GROSSESSE EXTRA-UTÉRINE : « Attendre au moins 3 mois avant de tomber à nouveau enceinte », Jacques Aubin KOTCHOFA
La grossesse extra-utérine est un phénomène dont est victime beaucoup de femme, malheureusement la question est très peu abordée. Jacques Aubin KOTCHOFFA, gynécologue obstétricien évoque la situation et les dispositions à prendre.
Qu’est-ce qu’une grossesse extra-utérine ?
La grossesse extra-utérine (GEU) est une anomalie de la nidation pendant le processus de la grossesse. Dans une GEU, l’œuf fécondé ne s’implante pas dans la cavité de l’utérus. Le plus souvent, il s’implante dans une trompe utérine, également appelée trompes de Fallope, et exceptionnellement l’œuf peut s’implanter sur un ovaire, dans la cavité abdominale ou au niveau du col de l’utérus.
Comment se manifeste-t-elle ?
La plupart des femmes présentent un saignement vaginal noirâtre de faible abondance, et/ou des douleurs ou des crampes dans le bas de l’abdomen, pouvant être sourdes ou aiguës.
Quelles sont les causes d’une grossesse extra-utérine ?
Une grossesse extra-utérine peut survenir lorsque l’ovule fécondé ne progresse pas de la trompe de Fallope jusqu’à la cavité utérine. Cela peut être causé par des infections ou par des cicatrices dans la trompe de Fallope résultant d’une chirurgie antérieure, empêchant le passage de l’ovule jusqu’à la cavité utérine.
À partir de quel mois peut-on détecter une grossesse extra-utérine ?
Le plus souvent, une grossesse extra-utérine est détectée au premier trimestre de la grossesse, c’est-à-dire entre 6 et 16 semaines après la fécondation. Le professionnel de santé base son diagnostic sur les signes cliniques, les résultats des analyses de sang pour confirmer une grossesse et une échographie pour déterminer l’emplacement du produit de conception.
Comment prend on en charge une patiente atteinte de grossesse extra-utérine ?
Le traitement peut être réalisé par méthode chirurgicale (par exemple, en cas de douleurs abdominales aiguës et de saignement intra-abdominal), par cœlioscopie ou par traitement médicamenteux, c’est-à-dire l’administration de méthotrexate.
Quels sont les risques de ne pas interrompre une grossesse extra-utérine ?
Une grossesse extra-utérine tubaire peut provoquer la rupture de la trompe de Fallope, entraînant une hémorragie interne. Cela nécessite un traitement médical d’urgence, car cette situation peut présenter des risques mortels.
Quel impact psychologique une telle opération a-t-elle sur la patiente ?
De nombreuses femmes craignent pour leur fertilité après le traitement d’une grossesse extra-utérine, que ce soit par chirurgie ou par voie médicamenteuse. Il est important de savoir qu’après une grossesse extra-utérine, les risques de récidive augmentent. La peur de vivre une nouvelle expérience similaire ou la crainte de ne plus pouvoir tomber enceinte sont souvent présentes chez les femmes ayant vécu une grossesse extra-utérine. De nombreux troubles psychiques, allant de comportements de régression à des syndromes confusionnels ou délirants, ont été décrits pendant la période post-opératoire. De nombreux facteurs interviennent dans l’apparition et l’aggravation de ces troubles.
Comment peut-on éviter une grossesse extra-utérine ?
Réduire le risque de contracter une maladie sexuellement transmissible ou une maladie inflammatoire pelvienne peut considérablement diminuer le risque de grossesse extra-utérine. Un bilan gynécologique avant la conception est également bénéfique. Il est recommandé d’attendre au moins 3 mois après un traitement pour une GEU avant d’essayer à nouveau de tomber enceinte.
Quel est le pourcentage de chances pour une patiente de retomber enceinte après une grossesse extra-utérine ?
Les chances sont réduites de moitié (une fois tous les deux mois) en cas de retrait de l’une des deux trompes de Fallope. En cas de récidives fréquentes de GEU ou de retrait des deux trompes de Fallope, la solution est souvent de recourir à une fécondation in vitro, qui consiste à implanter directement l’embryon dans l’utérus. De cette manière, le risque d’une nouvelle grossesse extra-utérine est réduit, même s’il n’est pas totalement écarté.
En tant que gynécologue obstétricien, quel est votre avis global sur cette question et quel est votre dernier mot ?
La grossesse extra-utérine est une urgence gynéco-obstétricale mettant en jeu le pronostic vital de la femme. Je recommande à toutes les femmes en âge de procréer de surveiller attentivement les signes d’une éventuelle grossesse et de consulter un spécialiste de la santé dès le moindre doute afin de vérifier l’implantation de l’ovule.
Propos recueillis par Céline GBOVI
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