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<title lang=en>Pregnancy loss: French clinical practice guidelines</title>
<creator>Huchon, C.</creator>
<creator>Deffieux, X.</creator>
<creator>Beucher, G.</creator>
<creator>Capmas, P.</creator>
<creator>Carcopino, X.</creator>
<creator>Costedoat-Chalumeau, N.</creator>
<creator>Delabaere, A.</creator>
<creator>Gallot, V.</creator>
<creator>Iraola, E.</creator>
<creator>Lavoue, V.</creator>
<creator>Legendre, G.</creator>
<creator>Lejeune-Saada, V.</creator>
<creator>Levêque, J.</creator>
<creator>Nedellec, S.</creator>
<creator>Nizard, J.</creator>
<creator>Quibel, T.</creator>
<creator>Subtil, D.</creator>
<creator>Vialard, F.</creator>
<creator>Lemery, D</creator>
<contributor>Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ) ; Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)</contributor>
<contributor>Service de Gynécologie Obstétrique ; Hôpital Nord [CHU - APHM]</contributor>
<contributor>UMR 6578 : Adaptabilité Biologique et Culturelle (UAABC) ; Université de la Méditerranée - Aix-Marseille 2 - Centre National de la Recherche Scientifique (CNRS)</contributor>
<contributor>CHU Pontchaillou [Rennes]</contributor>
<contributor>Institut de recherche, santé, environnement et travail [Rennes] (Irset) ; Université d'Angers (UA) - Université des Antilles et de la Guyane (UAG) - Université de Rennes 1 (UR1) - École des Hautes Études en Santé Publique [EHESP] (EHESP) - Institut National de la Santé et de la Recherche Médicale (INSERM) - Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )</contributor>
<contributor>Assistance aux Gestes et Applications THErapeutiques (AGATHE) ; Institut des Systèmes Intelligents et de Robotique (ISIR) ; Université Pierre et Marie Curie - Paris 6 (UPMC) - Centre National de la Recherche Scientifique (CNRS) - Université Pierre et Marie Curie - Paris 6 (UPMC) - Centre National de la Recherche Scientifique (CNRS) - Institut National de la Santé et de la Recherche Médicale (INSERM)</contributor>
<contributor>Département d'obstétrique[Lille] ; Hôpital Jeanne de Flandre [Lille] - Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)</contributor>
<contributor>Unité de Pathologie Cellulaire et Génétique (UPRES-EA2493) ; Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)</contributor>
<contributor>Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement (PEPRADE) ; Université d'Auvergne - Clermont-Ferrand I (UdA) - CHU Clermont-Ferrand</contributor>
<description>International audience</description>
<source>ISSN: 0301-2115</source>
<source>European Journal of Obstetrics and Gynecology and Reproductive Biology</source>
<publisher>Elsevier</publisher>
<identifier>hal-01295639</identifier>
<identifier>https://hal-univ-rennes1.archives-ouvertes.fr/hal-01295639</identifier>
<source>https://hal-univ-rennes1.archives-ouvertes.fr/hal-01295639</source>
<source>European Journal of Obstetrics and Gynecology and Reproductive Biology, Elsevier, 2016, 201, pp.18-26. 〈10.1016/j.ejogrb.2016.02.015〉</source>
<identifier>DOI : 10.1016/j.ejogrb.2016.02.015</identifier>
<relation>info:eu-repo/semantics/altIdentifier/doi/10.1016/j.ejogrb.2016.02.015</relation>
<identifier>PUBMED : 27039249</identifier>
<relation>info:eu-repo/semantics/altIdentifier/pmid/27039249</relation>
<language>en</language>
<subject lang=en> In-utero fetal death</subject>
<subject lang=en> Pregnancy loss</subject>
<subject lang=en> Miscarriage</subject>
<subject lang=en>Guidelines</subject>
<subject>[SDV] Life Sciences [q-bio]</subject>
<type>info:eu-repo/semantics/article</type>
<type>Journal articles</type>
<description lang=en>In intrauterine pregnancies of uncertain viability with a gestational sac without a yolk sac (with a mean of three orthogonal transvaginal ultrasound measurements <25 mm), the suspected pregnancy loss should only be confirmed after a follow-up scan at least 14 days later shows no embryo with cardiac activity (Grade C). In intrauterine pregnancies of uncertain viability with an embryo <7 mm on transvaginal ultrasound, the suspected pregnancy loss should only be confirmed after a follow-up scan at least 7 days later (Grade C). In pregnancies of unknown location after transvaginal ultrasound (i.e. not visible in the uterus), a threshold of at least 3510 IU/l for the serum human chorionic gonadotrophin assay is recommended; above that level, a viable intrauterine pregnancy can be ruled out (Grade C). Postponing conception after an early miscarriage in women who want a new pregnancy is not recommended (Grade A). A work-up for women with recurrent pregnancy loss should include the following: diabetes (Grade A), antiphospholipid syndrome (Grade A), hypothyroidism with anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-Tg) antibodies (Grade A), vitamin deficiencies (B9, B12) (Grade C), hyperhomocysteinaemia (Grade C), hyperprolactinaemia (Grade B), diminished ovarian reserve (Grade C), and a uterine malformation or an acquired uterine abnormality amenable to surgical treatment (Grade C). The treatment options recommended for women with a missed early miscarriage are vacuum aspiration (Grade A) or misoprostol (Grade B); and the treatment options recommended for women with an incomplete early miscarriage are vacuum aspiration (Grade A) or expectant management (Grade A). In the absence of both chorioamnionitis and rupture of the membranes, women with a threatened late miscarriage and an open cervix, with or without protrusion of the amniotic sac into the vagina, should receive McDonald cerclage, tocolysis with indomethacin, and antibiotics (Grade C). Among women with a threatened late miscarriage and an isolated undilated shortened cervix (<25 mm on ultrasound), cerclage is only indicated for those with a history of either late miscarriage or preterm delivery (Grade A). Among women with a threatened late miscarriage, an isolated undilated shortened cervix (<25 mm on ultrasound) and no uterine contractions, daily treatment with vaginal progesterone up to 34 weeks of gestation is recommended (Grade A). Hysteroscopic section of the septum is recommended for women with a uterine septum and a history of late miscarriage (Grade C). Correction of acquired abnormalities of the uterine cavity (e.g. polyps, myomas, synechiae) is recommended after three early or late miscarriages (Grade C). Prophylactic cerclage is recommended for women with a history of three late miscarriages or preterm deliveries (Grade B). Low-dose aspirin and low-molecular-weight heparin at a preventive dose are recommended for women with obstetric antiphospholipid syndrome (Grade A). Glycaemic levels should be controlled before conception in women with diabetes (Grade A)</description>
<date>2016</date>
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