5648 23.2493 36.243 26.2186 35.013C29.1879 33.7831 31.7258 31.7003 33.5114 29.028C35.297 26.3557 36.25 23.2139 36.25 20C36.2455 15.6916 34.5319 11.561 31.4855 8.51454C28.439 5.46806 24.3084 3.75455 20 3.75ZM23.3844 25.3656C23.5005 25.4818 23.5926 25.6196 23.6555 25.7714C23.7184 25.9231 23.7507 26.0858 23.7507 26.25C23.7507 26.4142 23.7184 26.5769 23.6555 26.7286C23.5926 26.8804 23.5005 27.0182 23.3844 27.1344C23.2682 27.2505 23.1304 27.3426 22.9786 27.4055C22.8269 27.4683 22.6643 27.5007 22.5 27.5007C22.3358 27.5007 22.1731 27.4683 22.0214 27.4055C21.8696 27.3426 21.7318 27.2505 21.6156 27.1344L15.3656 20.8844C15.2494 20.7683 15.1572 20.6304 15.0943 20.4787C15.0314 20.3269 14.999 20.1643 14.999 20C14.999 19.8357 15.0314 19.6731 15.0943 19.5213C15.1572 19.3696 15.2494 19.2317 15.3656 19.1156L21.6156 12.8656C21.7318 12.7495 21.8696 12.6574 22.0214 12.5945C22.1731 12.5317 22.3358 12.4993 22.5 12.4993C22.6643 12.4993 22.8269 12.5317 22.9786 12.5945C23.1304 12.6574 23.2682 12.7495 23.3844 12.8656C23.5005 12.9818 23.5926 13.1196 23.6555 13.2714C23.7184 13.4231 23.7507 13.5858 23.7507 13.75C23.7507 13.9142 23.7184 14.0769 23.6555 14.2286C23.5926 14.3804 23.5005 14.5182 23.3844 14.6344L18.0172 20L23.3844 25.3656Z\" fill=\"#B5C0CD\"><\/path><\/svg><\/button><\/div>\n<\/div>\n<\/div>\n<p><script defer>\n    document.addEventListener('DOMContentLoaded', function() {\n        const videosCarouselSwiper = new Swiper('.video-carousel-swiper-block_6a3d67dd491e0', {\n            slidesPerView: 1,\n            spaceBetween: 20,\n            loop: true,\n            pagination: {\n                el: '.swiper-article-video-carousel__pagination-container-block_6a3d67dd491e0',\n                clickable: true,\n            },\n            navigation: {\n                nextEl: '.video-carousel-swiper-button-next-block_6a3d67dd491e0',\n                prevEl: '.video-carousel-swiper-button-prev-block_6a3d67dd491e0',\n            },\n            on: {\n                slideChangeTransitionStart: function () {\n                    const videos = this.el.querySelectorAll('video');\n                    videos.forEach(video => {\n                        if (!video.paused) {\n                            video.pause();\n                            video.currentTime = 0;\n                        }\n                    });\n                },\n            }\n        })\n    })\n<\/script><\/p>\n<h2 class=\"wp-block-heading\" id=\"symptome-de-placenta-praevia\"><strong>Sympt\u00f4me de placenta pr\u00e6via<\/strong><\/h2>\n<p class=\"wp-block-paragraph\">Des m\u00e9trorragies indolores, survenant \u00e0 n\u2019importe quel terme de la grossesse, constituent la manifestation typique du placenta pr\u00e6via. Ces m\u00e9trorragies indolores peuvent \u00e9galement faire suite \u00e0 un rapport sexuel ou \u00e0 un examen vaginal, et parfois aucune cause n\u2019est retrouv\u00e9e. <\/p>\n<h2 class=\"wp-block-heading\" id=\"diagnostic-de-placenta-praevia\"><strong>Diagnostic de placenta pr\u00e6via<\/strong><\/h2>\n<ul class=\"wp-block-list\">\n<li><strong>Lors de l\u2019examen au sp\u00e9culum<\/strong>, il est possible de visualiser le placenta en cas de col dilat\u00e9. Il importe de souligner que le toucher vaginal et l\u2019examen au sp\u00e9culum ne sont r\u00e9alis\u00e9s qu\u2019au bloc op\u00e9ratoire. <\/li>\n<li><strong>La r\u00e9alisation d\u2019une \u00e9chographie <\/strong>aux