Missed abortion

Missed abortion

A missed abortion occurs when a fetus of less than 24 weeks' gestation dies in utero but is not expelled.

Clinical presentation

• History of amenorrhoea

• Regression of pregnancy symptoms

• Uterine size smaller than expected for gestational age

• Mild or no per vaginal bleeding

Management of missed abortion at the dispensary and health centre

Referral

• Refer to a higher-level health facility with adequate expertise and diagnostic equipment

Management of missed abortion at the hospital

Investigations

• Abdominal and pelvic ultrasound

• Full blood count, blood grouping, and cross-matching

• Clotting profile (PT, APTT, INR)

Pharmacological treatment

• Induce abortion with misoprostol if gestational age is more than 12 weeks

• Misoprostol (PV) 100 mcg every 8 hours to a maximum of 400 mcg, followed by sharp curettage in cases of incomplete abortion

• Evacuate by dilatation and curettage (D&C) if gestational age is less than 12 weeks

Note

• Avoid misoprostol in patients with a previous uterine scar

After evacuation, give:

• Metronidazole (PO) 400 mg every 8 hours for 7 days

AND

• Amoxicillin + clavulanic acid (FDC) (PO) 625 mg every 8 hours for 7 days

Patient education

• Counsel the patient and provide an appropriate contraceptive method.