title: [Obtaining of uterine vacuity in pregnancy loss].
abstract: OBJECTIVE
  To assess early and late benefits and harms of different management options for first trimester miscarriage and for induction of labor and obtaining of uterine vacuity in case of fetal death beyond of 14weeks of gestation.
  
  
  METHODS
  French and English publications were searched using PubMed and Cochrane Library.
  
  
  RESULTS
  Concerning missed miscarriage, expectant management is not recommended (LE1) because it increases the risk of failure, need of unplanned surgical procedure and blood transfusion (LE1). Surgical uterine evacuation remains more effective than medical treatment using misoprostol (LE1), but both techniques involve rare and comparable risks (EL1). When chosen, medical treatment should be a vaginal dose of 800μg of misoprostol, possibly repeated 24 to 48hours later (EL2). Administration of mifepristone prior to misoprostol is not recommended (EL2). In case of incomplete miscarriage, expectant management can be offered because it does not increase the risk of complications, neither haemorrhagic nor infectious (EL1). Medical treatment using misoprostol is not recommended (EL2) because it does not improve the evacuation rate when compared to our first option, and does not reduce the risk of complications (EL2). Surgical uterine evacuation leads to high evacuation rate (97-98%) and low risk of complications, haemorrhagic and infectious (<5%) (EL1). However, this option should not be the only one because of the good efficiency of the expectant management (more than 75% of evacuation) and comparably low risk of complications (EL1). Surgical aspiration should be favoured to curettage because it is quicker, less painful and leads to less bleeding (EL2). After a first trimester miscarriage future fertility is identical with each treatment (EL2). When a trophoblastic retention is suspected, a diagnostic hysteroscopy is recommended (EL2). In case of late intrauterine foetal death beyond 14weeks of gestation and without a past caesarean section, the most efficient protocol seems to be vaginal administration of misoprostol 200 to 400μg every 4 to 6hours (EL2). Twenty-four hours prior to misoprostol the administration of 200mg of mifepristone is recommended (EL3) because it improves the induction-expulsion time and diminishes the quantity of needed misoprostol (and so the complications linked to it) (EL3).
authors.affiliation: Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Caen, avenue Côte-de-Nacre, 14033 Caen cedex 9, France. Electronic address: beucher-g@chu-caen.fr.
authors.forename: G
authors.initials: G
authors.lastname: Beucher
authors.affiliation: Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Caen, avenue Côte-de-Nacre, 14033 Caen cedex 9, France.
authors.forename: P
authors.initials: P
authors.lastname: Dolley
authors.affiliation: Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Caen, avenue Côte-de-Nacre, 14033 Caen cedex 9, France; UFR de médecine, université de Caen - Basse-Normandie, avenue Côte-de-Nacre, 14033 Caen cedex 9, France.
authors.forename: Z
authors.initials: Z
authors.lastname: Stewart
authors.affiliation: Service de gynécologie-obstétrique, CHU Anne-de-Bretagne, 16, boulevard de Bulgarie, BP 90347, 35203 Rennes cedex 2, France.
authors.forename: V
authors.initials: V
authors.lastname: Lavoué
authors.affiliation: Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France; Faculté de médecine, université Paris-Sud, 91405 Orsay, France.
authors.forename: X
authors.initials: X
authors.lastname: Deffieux
authors.affiliation: Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Caen, avenue Côte-de-Nacre, 14033 Caen cedex 9, France; UFR de médecine, université de Caen - Basse-Normandie, avenue Côte-de-Nacre, 14033 Caen cedex 9, France.
authors.forename: M
authors.initials: M
authors.lastname: Dreyfus
mesh_terms: D000022:Abortion, Spontaneous / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D005260:Female; D005313:Fetal Death; D006801:Humans; D007751:Labor, Induced / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards*; D011247:Pregnancy; D011261:Pregnancy Trimester, First
keywords: Aspiration utérine chirurgicale; Chirurgical uterine evacuation; Early miscarriage; Early pregnancy failure; Fausse couche précoce; Fetal loss; Induction du travail; Labor induction; Late intrauterine fetal death; Misoprostol; Mort fœtale; Perte fœtale; Pregnancy loss; Pregnancy termination; Stillbirth