title: Pregnancy loss: French clinical practice guidelines.
abstract: In intrauterine pregnancies of uncertain viability with a gestational sac without a yolk sac (with a mean of three orthogonal transvaginal ultrasound measurements <25mm), 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 <7mm 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 3510IU/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 (<25mm 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 (<25mm 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).
authors.affiliation: Service de Gynécologie Obstétrique, CHI Poissy St Germain en Laye, Poissy, France; EA 7285 Risques Cliniques et Sécurité en Santé des Femmes, Université Versailles-Saint-Quentin en Yvelines, Versailles, France. Electronic address: cyrillehuchon@yahoo.fr.
authors.forename: C
authors.initials: C
authors.lastname: Huchon
authors.affiliation: Service de Gynécologie Obstétrique, Hôpital Antoine Béclère, Clamart, France; Faculté de Médecine, Université Paris Sud, Le Kremlin-Bicêtre, France.
authors.forename: X
authors.initials: X
authors.lastname: Deffieux
authors.affiliation: Service de Gynécologie Obstétrique et Médecine de la Reproduction, CHU de Caen, Caen, France.
authors.forename: G
authors.initials: G
authors.lastname: Beucher
authors.affiliation: Service de Gynécologie Obstétrique, Hôpital Bicêtre, Le Kremlin Bicêtre, France; Inserm, Centre de Recherche en Epidémiologie et Santé des Populations, Le Kremlin Bicêtre, France.
authors.forename: P
authors.initials: P
authors.lastname: Capmas
authors.affiliation: Service de Gynécologie Obstétrique, Assistance Publique des Hôpitaux de Marseille, Hôpital Nord, Marseille, France; Université d'Aix-Marseille Université, Faculté de Médecine, Marseille, France.
authors.forename: X
authors.initials: X
authors.lastname: Carcopino
authors.affiliation: Université René Descartes Paris V, AP-HP, Centre de Référence Maladies Auto-immunes et Systémiques Rares, Service de Médecine Inter Pôle Médecine, Hôpital Cochin, Paris, France.
authors.forename: N
authors.initials: N
authors.lastname: Costedoat-Chalumeau
authors.affiliation: Pôle de Gynécologie Obstétrique Reproduction Humaine, CHU Estaing, Clermont-Ferrand, France; EA7281-R2D2, Université d'Auvergne, Faculté de Médecine, Clermont-Ferrand, France.
authors.forename: A
authors.initials: A
authors.lastname: Delabaere
authors.affiliation: Service de Gynécologie Obstétrique, Hôpital Antoine Béclère, Clamart, France.
authors.forename: V
authors.initials: V
authors.lastname: Gallot
authors.affiliation: Service de Gynécologie Obstétrique, Hôpital Antoine Béclère, Clamart, France.
authors.forename: E
authors.initials: E
authors.lastname: Iraola
authors.affiliation: Centre Hospitalier Universitaire de Rennes, Université de Rennes 1, INSERM U1085, Service de Gynécologie, Hôpital Sud, Rennes, France.
authors.forename: V
authors.initials: V
authors.lastname: Lavoue
authors.affiliation: Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire d'Angers, Angers, France; CESP-INSERM, U1018, Equipe 7, Genre, Santé Sexuelle et Reproductive, Université Paris Sud, Le Kremlin-Bicêtre, France.
authors.forename: G
authors.initials: G
authors.lastname: Legendre
authors.affiliation: Service de Gynécologie-Obstétrique, Centre Hospitalier d'Auch en Gascogne, France.
authors.forename: V
authors.initials: V
authors.lastname: Lejeune-Saada
authors.affiliation: Centre Hospitalier Universitaire de Rennes, Université de Rennes 1, INSERM U1085, Service de Gynécologie, Hôpital Sud, Rennes, France.
authors.forename: J
authors.initials: J
authors.lastname: Leveque
authors.affiliation: Service de Gynécologie Obstétrique, Hôpital Antoine Béclère, Clamart, France.
authors.forename: S
authors.initials: S
authors.lastname: Nedellec
authors.affiliation: Service de Gynécologie Obstétrique, Groupe Hospitalier Pitié Salpêtrière, APHP, Sorbonne Universités, UMPC Univ Paris 06, CNRS UMR 7222, INSERM U1150, Paris, France.
authors.forename: J
authors.initials: J
authors.lastname: Nizard
authors.affiliation: Service de Gynécologie Obstétrique, CHI Poissy St Germain en Laye, Poissy, France.
authors.forename: T
authors.initials: T
authors.lastname: Quibel
authors.affiliation: Service de Gynécologie Obstétrique, Hôpital Jeanne de Flandre, EA 2694, PRES Université Lille Nord de France, Lille, France.
authors.forename: D
authors.initials: D
authors.lastname: Subtil
authors.affiliation: Service de Cytogénétique, CHI Poissy St Germain en Laye, Poissy, France; EA 2493, UFR des Sciences de la Santé Simone Veil, Université Versailles-Saint-Quentin en Yvelines, St Quentin en Yvelines, France.
authors.forename: F
authors.initials: F
authors.lastname: Vialard
authors.affiliation: Université d'Aix-Marseille Université, Faculté de Médecine, Marseille, France; EA 4681 PEPRADE, Université d'Auvergne, Faculté de Médecine, Clermont-Ferrand, France.
authors.forename: D
authors.initials: D
authors.lastname: Lemery
mesh_terms: D000022:Abortion, Spontaneous / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D011247:Pregnancy
keywords: Guidelines; In-utero fetal death; Miscarriage; Pregnancy loss