p\u00e9riodes de d\u00e9pistage de la grossesse permet une d\u00e9tection pr\u00e9coce du placenta pr\u00e6via. Il convient de r\u00e9aliser non seulement une \u00e9chographie transabdominale, mais aussi une \u00e9chographie transvaginale. Il est \u00e9tabli que l\u2019\u00e9chographie transvaginale est s\u00fbre et plus pr\u00e9cise pour le diagnostic du placenta pr\u00e6via. Le diagnostic est pos\u00e9 entre la vingt-huiti\u00e8me et la trente-deuxi\u00e8me semaine de grossesse, en mesurant avec pr\u00e9cision la distance entre le bord du placenta et le canal cervical. Il convient toutefois d\u2019\u00eatre prudent lors de l\u2019\u00e9chographie transvaginale, car celle-ci peut provoquer une h\u00e9morragie. <\/li>\n<\/ul>\n<p class=\"wp-block-paragraph\">Il faut \u00e9galement pr\u00e9ciser que la plupart des placentas consid\u00e9r\u00e9s comme bas ins\u00e9r\u00e9s en d\u00e9but de grossesse ne sont plus retrouv\u00e9s en fin de grossesse. Le placenta ne se d\u00e9place pas, mais s\u2019accro\u00eet en direction de la circulation sanguine qui s\u2019intensifie au fond de l\u2019ut\u00e9rus. Le changement de sa position est le r\u00e9sultat de la formation du segment inf\u00e9rieur de l\u2019ut\u00e9rus en croissance. <\/p>\n<p class=\"wp-block-paragraph\">La placentation anormale dans le segment inf\u00e9rieur de l\u2019ut\u00e9rus, mal vascularis\u00e9, entra\u00eene une croissance compensatrice du placenta et une augmentation de sa surface en r\u00e9ponse \u00e0 la diminution de la perfusion placentaire, provoquant des modifications histopathologiques correspondantes \u00e0 type de n\u00e9crose de coagulation des villosit\u00e9s choriales et de d\u00e9p\u00f4ts de fibrine dans l\u2019espace interlobulaire. Les changements morphologiques qui se produisent dans le placenta pr\u00e6via peuvent jouer un r\u00f4le important dans le maintien d\u2019une perfusion ad\u00e9quate, ce qui permet d\u2019\u00e9viter les r\u00e9sultats n\u00e9onatals d\u00e9favorables.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Le diagnostic diff\u00e9rentiel<\/strong> est g\u00e9n\u00e9ralement \u00e9tabli entre les \u00e9tats responsables de m\u00e9trorragies au cours de la grossesse, \u00e0 n\u2019importe quel terme. Aux premier et deuxi\u00e8me trimestres, cette complication peut \u00eatre due \u00e0 :<\/p>\n<ul class=\"wp-block-list\">\n<li>h\u00e9matome sous-chorionique ;<\/li>\n<li>Risque d\u2019interruption de grossesse ;<\/li>\n<li>Grossesse extra-ut\u00e9rine ;<\/li>\n<li>cancer du col de l\u2019ut\u00e9rus. <\/li>\n<\/ul>\n<p class=\"wp-block-paragraph\">Au troisi\u00e8me trimestre, les m\u00e9trorragies r\u00e9sultent le plus souvent d\u2019une menace d\u2019accouchement pr\u00e9matur\u00e9, dans 1 % des cas d\u2019un d\u00e9collement pr\u00e9matur\u00e9 d\u2019un placenta normalement ins\u00e9r\u00e9 et, plus rarement, d\u2019un vasa pr\u00e6via. <\/p>\n<p class=\"wp-block-paragraph\">Il convient de noter que les femmes pr\u00e9sentant un placenta pr\u00e6via ou un placenta bas ins\u00e9r\u00e9 ont un risque accru d\u2019accouchement pr\u00e9matur\u00e9 tout au long de la grossesse. Les femmes enceintes pr\u00e9sentant un placenta pr\u00e6via ont un risque d\u2019accouchement pr\u00e9matur\u00e9 plus \u00e9lev\u00e9 que celles pr\u00e9sentant un placenta bas ins\u00e9r\u00e9. <\/p>\n<p class=\"wp-block-paragraph\">L\u2019administration de