[Management of women with a previous late fetal loss (14 to 22weeks of gestation)]

Abstract

Objective: To provide guidelines concerning management after a late fetal pregnancy loss: etiological assessment, follow-up and therapeutic management for subsequent pregnancy.

Methods: French and English publications led to guidelines.

Results: In case of a previous late fetal loss, exploration of cavity has to be done (grade C), except hysterosalpingography, which is not recommended (grade A). If uterine anomalies are found, it is recommended to correct them (grade C). In case of stillbirth or unknown foetal vitality before expulsion, antiphospholipid syndrome has to be looked for (grade A). In pregnant women, measurement of cervical length has to be done between 15 and 24weeks of gestation (grade B); in case of singleton pregnancy and short cervix (less than 25mm), a Mc Donald cerclage has to be done (grade A). A cerclage is also recommended in case of three previous fetal loss (grade B). In case of failure of a previous Mc Donald cerclage, a cervico-isthmic cerclage is recommended (grade C).

Conclusion: In case of a previous fetal loss, uterine cavity has to be explored. In subsequent pregnancy, cervical length has to be evaluated between 15 and 24SA to indicate a cervical cerclage.

Keywords: Cerclage; Cerclage cervico-isthmique; Cervical length; Cervico-isthmic cerclage; Fausse couche tardive; Guidelines; Late pregnancy loss; Malformation utérine; Pessaire; Progesterone; Progestérone; Recommandations; Uterine malformation; Échographie cervicale.