{"id":6381,"date":"2022-02-24T15:38:36","date_gmt":"2022-02-24T15:38:36","guid":{"rendered":"https:\/\/heloa.app\/blog\/non-classe\/et-si-mon-bebe-se-presente-par-le-siege"},"modified":"2025-04-10T10:31:44","modified_gmt":"2025-04-10T08:31:44","slug":"et-si-mon-bebe-se-presente-par-le-siege","status":"publish","type":"post","link":"https:\/\/heloa.app\/fr\/blog\/grossesse\/sante\/et-si-mon-bebe-se-presente-par-le-siege","title":{"rendered":"Et si mon b\u00e9b\u00e9 se pr\u00e9sente par le si\u00e8ge ?"},"content":{"rendered":"<p>En pr\u00e9ambule \u00e0 cette question, il est important de rappeler qu\u2019un b\u00e9b\u00e9 peut fr\u00e9quemment se pr\u00e9senter par le si\u00e8ge en cours de grossesse (ce qui est observ\u00e9 en \u00e9chographie). Jusqu\u2019\u00e0 34 semaines d\u2019am\u00e9norrh\u00e9e (c\u2019est-\u00e0-dire 7 mois et demi de grossesse), cela n\u2019a aucune signification, ni pathologique ni d\u00e9finitive, concernant l\u2019accouchement \u00e0 venir.<\/p><h2 id=\"la-pr%C3%A9sentation-par-le-si%C3%A8ge\">La pr\u00e9sentation par le si\u00e8ge<\/h2><p>La fr\u00e9quence des b\u00e9b\u00e9s se pr\u00e9sentant par le si\u00e8ge est de 4\u00a0% des grossesses.<\/p><p>Si l\u2019on retrouve parfois une cause \u00e0 cette position (malformation ut\u00e9rine, grossesse g\u00e9mellaire, placenta bas ins\u00e9r\u00e9, exc\u00e8s de <a href=\"https:\/\/heloa.app\/fr\/blog\/grossesse\/sante\/perte-eaux-grossesse\">liquide amniotique<\/a>, fibrome ut\u00e9rin, etc.), la pr\u00e9sentation par le si\u00e8ge n\u2019a le plus souvent pas de cause particuli\u00e8re. Elle n\u2019est pas appel\u00e9e \u00e0 se r\u00e9p\u00e9ter lors de grossesses ult\u00e9rieures, sauf si la cause persiste.<\/p><p>Il est classique de diff\u00e9rencier une <a href=\"https:\/\/heloa.app\/fr\/blog\/grossesse\/accouchement\/vme-accouchement\">pr\u00e9sentation du si\u00e8ge<\/a> pour un premier b\u00e9b\u00e9 (\u00ab\u00a0si\u00e8ge de primipare \u00bb) d\u2019une pr\u00e9sentation du si\u00e8ge chez une femme qui a d\u00e9j\u00e0 eu des enfants (\u00ab si\u00e8ge de multipare \u00bb). <\/p><p>De la m\u00eame fa\u00e7on, on diff\u00e9rencie :<\/p><ul><li>le si\u00e8ge dit \u00ab\u00a0complet\u00a0\u00bb, dans lequel les membres inf\u00e9rieurs du b\u00e9b\u00e9 sont repli\u00e9s en tailleur sous ses fesses et apparaissent en premier \u00e0 l\u2019accouchement ; <\/li><li>le si\u00e8ge dit \u00ab\u00a0d\u00e9compl\u00e9t\u00e9\u00a0\u00bb, o\u00f9 les membres inf\u00e9rieurs d\u00e9pli\u00e9s remontent le long de l\u2019abdomen et du thorax et atteignent la t\u00eate du f\u0153tus. <\/li><\/ul><h2 id=\"le-mode-daccouchement-en-cas-de-pr%C3%A9sentation-par-le-si%C3%A8ge\">Le mode d&rsquo;accouchement en cas de pr\u00e9sentation par le si\u00e8ge<\/h2><p>Quoi qu\u2019il en soit, il est indispensable pour l\u2019\u00e9quipe obst\u00e9tricale de conna\u00eetre pr\u00e9cis\u00e9ment <strong>avant<\/strong> le terme de la grossesse les conditions de la naissance pour d\u00e9cider du mode d\u2019accouchement : <\/p><ul><li>autorisation de voie basse (voie naturelle) ;<\/li><li>d\u00e9cision de <a href=\"https:\/\/heloa.app\/fr\/blog\/grossesse\/accouchement\/je-souhaite-une-cesarienne\">c\u00e9sarienne<\/a> (programm\u00e9e ou pendant le travail). \u00a0<\/li><\/ul><p>Pour prendre cette d\u00e9cision, des examens compl\u00e9mentaires vous seront propos\u00e9s. Ils permettront de d\u00e9terminer les mensurations de votre bassin (scanner du bassin ou radiopelvim\u00e9trie), qui doivent \u00eatre suffisamment larges pour autoriser la voie basse : c\u2019est une condition <em>sine qua non<\/em> !