progest\u00e9rone, la mise en place d\u2019un pessaire cervical et\/ou d\u2019un cerclage peuvent constituer des interventions prophylactiques potentiellement efficaces ; toutefois, on ne dispose pas de donn\u00e9es syst\u00e9matiques concernant l\u2019innocuit\u00e9 et l\u2019efficacit\u00e9 de ces m\u00e9thodes. <\/p>\n<p class=\"wp-block-paragraph\">Le d\u00e9collement pr\u00e9matur\u00e9 d\u2019un placenta normalement ins\u00e9r\u00e9 se manifeste lui aussi par des m\u00e9trorragies, mais associ\u00e9es \u00e0 des douleurs intenses. <\/p>\n<p class=\"wp-block-paragraph\">Le vasa pr\u00e6via correspond \u00e0 une insertion anormale des vaisseaux ombilicaux sur les membranes. Cette anomalie touche une grossesse sur 5 000. L\u2019int\u00e9grit\u00e9 de ces vaisseaux peut \u00eatre compromise en cas de rupture des membranes, qu\u2019elle soit spontan\u00e9e ou provoqu\u00e9e. <\/p>\n<h2 class=\"wp-block-heading\" id=\"complication-de-placenta-praevia\"><strong>Complication de placenta pr\u00e6via<\/strong><\/h2>\n<p class=\"wp-block-paragraph\">Le placenta accreta v\u00e9ritable est une complication du placenta pr\u00e6via, et cette pathologie doit \u00eatre \u00e9cart\u00e9e lors de l\u2019\u00e9chographie. Dans la plupart des cas, cette condition n\u00e9cessite une hyst\u00e9rectomie en raison des h\u00e9morragies massives qu\u2019elle entra\u00eene. Cependant, il est possible de pr\u00e9server l\u2019ut\u00e9rus gr\u00e2ce \u00e0 une chirurgie de haute technologie programm\u00e9e. Il est \u00e9galement possible d\u2019appliquer la technique de s\u00e9paration diff\u00e9r\u00e9e du placenta jusqu\u2019\u00e0 ce que le lit placentaire soit d\u00e9vascularis\u00e9, de sorte que le tissu placentaire restant puisse \u00eatre retir\u00e9 de mani\u00e8re plus s\u00fbre. En cas de suspicion de placenta accreta v\u00e9ritable, une IRM est n\u00e9cessaire. <\/p>\n<p class=\"wp-block-paragraph\">Parmi les m\u00e9thodes diagnostiques n\u2019ayant qu\u2019un int\u00e9r\u00eat historique figurent l\u2019imagerie radio-isotopique et l\u2019art\u00e9riographie. <\/p>\n<h2 class=\"wp-block-heading\" id=\"traitement\"><strong>Traitement<\/strong><\/h2>\n<ul class=\"wp-block-list\">\n<li><strong>Traitement tocolytique<\/strong> \u2014 il peut \u00eatre envisag\u00e9 en cas de m\u00e9trorragies peu abondantes survenant avant 36 semaines de grossesse ; des m\u00e9dicaments sont par ailleurs utilis\u00e9s pour pr\u00e9venir le syndrome de d\u00e9tresse respiratoire du f\u0153tus et \u00e0 vis\u00e9e neuroprotectrice. <\/li>\n<li><strong>Traitement h\u00e9mostatique<\/strong> \u2014 les h\u00e9mostatiques, les produits sanguins et les substituts du plasma, ainsi que les inhibiteurs de la fibrinolyse, sont utilis\u00e9s afin d\u2019arr\u00eater l\u2019h\u00e9morragie.<\/li>\n<li><strong>Mesures de repos<\/strong> \u2014 il est recommand\u00e9 \u00e0 la patiente d\u2019observer un repos au lit, de r\u00e9duire son activit\u00e9 et d\u2019\u00e9viter les rapports sexuels.<\/li>\n<li><strong>Correction de l\u2019an\u00e9mie <\/strong> \u2014 en cas d\u2019h\u00e9morragies r\u00e9p\u00e9t\u00e9es, il existe un risque d\u2019an\u00e9mie, qui n\u00e9cessite \u00e9galement une correction m\u00e9dicamenteuse par suppl\u00e9mentation martiale (pr\u00e9parations de fer). <\/li>\n<li><strong>Disponibilit\u00e9 transfusionnelle<\/strong> \u2014 lorsqu\u2019une patiente porteuse d\u2019un tel diagnostic est hospitalis\u00e9e, il est n\u00e9cessaire de disposer du groupe sanguin appropri\u00e9 et de ses composants, afin d\u2019y avoir rapidement acc\u00e8s en cas de besoin.