- 1 Introduction
- 2 Symptoms of missed abortion
- 3 Signs of missed abortion
- 4 Investigations
- 5 Treatment for missed abortion
- 6 Treatment objectives
- 7 Non-pharmacological treatment
- 8 Pharmacological treatment
- 9 A. Ripening of cervix to facilitate surgical evacuation
- 10 B. Emptying uterus with Medication in Missed Abortion
Missed abortion refers to foetal death in-utero before 28 weeks gestation.
Missed abortion is just one of different types of abortion. Others include complete abortion, septic abortion, safe abortion, missed abortion, inevitable abortion, incomplete abortion, threatened abortion etc.
Symptoms of missed abortion
The following are the symptoms of missed abortion:
- There is reversal of the symptoms of pregnancy
- There may be recurrent bloody vaginal discharge
- Absent maternal perception of foetal movements (if quickening has already occurred)
Signs of missed abortion
Signs of missed abortion include the following:
- Uterus is smaller than gestational age/ dates
- Foetal heart tones are not heard either with the Pinards stethoscope or with a foetal Doppler device such as Sonicaid
- FBC and sickling test
- Blood grouping and cross matching
- Blood film for malaria parasites if necessary
- Blood clotting profile for the larger pregnancies
- Pregnancy test
- Ultrasound scan
- Fasting blood sugar
Treatment for missed abortion
The treatment objectives of missed abortion include the following:
- To make patient fit for uterine evacuation
- To ensure safe uterine evacuation
- To establish cause of foetal death if possible
- Evacuation of the uterus by suction curettage (manual or with machine); < 12 weeks gestation
- Surgical evacuation of uterus (D&E) after cervical ripening with medication; second trimester
A. Ripening of cervix to facilitate surgical evacuation
Evidence Rating: [A]
Misoprostol, oral or vaginal, 400 micrograms stat. at least 3 hours prior to surgical evacuation
B. Emptying uterus with Medication in Missed Abortion
(See Misoprostol treatment in ‘Induced Abortion‘ for details)
Evidence Rating: [B]
Oxytocin drip may be used for induction where other cervical ripening methods (e.g. Foleys catheter balloon) are used.
Oxytocin should not be used concurrently together with Misoprostol for uterine sizes geater than 20 weeks.
A 4 to 6 hour time interval must be given between use of the two drugs.
If both must be used this must be done with extreme caution as risk for uterine rupture is great.