Missed Abortion

What is a missed Abortion?

Missed Abortion (threatening or inevitable abortion, угрожающий аборт) is a gynecological pathological situation where an intrauterine pregnancy is present but is no longer developing normally, it is associated with a higher risk of miscarriage or incomplete abortion.

Without prompt medical aid, missed abortion could develop into an incomplete abortion and fetal death, which in turn leads to the clinical features of dead fetus syndrome with disseminated intravascular coagulation, progressive hypofibrinogenemia, and vaginal bleeding after delivery (postpartum bleeding).

The dead fetus syndrome develops only when miscarriage occurs in the 2nd trimester or later (late miscarriages).

What is an incomplete abortion?

An incomplete abortion (неизбежный аборт, неполный выкидыш, аборт в ходу) is a spontaneous abortion in which the abortion is only partially completed. An incomplete abortion means that the pregnancy has ended and cannot be salvaged, and no fetus will develop, but parts of the tissue or pregnancy products are retained in the uterus.

Symptoms

What are the signs of a missed abortion?

1. Missed Abortion is suspected when the uterus fails to enlarge (when the embryo is no longer growing), and when you can not hear the fetal heartbeat with a doppler stethoscope by the twelfth week of pregnancy. Using a Doppler ultrasound device, fetal heartbeat can be detected between 9-12 weeks of pregnancy.
2. Heavy bleeding after delivery or miscarriage that occurs during the second trimester of pregnancy (between 14 and 26 weeks of gestation).
3. Abdominal pain
4. Low grade fever

What are the symptoms of an incomplete abortion?

Common symptoms of an incomplete abortion include:

1. Fever
2. Heavy vaginal bleeding
3. Severe abdominal cramping and lower back pain
4. Symptoms of a septic shock, such as confusion and restlessness, shaking chills, paleness and cold hands and feet, orthostatic hypotension, heart palpitations, heavy sweating and pale moist skin, tachycardia (rapid heart rate) and pounding heart, very low or very high body temperatures, hyperventilation (rapid breathing rate) and dyspnea (shortness of breath)

Causes

What are the main causes of a missed abortion?

Genetic or anatomical disorders are believed to play a major role in its occurrence, as well as it can be linked to poor lifestyle choices, such as poor nutrition, overweight, drug and smoking abuse, lifting heavy materials, overuse of alcohol, etc. Other contributing factors include chronic stress, violence, hypertension, skeletal problems, cardiovascular diseases, and inappropriate and poor working habits, such as sexual abuse and prostitution, poor working postures, and hard physical work during pregnancy (physical exertion at work).

Treatment

How to treat a missed abortion?

If a heartbeat cannot be heard by the twelfth week of pregnancy via a doppler stethoscope, abortion should be completed as soon as the diagnosis is confirmed (by a doctor) in the first 28 weeks of pregnancy (gestation), this can be managed by inserting a 20mg dinoprostone (a prostaglandin E2) suppository to the vagina once every two-three hours as necessary to induce contractions. Preoperative cervical dilation with laminaria (a thin rod shaped instrument) is performed to decrease complications (the dilation and evacuation procedure). Medicinal therapy using misoprostol is an acceptable alternative to dinoprostone, as vaginal misoprostol is an effective treatment for the management of incomplete abortion and early fetal death.

Missed abortion occurring after the 28th week of pregnancy (late missed abortion) can be completed by intravenous (IV) oxytocin infusion to induce contractions and labor (delivery of the fetus). A D&C procedure (dilation and curettage) or a suction curettage (vacuum aspiration) is performed along with oxytocin infusion for women in the first and second trimesters of pregnancy (in the first 28 weeks of pregnancy) to remove the retained pregnancy tissue after abortion, to clear out any tissue that remains in the uterus after a miscarriage, and to ensure all placental tissue has been removed.

Oxytocic drugs are used to stimulate the smooth muscle of the uterus to contract during the dilation and evacuation procedure, which is done by inserting a laminaria into the cervix to help keep it open.

Next steps management

How to diagnose a missed abortion?

1. Ultrasound to confirm the death of the fetus, (ultrasound showing no cardiac activity provides the earliest diagnosis)
2. Serum or urine B-hCG testing (in a missed abortion the B subunit of human chorionic gonadotropin becomes negative earlier than expected or does not double within 72 hrs).
3. A control ultrasound after the abortion, (as a control to be sure of the abortion)

Verified by: Dr.Diab (November 21, 2017)

Citation: Dr.Diab. (November 21, 2017). What is a Missed Abortion? Causes Symptoms and Treatment. Medcoi Journal of Medicine, 21(2). urn:medcoi:article15768.