Missed miscarriages

What is a missed miscarriage?

A missed miscarriage, also known as a missed abortion or a silent miscarriage is when the fetus is dead but the body does not recognize the pregnancy loss or expel the pregnancy tissue so the dead fetus remains inside the uterus for a variable period. As a result, the placenta may continue to release hormones, so you may continue to experience signs of pregnancy. It is also called early fetal demise.

What causes missed miscarriage?

Majority (50%) of early miscarriages are due to chromosomal abnormality in the fetus. structural abnormalities of the uterus, endocrinal disorders and infections may also play a role.

What are the signs of missed miscarriage?

Since the uterus does not expel the dead fetus there are no signs of a typical miscarriage like heavy bleeding, abdominal cramps etc. instead –

• Persistence of brownish vaginal discharge.
• Subsidence of pregnancy symptoms.
• Retrogression of breast changes.
• Stopped uterine growth which in fact becomes smaller in size.

How is this diagnosed?

• Nonaudibility of the fetal heart sound even with Doppler ultrasound if it had been audible before.
• Immunological test for pregnancy becomes negative.
• Ultrasonography reveals an empty sac early in the pregnancy or the absence of fetal cheart motion and fetal movements.

How is missed miscarriage managed?

Uterus is less than 12 weeks:

1. Many women expel the fetus spontaneously.
2. Prostaglandin E1 (misoprostol) 800 mg given vaginally. Expulsion usually occurs within 48 hours.
3. Suction evacuation or dilatation and evacuation is done either as a definitive treatment or when the medical method fails.

Uterus more than 12 weeks:

1. Prostaglandin E1 analog (misoprostol) 200 µg tablet is inserted into the vagina.
2. Oxytocin—10–20 units of oxytocin in 500 mL of normal saline at 30 drops/min is started. If fails, escalating dose of oxytocin to the maximum of 200 mlU/min may be used with monitoring.
3. Many patients need surgical evacuation following medical treatment. Following medical treatment, ultrasonography should be done to document empty uterine cavity. Otherwise evacuation of the retained products of conception (ERPC) should be done.