Missed Abortion

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Introduction

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:

  1. There is reversal of the symptoms of pregnancy
  2. There may be recurrent bloody vaginal discharge
  3. Absent maternal perception of foetal movements (if quickening has already occurred)

Signs of missed abortion

Signs of missed abortion include the following:

  1. Uterus is smaller than gestational age/ dates
  2. Foetal heart tones are not heard either with the Pinards stethoscope or with a foetal Doppler device such as Sonicaid

Investigations

  • 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

Treatment objectives

The treatment objectives of missed abortion include the following:

  1. To make patient fit for uterine evacuation
  2. To ensure safe uterine evacuation
  3. To establish cause of foetal death if possible

Non-pharmacological treatment

  1. Evacuation of the uterus by suction curettage (manual or with machine); < 12 weeks gestation
  2. Surgical evacuation of uterus (D&E) after cervical ripening with medication; second trimester

Pharmacological treatment

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)

Or

Evidence Rating: [B]

Oxytocin drip may be used for induction where other cervical ripening methods (e.g. Foleys catheter balloon) are used.

Note

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.

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