Missed abortion

This is the situation where there is fetal death before 24 weeks gestation but the fetus is not lost from the uterus.

This definition was changed from 28 weeks to 24 weeks on the 1st of October 1992.

Clinical presentation:

• questionable vaginal bleeding
• uterus small for dates
• cervix is closed
• few obvious symptoms

Diagnosis:

• pregnancy test is either positive or negative
• fetal heart, movements and ultrasound evidence of fetal life are all absent

Management:

• assess clotting status
• ERPC
• Rhesus prophylaxis if appropriate
• effective medical management include:
  • high dose of prostaglandin with longer duration of use
  • priming with antiprogesterone (1)

Bleeding into the chorio-decidual space may result in the formation of an organized, laminated mass called a carneous mole.

Reference:

• (1) Royal College of Obstetricians and Gynaecologists (RCOG) 2006. The management of early pregnancy loss