<\/p><p>L\u2019\u00e9quipe obst\u00e9tricale tiendra \u00e9galement compte des \u00e9l\u00e9ments relatifs au b\u00e9b\u00e9 : son poids et son volume pr\u00e9visibles, \u00e9valu\u00e9s par les \u00e9chographies. <\/p><p>Ainsi, un gros b\u00e9b\u00e9 en si\u00e8ge imposera le recours \u00e0 la c\u00e9sarienne. Ce sera \u00e9galement le cas si le degr\u00e9 de flexion de la t\u00eate du b\u00e9b\u00e9 est insuffisant (car la t\u00eate du f\u0153tus doit \u00eatre fl\u00e9chie pour un accouchement facile, sinon le recours \u00e0 la c\u00e9sarienne s\u2019impose). <\/p><p>Le placenta doit \u00eatre normalement ins\u00e9r\u00e9 et il ne doit pas y avoir d\u2019obstacle \u00e0 la descente et \u00e0 la sortie du b\u00e9b\u00e9 (fibrome ou placenta bas ins\u00e9r\u00e9 par exemple). En effet, cela g\u00eanerait l\u2019accouchement par voie basse.<\/p><p>Enfin, vous devez \u00eatre partie prenante dans cette d\u00e9cision et vouloir faire valoir votre souhait. L\u2019accouchement par le si\u00e8ge requiert une aide active de votre part, par la qualit\u00e9 des efforts expulsifs n\u00e9cessaires.<\/p><p>Quoi qu\u2019il en soit, l\u2019information pr\u00e9alable du couple est un \u00e9l\u00e9ment d\u2019importance. Toutes les conditions et d\u00e9cisions seront clairement expos\u00e9es et feront l\u2019objet d\u2019un <a href=\"https:\/\/heloa.app\/fr\/blog\/parents\/sexualite\/le-consentement\">consentement<\/a> \u00e9crit. <\/p><p>Pour finir, il faut noter que le recours \u00e0 la c\u00e9sarienne pour pr\u00e9sentation du si\u00e8ge n\u2019impose pas n\u00e9cessairement un accouchement par c\u00e9sarienne lors des naissances ult\u00e9rieures. Donc, m\u00eame si pour ce b\u00e9b\u00e9 en si\u00e8ge vous allez \u00eatre c\u00e9saris\u00e9e, cela n&rsquo;aura aucune incidence sur la voie d\u2019accouchement de votre prochaine grossesse \u2013 sauf \u00e9videmment si le b\u00e9b\u00e9 se pr\u00e9sente \u00e0 nouveau en si\u00e8ge !<br><\/p><p>Dr Nathan WROBEL<br>Gyn\u00e9cologue-obst\u00e9tricien, Paris<\/p>","protected":false},"excerpt":{"rendered":"<p>La fr\u00e9quence des b\u00e9b\u00e9s se pr\u00e9sentant par le si\u00e8ge est de 4\u00a0% des grossesses. En cas de pr\u00e9sentation par le si\u00e8ge, comment les parents et l&rsquo;\u00e9quipe d\u00e9cident-ils du mode d&rsquo;accouchement ? <\/p>\n","protected":false},"author":4,"featured_media":5705,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_kad_blocks_custom_css":"","_kad_blocks_head_custom_js":"","_kad_blocks_body_custom_js":"","_kad_blocks_footer_custom_js":"","_kad_post_transparent":"","_kad_post_title":"","_kad_post_layout":"","_kad_post_sidebar_id":"","_kad_post_content_style":"","_kad_post_vertical_padding":"","_kad_post_feature":"","_kad_post_feature_position":"","_kad_post_header":false,"_kad_post_footer":false,"_kad_post_classname":"","rank_math_title":"B\u00e9b\u00e9 en si\u00e8ge - Mode d'accouchement et d\u00e9cisions","rank_math_description":"D\u00e9couvrez comment les parents et l'\u00e9quipe m\u00e9dicale d\u00e9cident du mode d'accouchement lorsque le b\u00e9b\u00e9 se pr\u00e9sente par le si\u00e8ge. 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