<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\" id=\"accouchement-les-caracteristiques-de-la-cesarienne\"><strong>Accouchement : les caract\u00e9ristiques de la c\u00e9sarienne<\/strong><\/h2>\n<p class=\"wp-block-paragraph\">Le principal mode d\u2019accouchement demeure la c\u00e9sarienne programm\u00e9e \u00e0 37 semaines. Cependant, certaines patientes peuvent pr\u00e9senter des complications n\u00e9cessitant une c\u00e9sarienne en urgence \u00e0 un \u00e2ge gestationnel plus pr\u00e9coce. Elles sont g\u00e9n\u00e9ralement provoqu\u00e9es par un saignement massif de plus de 250 ml. <\/p>\n<p class=\"wp-block-paragraph\">Lors de la c\u00e9sarienne, il est recommand\u00e9 de pratiquer une incision cutan\u00e9e verticale afin d\u2019obtenir un acc\u00e8s optimal. Lorsque le placenta occupe le segment inf\u00e9rieur de l\u2019ut\u00e9rus, ou que ce segment est insuffisamment form\u00e9, une incision ut\u00e9rine verticale est n\u00e9cessaire. Apr\u00e8s la naissance du b\u00e9b\u00e9, le placenta doit se s\u00e9parer spontan\u00e9ment ; toute s\u00e9paration manuelle est interdite. Les femmes doivent \u00eatre inform\u00e9es de la possibilit\u00e9 d\u2019une embolisation des art\u00e8res ut\u00e9rines ou d\u2019une hyst\u00e9rectomie. L\u2019analg\u00e9sie neuraxiale est recommand\u00e9e. On ne doit utiliser l\u2019anesth\u00e9sie g\u00e9n\u00e9rale qu\u2019en cas d\u2019urgence.<\/p>\n<h2 class=\"wp-block-heading\" id=\"accouchement-par-voies-naturelles\"><strong>Accouchement par voies naturelles<\/strong><\/h2>\n<p class=\"wp-block-paragraph\">Les patientes pr\u00e9sentant un placenta bas ins\u00e9r\u00e9 peuvent b\u00e9n\u00e9ficier d\u2019une prise en charge physiologique de l\u2019accouchement, \u00e0 condition que la grossesse soit \u00e0 terme et qu\u2019une amniotomie pr\u00e9coce ait \u00e9t\u00e9 pratiqu\u00e9e. Il convient de pr\u00e9ciser qu\u2019il n\u2019existe pas de donn\u00e9es sur les avantages de l\u2019utilisation du m\u00e9thotrexate.<\/p>\n<h2 class=\"wp-block-heading\" id=\"pronostic-pour-le-foetus\"><strong>Pronostic pour le f\u0153tus<\/strong><\/h2>\n<p class=\"wp-block-paragraph\">La mortalit\u00e9 et la morbidit\u00e9 n\u00e9onatales en cas de placenta pr\u00e6via sont multipli\u00e9es par 3 \u00e0 4, ce qui est g\u00e9n\u00e9ralement li\u00e9 \u00e0 la pr\u00e9maturit\u00e9. <\/p>\n<div class=\"social-banner-block\">\n<div class=\"social-banner-content\">\n<p class=\"h5-title text-black\">Retrouvez d\u2019autres contenus scientifiquement exacts sur nos m\u00e9dias sociaux<\/p>\n<p><span class=\"social-banner-text text-grey\">Abonnez-vous et ne manquez pas les derni\u00e8res ressources<\/span><\/p>\n<div class=\"social-links-wrapper\"><a class=\"social-icon-link\" href=\"https:\/\/www.facebook.com\/VOKA3DAnatomyAndPathology\/\" target=\"_blank\" rel=\"nofollow noopener\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/common\/Social%20Icons\/facebook.svg\" alt=\"social link\"><\/a><a class=\"social-icon-link\" href=\"https:\/\/www.instagram.com\/voka.io\/\" target=\"_blank\" rel=\"nofollow noopener\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/common\/Social%20Icons\/insta.svg\" alt=\"social link\"><\/a><a