Le déni de grossesse : étude réalisée sur 75 dossiers de découverte tardive de grossesse

RésuméLe déni de grossesse est une entité floue, mal définie, ne faisant l’objet d’aucun consensus international. Pourtant, ce phénomène est souvent rencontré par les professionnels de santé, suscitant de nombreuses interrogations tant sur son origine que sur sa prise en charge. Le déni de grossesse constitue une situation potentiellement à risque pour la mère et son enfant. Nous présentons notre étude rétrospective sur cinq ans à la maternité du CHU d’Angers à partir de 75 dossiers de femmes ayant découvert tardivement leur grossesse. L’absence de consensus précis et la nécessité d’établir des critères d’inclusion ont permis une réflexion concernant la définition du déni de grossesse. Nous avons recherché des paramètres épidémiologiques, cliniques et de prise en charge dans une tentative explicative et préventive. L’analyse des données recueillies nous amène à proposer systématiquement un entretien psychologique ou psychiatrique à toute femme qui présente un déni de grossesse. On peut penser que le double abord parallèle, somatique et psychique, pourrait améliorer la prise en charge et prévenir les récidives.

The denial of pregnancy is a vague and badly defined entity with no international consensus. Yet this phenomenon is often found by health professionals, provoking much questioning on its aetiology and how to treat it. The denial of pregnancy constitutes a potentially risky situation for both mother and child.ObjectiveThe objective of this study is to describe the medical, social and professional profiles, and the clinical characteristics of patients showing denial of pregnancy at the Maternity Hospital at Angers CHU. The short-term outcome for babies born from these pregnancies is described. The aim of the analyses is to improve the treatment and prevention of this syndrome.MethodA retrospective analysis of epidemiological and clinical parameters from the medical records of women showing denial of pregnancy over a period of 5 years between 1 January 2005 and 31 December 2009.PatientsIn the CIM-10, no specific code for denial of pregnancy exists. Consequently, we looked for an existing code that could be adapted to cover such cases. A total of 392 files were extracted of which 75 cases involved doctors discovering patients with an advanced pregnancy. We divided them into those discovered with less than, or greater than, 20 weeks amenorrhoea. The 75 pregnancies involved 76 babies.ResultsThe average frequency of denial of pregnancy over the five year period was 2.3/1000 births for women with 20 and 38 weeks amenorrhoea. The frequency of total denial until birth was 0.3/1000 births. The age of the women varied from 16 to 44 years. The proportion of women in a socially precarious situation was more than 40%. Half of the women had had at least one child before, 9% of the women had shown a late discovery of pregnancy, and 20% had a history of a psychiatric problem. In 92% of cases the baby stayed with the Mother, in 8% the babies died before birth, in 3% the baby died after birth, and 4% were given up for adoption. There were significantly more abandonments among women who had shown a denial of pregnancy than in the general population. There were no significant differences in the epidemiological or clinical parameters between the pregnancies discovered between 15 and 19 weeks amenorrhoea and those discovered after 20 weeks amenorrhoea. Twenty-five percent of women had been for a psychological or psychiatric consultation although the consultation was rarely motivated by a denial of pregnancy.ConclusionsThe difficulties we had to identify a denial of pregnancy attest to the ignorance of this phenomenon and the difficulty of defining it precisely. The relevance of a previous psychiatric consultation is uncertain, as few studies on denial of pregnancy have been carried out. We propose that a psychological or psychiatric consultation should be offered to any woman having shown denial of pregnancy in order to provide the necessary support.