Diagnosis and treatment of missed abortion

Missed abortion as the name suggest is the abortion already taken place but not expelled out and remains in the womb undiagnosed. In these cases the bleeding stops and patient often feel that now fetus is out of danger, but the fact remains that embryo is already dead.

Diagnosis of missed abortion

As bleeding starts in pregnancy or even when the bleeding stops estimation of HCG level is done, the HCG level inspite of rising as in normal pregnancy and live fetus, it usually falls. In ultrasonography the development of fetus is not seen and if the fetus is more than 8 weeks the heart sound which should be heard is absent.

On internal pelvic examination, uterus size is either the same or decreasing as compared to the period of gestation. The cervix is closed, and the embryo is dead but has not been cast off from the body.

Treatment of missed abortion

As the fetus is already dead, so the main aim of treatment of missed abortion is to safely expel the dead embryo out of the womb without any complication.

If the missed abortion is confirmed by all the tests, the doctor proceeds to do an evacuation of the uterine contents. In a missed abortion which occurs in early pregnancy that is less than 8 weeks the procedure is done by suction evacuation. If the duration of pregnancy is between 8 to 10 weeks, a dilatation and curettage (D & C) is done. If the fetus is of more than 10 weeks and the bony constituents are formed, evacuation is done by inducing labor.

In earlier days an intravenous drip with the drug pitocin (oxytocin) was given. Oxytocin is a hormone released from posterior part of pituitary gland in the brain and its main function is to stimulate uterine contraction at the time of labor. Measured amount of oxytocin are injected into the intravenous glucose drip being fed to the patient. The patient is monitored throughout the time she is on drip. The drug starts uterine contraction and soon the dead fetus is expelled in a natural way of delivery. The doctor then inspects the expelled contents and if there is any slight doubt that the expelled content is not complete, they may go for D & C and remove and remnants as a small retained remnant can lead to life threatening hemorrhage.

Now a day prostaglandins are used to expulsion of dead embryo. Prostaglandins are used in the form of vaginal suppositories. Prostaglandins are the natural tissue substances which induce the labor gradually. An average time for induction and delivery of the contents is usually 14 hours.

Some missed abortions do abort or expel spontaneously. A case of missed abortion should always be treated at a well equipped clinic or hospital, where there are facility to give intravenous fluids, blood transfusion, and the interest of the patient can be looked after.

In a missed abortion, there are some factors produced by the dead fetus, which causes coagulation defects, and is likely that profuse bleeding may occur. Keeping that n mind, the patient must go to a well equipped clinic. There is no reason to feel apprehensive. The premedication for any of the procedure mentioned include sedation and anti emetic to combat nausea which may occur when cervix dilates. Some women may even have diarrhea but diphenoxylate is enough to control the diarrhea.

Diagnosis and treatment of missed abortion

Diagnosis of missed abortion

Treatment of missed abortion

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