[Threatened late miscarriage. French guidelines]

Abstract

Objectives: To define guidelines for the management of women diagnosed with threatened late miscarriage (TLM).

Materials and methods: A systematic review of the literature was performed using Pubmed and the Cochrane library databases and the guidelines from main international societies.

Results: Management of women diagnosed with threatened LM requires a complete history-taking searching for a previous history of LM and/or of premature delivery (Grade B). Speculum examination is required to diagnose membrane prolapse (Grade B) and vaginal ultrasound scan is recommended to measure the cervical length (Grade B). Finally, initial management should allow to rule out chorioamniotitis (Grade B). Vaginal progesterone therapy (90-200mg daily) is recommended for women diagnosed with a sole shortened cervix (<25mm) in mid-pregnancy (Grade A). Cerclage is only recommended in women with both history of previous premature delivery and/or previous LM and shortened cervical length diagnosed before 24 weeks of gestation (Grade A). Finally, cervical cerclage (Mc Donald technique) associated with systematic tocolytic therapy (indometacine) and antibiotics are to be recommended in women diagnosed with TLM with dilated cervical os eventually associated with membrane prolapse (GradeC).

Keywords: Antibiothérapie; Antibiotics; Bacterial vaginosis; Cerclage; Cervical length; Fausse couche tardive; Late miscarriage; Longueur cervicale; Membrane prolapse; Progesterone therapy; Progestérone; Protrusion des membranes; Vaginose bactérienne.