class=\"social-icon-link\" href=\"https:\/\/www.linkedin.com\/company\/voka-io\/posts\/?feedView=all\" target=\"_blank\" rel=\"nofollow noopener\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/common\/Social%20Icons\/linkedin.svg\" alt=\"social link\"><\/a><a class=\"social-icon-link\" href=\"https:\/\/www.youtube.com\/@vokaio\" target=\"_blank\" rel=\"nofollow noopener\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/common\/Social%20Icons\/youtube.svg\" alt=\"social link\"><\/a><a class=\"social-icon-link\" href=\"https:\/\/www.pinterest.com\/voka3danatomyandpathology\/\" target=\"_blank\" rel=\"nofollow noopener\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/common\/Social%20Icons\/pinterest.svg\" alt=\"social link\"><\/a><a class=\"social-icon-link\" href=\"https:\/\/www.tiktok.com\/@voka.io\" target=\"_blank\" rel=\"nofollow noopener\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/common\/Social%20Icons\/tiktok.svg\" alt=\"social link\"><\/a><a class=\"social-icon-link\" href=\"https:\/\/discord.gg\/7ejUpq8DRR\" target=\"_blank\" rel=\"nofollow noopener\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/common\/Social%20Icons\/discord.svg\" alt=\"social link\"><\/a><\/div>\n<\/div>\n<p><img decoding=\"async\" class=\"social-banner-image\" loading=\"lazy\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/common\/social-media-banner-mobile-image.webp\" alt=\"Banner background\"><\/div>\n<h2 class=\"wp-block-heading\" id=\"pronostic-pour-la-mere\"><strong>Pronostic pour la m\u00e8re<\/strong><\/h2>\n<p class=\"wp-block-paragraph\">Lorsque le placenta est positionn\u00e9 sur la paroi ant\u00e9rieure de l\u2019ut\u00e9rus, le risque de saignement abondant est accru, ce qui peut n\u00e9cessiter une hyst\u00e9rectomie. Cette cat\u00e9gorie de patientes est expos\u00e9e \u00e0 un risque accru de complications, telles que : <\/p>\n<ul class=\"wp-block-list\">\n<li>Transfusion ;<\/li>\n<li>l\u00e9sion des organes adjacents ;<\/li>\n<li>Septic\u00e9mie ;<\/li>\n<li>Activit\u00e9s de r\u00e9animation ;<\/li>\n<li>D\u00e9veloppement du placenta pr\u00e6via dans la prochaine grossesse ;<\/li>\n<li>Mort.<\/li>\n<\/ul>\n<div>\n<h2 class=\"faq-title h2-article\" id=\"faq\">FAQ<\/h2>\n<div class=\"faq-section\">\n<div class=\"faq-item faq-answer-hidden\">\n<div class=\"question-block\">\n<div class=\"faq-question\">\n<p class=\" text-black h5-title\">1. Quelles sont les manifestations cliniques du placenta pr\u00e6via ?<\/p>\n<\/div>\n<div class=\"faq-answer text-main-text-color main-text-medium\">La principale manifestation clinique du placenta pr\u00e6via est une m\u00e9trorragie indolore, pouvant survenir brutalement \u00e0 n\u2019importe quel terme de la grossesse. Les m\u00e9trorragies apparaissent souvent apr\u00e8s un rapport sexuel ou un examen gyn\u00e9cologique, mais se d\u00e9veloppent parfois sans cause apparente. En cas de placenta pr\u00e6via complet, les m\u00e9trorragies sont g\u00e9n\u00e9ralement plus abondantes et plus pr\u00e9coces qu\u2019en cas de placenta pr\u00e6via partiel.<\/div>\n<\/div>\n<div class=\"expand-button-wrapper\"><button class=\"text-accent expand-button\">+<\/button><\/div>\n<\/div>\n<div class=\"faq-item faq-answer-hidden\">\n<div class=\"question-block\">\n<div class=\"faq-question\">\n<p class=\" text-black h5-title\">2. Quand diagnostique-t-on un placenta pr\u00e6via complet ?