Abortion, missed

Notes
  • It is also known as missed miscarriage or silent miscarriage
  • It happens when a fetus dies but the placenta still continues to release hormones, leading to the continued experience of signs of pregnancy.
  • Statistics: prevalence of missed abortion among all pregnancies - 1%; the overall risk of miscarriage -17 to 22%; the risk of miscarriage increases with the age of the partners rising to 88% when the father is > 50 years old.
Symptoms
  • Mild vaginal bleeding
  • Failure to detect a heartbeat during routine checkup
  • History of amenorrhea
  • Symptoms of pregnancy such as breast tenderness, nausea and fatigue may disappear
  • Uterine size smaller than dates
Diagnosis
  • Clinical review
  • Pregnancy test
  • Ultrasound
  • Bleeding and clotting time in case DIC has developed
  • Urinalysis and microscopy
  • Test for syphilis
  • Complete Blood Test
Differential
  • Benign hydatidiform mole
  • Cervical cancer
  • Cervical ectopic pregnancy
  • Dysfunctional uterine bleeding
  • Incompetent cervix
  • Tubal ectopic pregnancy
Prevention

None

Management
  • If the gestation is over 12 weeks administer - Tabs Misoprostol 600mcg STAT or 400mcg sublingually or 400mcg per vaginum (PV). If evacuation is incomplete progress to MVA.
  • If the gestation is less than 12 weeks administer evacuate uterus by manual vacuum aspiration (MVA). This is done under paracervical block where 2.5ml of 1% Lignocaine is injected in areas at 2, 4, 8 and 10 o’clock positions avoiding intravascular injection. OR
  • Where the less invasive MVA is not available Sharp curettage (SC or D & C) is done.
  • If DIC is suspected blood or frozen plasma is administered.

##To treat or prevent infections and manage pain, administer;

  • Caps Doxycycline 100mg BD x 1/52
  • Tabs Metronidazole 400mg TID x 1/52
  • Tabs Ibuprofen 400mg TID x 5/7
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