Management of patients with a history of late abortion or very premature delivery [Prise en charge des patientes ayant un antécédent d'avortement tardif ou d'accouchement très prématuré]

摘要

Patients have a very late abortion or premature delivery in 2-3 % of pregnancies. Management in a subsequent pregnancy should seek an infection, a fetal cause (aneuploidy, malformation syndrome, intrauterine death) or vascular pathology (preeclampsia, IUGR, intrauterine death). In women with a late abortion or very premature childbirth history, several preventive treatments of prematurity are now available. The main cause of prematurity is ascending infection from the vagina. Cerclage or pessary is designed to better isolate the uterine cavity. Their effectiveness has been validated in patients for whom the repeated measurement of cervical length by transvaginal ultrasound shows a cervical length 25 mm. Early pregnancy vaginosis and treatment with Dalacin? seem to significantly reduce the risk of prematurity. Finally, the routine administration of intramuscular or vaginal progesterone at the beginning of the 2nd quarter also proved effective in several randomized studies.