<\/p>\n<\/div>\n<div class=\"faq-answer text-main-text-color main-text-medium\">Le placenta pr\u00e6via complet est diagnostiqu\u00e9 \u00e0 l\u2019\u00e9chographie, lorsque le placenta recouvre enti\u00e8rement l\u2019orifice interne du col de l\u2019ut\u00e9rus. Le diagnostic d\u00e9finitif est pos\u00e9 apr\u00e8s 28 semaines de grossesse, car une migration placentaire reste possible avant ce terme. L\u2019\u00e9chographie transvaginale est la m\u00e9thode diagnostique la plus pr\u00e9cise.<\/div>\n<\/div>\n<div class=\"expand-button-wrapper\"><button class=\"text-accent expand-button\">+<\/button><\/div>\n<\/div>\n<div class=\"faq-item faq-answer-hidden\">\n<div class=\"question-block\">\n<div class=\"faq-question\">\n<p class=\" text-black h5-title\">3. Qu\u2019est-ce qui est interdit en cas de placenta pr\u00e6via diagnostiqu\u00e9 ?<\/p>\n<\/div>\n<div class=\"faq-answer text-main-text-color main-text-medium\">Les restrictions en cas de placenta pr\u00e6via comprennent : une interdiction absolue des rapports sexuels, l\u2019exclusion de tout effort physique (y compris le port de charges de plus de 3 kg) et le renoncement aux touchers vaginaux en dehors du bloc op\u00e9ratoire. Les d\u00e9placements prolong\u00e9s et les voyages en avion sont contre-indiqu\u00e9s chez ces patientes en raison du risque de provoquer une h\u00e9morragie. Une attention particuli\u00e8re doit \u00eatre port\u00e9e au repos psycho-\u00e9motionnel, car les situations de stress peuvent constituer un facteur d\u00e9clenchant de complications h\u00e9morragiques. Tout saignement d\u2019origine g\u00e9nitale impose un recours imm\u00e9diat \u00e0 des soins m\u00e9dicaux.<\/div>\n<\/div>\n<div class=\"expand-button-wrapper\"><button class=\"text-accent expand-button\">+<\/button><\/div>\n<\/div>\n<div class=\"faq-item faq-answer-hidden\">\n<div class=\"question-block\">\n<div class=\"faq-question\">\n<p class=\" text-black h5-title\">4. Quels sont les dangers du placenta pr\u00e6via marginal ?<\/p>\n<\/div>\n<div class=\"faq-answer text-main-text-color main-text-medium\">Le placenta pr\u00e6via marginal est dangereux en raison du risque d\u2019h\u00e9morragies soudaines, susceptibles d\u2019entra\u00eener une an\u00e9mie et un accouchement pr\u00e9matur\u00e9. Bien que, dans cet \u00e9tat, le placenta ne recouvre l\u2019orifice que partiellement, la probabilit\u00e9 d\u2019une c\u00e9sarienne en urgence persiste si l\u2019h\u00e9morragie devient mena\u00e7ante.<\/div>\n<\/div>\n<div class=\"expand-button-wrapper\"><button class=\"text-accent expand-button\">+<\/button><\/div>\n<\/div>\n<div class=\"faq-item faq-answer-hidden\">\n<div class=\"question-block\">\n<div class=\"faq-question\">\n<p class=\" text-black h5-title\">5. Quelles sont les recommandations cliniques en cas de placenta pr\u00e6via ?<\/p>\n<\/div>\n<div class=\"faq-answer text-main-text-color main-text-medium\">Les recommandations cliniques en cas de placenta pr\u00e6via comprennent une c\u00e9sarienne programm\u00e9e \u00e0 36-37 semaines en cas de placenta pr\u00e6via complet, une hospitalisation obligatoire en cas d\u2019h\u00e9morragie et une surveillance \u00e9chographique r\u00e9guli\u00e8re. En cas de m\u00e9trorragies peu abondantes \u00e0 un terme pr\u00e9coce, une attitude expectative avec repos au lit strict est envisageable.