Missed Abortion.
MIssed Abortion
Define Missed abortion : When foetus is dead and retained inside the uterus for a viable period, It is called missed abortion or silent miscarriage or early fetal demise.
We have described in article :
Causes of missed abortion
Diagnosis of missed abortion
Investigations of missed abortion
Complications of missed abortion:
Causes of missed abortion:
1.) Chromosomal abnormality within the foetus: Due to
- Poor quality sperm or ovum.
- Abnormal cell division of foetus.
2) Genetic abnormalities of father or mother.
3) Infection:
4) Abnormal uterine anatomy:
- Unicornuate uterus.
- Septate uterus.
5) Abnormal hormonal levels within the mothers: Low progesterone.
- Untreated thyroid disease.
- Diabetes mellitus.
7) Immune disorders.
8) Substance abuse.
Management of missed abortion:
Diagnosis: The patient presents with features of threatened abortion followed by :
- Persistence of brownish vaginal discharge
- Subsidence of pregnancy symptoms.
- Retrogression of breast changes.
- Cessation of uterine growth which in fact becomes smaller in size
- Non-audibility of the fetal heart sound even with Doppler cardioscope if it had been audible before.
- Cervix feels firm
Investigations of missed abortion:
- Immunological test for pregnancy becomes negative.
- Real time ultrasonography reveals an empty sac carly in the pregnancy or the absence of foetal motion or foetal heart movement later in the pregnancy.
- Bleeding time, clotting time, platelet count, FDP: For treatment planning
- Blood grouping, Rh typing & cross matching.
Treatment of Missed abortion:
1) Uterus is less than 12 weeks: Vaginal evacuation by suction evacuation or slowly dilatation cervix by laminara tent followed by D & E of the uterus under G/A.
2) Uterus more than 12 weeks :
- First dilation of cervix then evacuation.
- Induction is done by following drugs:
✓ Oxytocin
Complications of missed abortion:
1) Psychological upset.
2) Infection: Sepsis (by gas forming organisms like Clostridium welchii).
3) Blood coagulation disorder: DIC
4) During labour :
- Uterine inertia 57.
- Retained placenta.
- Postpartum haemorrhage.
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