Missed Abortion
Definition
A missed abortion occurs when the fetus dies in utero but is not expelled spontaneously. This may go unrecognized until routine assessment or symptoms arise.
Etiology / Risk Factors
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Chromosomal abnormalities of the fetus
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Maternal systemic conditions (e.g., uncontrolled diabetes, thyroid disease)
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Infections (TORCH infections)
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Uterine anomalies (fibroids, septum)
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Advanced maternal age (>35 years)
Signs and Symptoms
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History of amenorrhea with cessation of pregnancy symptoms (nausea, breast tenderness, fatigue)
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Regression of pregnancy symptoms
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Uterine size smaller than gestational age
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Mild per vaginal bleeding (spotting)
Investigations
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Abdominal/pelvic ultrasound to confirm absence of fetal cardiac activity and retained products
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Full Blood Count (FBC) to assess hemoglobin and infection
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Clotting profile if there is bleeding or suspicion of coagulopathy
Management
Medical Management
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Induce abortion with Misoprostol as per gestational age:
| Gestation | Dose | Route | Frequency | Notes |
|---|---|---|---|---|
| 1st trimester (≤12 weeks) | 800 μg | PV OR 600 μg | SL every 3 hours, max 2 doses; can repeat after 24 h | Evacuation if unsuccessful |
| 13–17 weeks | 200 μg | PV | Every 6 hours, max 4 doses | Facility-based administration recommended |
| 18–26 weeks | 100 μg | PV | Every 6 hours, max 4 doses in 24 h | Facility-based administration |
Surgical Management
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Evacuation (MVA or D&E) if gestational age <12 weeks or if medical induction fails
Post-evacuation Care
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Antibiotic prophylaxis:
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Amoxicillin 500 mg PO every 8 hours for 5 days
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Metronidazole 400 mg PO every 8 hours for 5 days
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Contraceptive counselling and provision
Patient Education and Counselling
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Explain the nature of missed abortion and the treatment plan
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Discuss possible side effects of misoprostol (cramps, bleeding, nausea, diarrhea)
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Advise warning signs: heavy bleeding, fever, foul-smelling discharge, severe pain
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Provide psychosocial support and follow-up care
Summary / Key Points
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Missed abortion: Fetal death in utero with no spontaneous expulsion
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Clinical signs: Amenorrhea, regression of pregnancy symptoms, mild PV bleeding, small uterus
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Investigations: Ultrasound, FBC, clotting profile
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Management: Medical induction with misoprostol according to gestation, surgical evacuation if necessary, post-evacuation antibiotics
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Patient counselling: Contraception, warning signs, psychosocial support