Management of women with a previous late fetal loss (14 to 22 weeks of gestation)
Prise en charge d'un antécédent de fausse couche tardive (14 à 22 SA)
Résumé
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 (gradeC), except hysterosalpingography, which is not recommended (grade A). If uterine anomaliesare found, it is recommended to correct them (grade C). In case of stillbirth or unknown foetalvitality before expulsion, antiphospholipid syndrome has to be looked for (grade A). In pregnantwomen, measurement of cervical length has to be done between 15 and 24 weeks of gestation(grade B); in case of singleton pregnancy and short cervix (less than 25 mm), a Mc Donaldcerclage has to be done (grade A). A cerclage is also recommended in case of three previousfetal loss (grade B). In case of failure of a previous Mc Donald cerclage, a cervico-isthmiccerclage is recommended (grade C).Conclusion -In case of a previous fetal loss, uterine cavity has to be explored. In subsequentpregnancy, cervical length has to be evaluated between 15 and 24 SA to indicate a cervicalcerclage.