Critères d’arrêt de la grossesse en cas de prééclampsie

Abstract

Few studies establishing clear criteria for the medical interruption of a pregnancy complicated by PE are available today. Most of these studies are either retrospective or observational. When combining an analysis of the available literature together with the experts’ opinions, one can propose the following set of criteria for therapeutic interruption of pregnancy in the setting of PE, which apply mainly for the severe forms of the disease. These criteria can be subdivided into maternal and fetal criteria.Maternal criteria are a severe uncontrollable HT, eclampsia, acute pulmonary edema, retro placental haematoma, oligura (<100ml in 4hours) resistant to appropriate fluid expansion, persistent signs of imminent eclampsia (headache or visual disturbances), persistent epigastric pain, HELLP syndrome, new-onset renal failure and a gestation time within the first 24weeks.The fetal criteria are prolonged and variable fetal heart rate (FHR) decelerations, a short term variability in FHR <3bpm, a Manning score ≤4 on two separate occasions, severe oligohydramnios, an estimated fetal weight below the 5th percentile beyond the 32nd week of amenorrhea and an inverted diastolic flow in the umbilical artery beyond the 32nd week of amenorrhea. In case of non-severe PE beyond the 36th week of amenorrhea, interruption of the pregnancy must be considered.