Missed abortion – This course is designed to understand the care of pregnant women and newborn: antenatal, intra-natal and postnatal; breast feeding, family planning, newborn care and ethical issues, The aim of the course is to acquire knowledge and develop competencies regarding midwifery, complicated labour and newborn care including family planning.
Missed abortion
Definition of Missed Abortion:
Missed abortion is one where the fetus dies before 28th week of gestation inside the uterine cavity but the uterus fails to respond normally by expelling it.
The dead product of conception are retained inside the uterine cavity for prolonged period
or
Missed abortion is a pregnancy that ends before the baby can survive outside the womb because it has not yet reached viability.
Management of Missed Abortion:
A. Diagnosis
Clinical features:
Symptoms:
- The patient initially has the symptom of normal pregnancy but later symptoms rather regress. Breast sings retrogress, uterus ceases to enlarge- sensation of weight in the pelvis and lower abdomen
- Nausea disappear.
- Intermittent brownish, dirty discharge.
- Cessation of fetal movement .
Signs:
- Uterus is enlarged, but smaller than the period of amenorrhoea, hard in a consistency.
- Failure to gain weight by the mother.
- Absence of fetal heart sound.
- P/V examination: Cervix is closed & firm to feel. Brownish discharge
B. Investigation:
1. Urinary pregnancy test: negative, after several weeks of fetal death.
2. Ultra-sonography: confirms the diagnosis: No fetal heart activity,
3. Plain X-ray abdomet: No fetal shadow.
4. Bleeding time, FDP, clotting time, platelet count: For planning of treatment.
5. Blood grouping & cross matching.
C. Treatment of Septic Abortion:
1. Hospitalization.
2. If uterus size up to 12 weeks: D & C.
3. If uterus size >12 weeks:
- At first induction of labour by –
✓ PG (misoprostol; PGF2/PG! analogue) – route- PO, PV, PR, intracervical extra-amniotic injection (or gel)
✓ Oxytocin: when pain starts. (5 unit/L upto 100 Kit/L) - Followed by curettage
4. Sedation
5. Blood transfusion (if needed): [Initially BT, CT & fibrinogen level is done; If hypofibrinogenemia (danger level < 700 mg/dl), blood transfusion is given; Then after 3 weeks attempts to evacuate the uterus should be taken]
6. Abdominal hysterotomy: When repeated dose of oxytocin fails to evacuate the uterus.
Complications of Missed Abortion:
1. Hypo-fibrinogenemia -> leading to coagulation failure (DIG) & ultimately bleeding tendency, after 3 “wks” of foetal death.
2. Sepsis.
3. Psychological disturbance.
4. DIC
Problem Based Questions
Q. A 2nd gravid came at 20 weeks of pregnancy complaining of absence of symptoms of pregnancy for one week. On per abdominal examination reveals uterus 14 weeks size.
What is the likely diagnosis?
a) How will you proceed to manage her?
b) What are the complications of the condition?
Answer:
- Diagnosis: Missed abortion
- Management + complication: please see above
Q. A 3rd gravida women presented at 12th weeks of pregnancy with slight vaginal bleeding. Her USG revealed 10 weeks non-viable fetus.
a) What is the likely diagnosis?
b) How will you proceed to manage her?
c) What would happen if the case left untreated?
Answer:
- Diagnosis: Missed abortion
- For b + c: please see above.
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