<\/div>\n<\/div>\n<div class=\"expand-button-wrapper\"><button class=\"text-accent expand-button\">+<\/button><\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"sources-list-block sources-list-hidden\" id=\"references\">\n<div class=\"sources-list-content\">\n<div class=\"sources-list-title\">\n<p class=\"small-text-bold text-black sources-list-title-text\">R\u00e9f\u00e9rences<\/p>\n<div class=\"sources-expand-button-wrapper-mobile\">\n<div class=\"sources-expand-button\"><svg width=\"32\" height=\"32\" viewbox=\"0 0 32 32\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M8 12L16 20L24 12\" stroke=\"#8C9AAB\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\"><\/path><\/svg><\/div>\n<\/div>\n<\/div>\n<div class=\"sources-list-items\">\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">1.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>VOKA 3D Anatomy & Pathology \u2013 Complete Anatomy and Pathology 3D Atlas [Internet] [VOKA 3D Anatomie et Pathologie \u2013 Atlas 3D complet d\u2019anatomie et de pathologie [Internet]. VOKA 3D Anatomy & Pathology (VOKA 3D Anatomie et Pathologie). <\/cite><\/p>\n<p><span class=\"small-text-medium text-grey\">Disponible \u00e0 l\u2019adresse suivante\u00a0: https:\/\/catalog.voka.io\/<\/span><\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">2.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>Ahn KH, Lee EH, Cho GJ, Hong SC, Oh MJ, Kim HJ. Anterior placenta previa in the mid-trimester of pregnancy as a risk factor for neonatal respiratory distress syndrome [Placenta pr\u00e6via ant\u00e9rieur au deuxi\u00e8me trimestre de la grossesse comme facteur de risque de syndrome de d\u00e9tresse respiratoire n\u00e9onatale]. PLoS One. 2018;13(11):e0207061.<\/cite><\/p>\n<\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">3.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>Ryu JM, Choi YS, Bae JY. Bleeding control using intrauterine continuous running suture during cesarean section in pregnant women with placenta previa [Contr\u00f4le de l\u2019h\u00e9morragie par surjet continu intra-ut\u00e9rin lors de la c\u00e9sarienne chez les femmes enceintes pr\u00e9sentant un placenta pr\u00e6via]. Arch Gynecol Obstet. 2019 Jan;299(1):135-139.<\/cite><\/p>\n<\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">4.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>Silver RM, Branch DW. Placenta Accreta Spectrum[Spectre du placenta accreta]. N Engl J Med. 2018 Apr 19;378(16):1529-1536.<\/cite><\/p>\n<\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">5.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>Jing L, Wei G, Mengfan S, Yanyan H. Effect of site of placentation on pregnancy outcomes in patients with placenta previa [Effet du site de placentation sur les issues de grossesse chez les patientes pr\u00e9sentant un placenta pr\u00e6via]. PLoS One. 2018;13(7):e0200252.<\/cite><\/p>\n<\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">6.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>Carusi DA. The Placenta Accreta Spectrum: Epidemiology and Risk Factors [Le spectre du placenta accreta : \u00e9pid\u00e9miologie et facteurs de risque]. Clin Obstet Gynecol. 2018 Dec;61(4):733-742.<\/cite><\/p>\n<\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">7.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>ACOG Committee Opinion No. 764: Medically Indicated Late-Preterm and Early-Term Deliveries [764: Accouchements pr\u00e9matur\u00e9s tardifs et \u00e0 terme pr\u00e9coce sur indication m\u00e9dicale]. Obstet Gynecol. 