[Termination of pregnancy and palliative care in case of vascular intra-uterine growth retardation].

OBJECTIVE

Discuss the place of medical termination of pregnancy and palliative care in case of vascular intra uterine growth retardation.

METHODS

Bibliographic review using the Medline and PubMed databases and the guidelines of the international professional societies.

RESULTS

The prognostic evaluation in case of IUGR is essential. It is based on several criteria, including gestational age and ultrasound (estimated fetal weight and Doppler). In some situations, postnatal prognosis may seem so pejorative that absence of active care can be decided with the parents. The choice can then be focused on a decision not to proceed with fetal extraction while Doppler or fetal heart rate abnormalities could justify it and "wait" for spontaneous fetal death or have a more active attitude of medical termination of pregnancy (TOP) with or without feticide or palliative care after birth. In some cases, IUGR is accompanied by maternal complications such as preeclampsia. The severity of the maternal disease may sometimes justify a termination of pregnancy for maternal rescue. That either maternal or fetal indication, these situations are often difficult to manage because of the difficulty in establishing fetal prognosis, particularly when the maternal condition requires urgent decision.

CONCLUSION

In these difficult situations, ultrasound assessment must be conducted by a senior and the discussion should always be multidisciplinary. If TOP is requested by the parents, it must be discussed in a multidisciplinary center for prenatal diagnosis in accordance with French law. Maternal emergency is the only derogatory status.