2019 Feb;133(2):e151-e155. <\/cite><\/p>\n<\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">8.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>Wing DA, Paul RH, Millar LK. Management of the symptomatic placenta previa: a randomized, controlled trial of inpatient versus outpatient expectant management [Prise en charge du placenta pr\u00e6via symptomatique : essai contr\u00f4l\u00e9 randomis\u00e9 de prise en charge expectante hospitali\u00e8re versus ambulatoire]. Am J Obstet Gynecol. 1996 Oct;175(4 Pt 1):806-11.<\/cite><\/p>\n<\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">9.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>Riveros-Perez E, Wood C. Retrospective analysis of obstetric and anesthetic management of patients with placenta accreta spectrum disorders [Analyse r\u00e9trospective de la prise en charge obst\u00e9tricale et anesth\u00e9sique des patientes pr\u00e9sentant des troubles du spectre du placenta accreta]. Int J Gynaecol Obstet. 2018 Mar;140(3):370-374. <\/cite><\/p>\n<\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">10.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>Jansen C, de Mooij YM, Blomaard CM, Derks JB, van Leeuwen E, Limpens J, Schuit E, Mol BW, Pajkrt E. Vaginal delivery in women with a low-lying placenta: a systematic review and meta-analysis [Accouchement par voie basse chez les femmes pr\u00e9sentant un placenta bas ins\u00e9r\u00e9 : revue syst\u00e9matique et m\u00e9ta-analyse]. BJOG. 2019 ao\u00fbt ; 126(9):1118-1126.<\/cite><\/p>\n<\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">11.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>American College of Obstetricians and Gynecologists; Society for Maternal-Fetal Medicine. Obstetric Care Consensus No. Placenta Accreta Spectrum [7:  Spectre du placenta accreta]. Obstet Gynecol. 2018 Dec;132(6):e259-e275.<\/cite><\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"sources-expand-button-wrapper\">\n<div class=\"sources-expand-button\"><svg width=\"32\" height=\"32\" viewbox=\"0 0 32 32\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M8 12L16 20L24 12\" stroke=\"#8C9AAB\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\"><\/path><\/svg><\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Le placenta pr\u00e6via (placenta previa) est un \u00e9tat dans lequel l&rsquo;implantation du placenta se produit dans le segment inf\u00e9rieur de l&rsquo;ut\u00e9rus, mal vascularis\u00e9, en recouvrant l&rsquo;orifice interne du col de l&rsquo;ut\u00e9rus. Cet \u00e9tat survient dans 0,3 \u00e0 2 % des grossesses au troisi\u00e8me trimestre. \u00c0 des stades plus pr\u00e9coces, un \u00e9tat similaire est d\u00e9fini comme [&hellip;]<\/p>\n","protected":false},"author":5,"featured_media":0,"template":"","diseases_category":[258],"class_list":["post-690","diseases_post","type-diseases_post","status-publish","hentry","diseases_category-obstetrique"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v25.0 (Yoast SEO v27.8) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Placenta pr\u00e6via : classification, causes, sympt\u00f4mes, traitement<\/title>\n<meta name=\"description\" content=\"Placenta pr\u00e6via au cours de la grossesse : \u00e9tiologie, tableau clinique, types, risques, complications et approches actuelles de prise en charge. 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