Missed Abortion

Missed abortion, also known as a missed miscarriage or silent miscarriage, happens when the baby or embryo dies in the uterus as a result of bleeding between the placental and uterine walls rather than being evacuated. The products remain in the uterine cavity for more than four to twelve weeks of gestation.

Causes

Missed abortions are caused by chromosomal defects in the fetus, which prevent the pregnancy from developing or continuing.

Signs and Symptoms

1. Vaginal bleeding
2. Brownish vaginal discharge without pain
3. Heavy abdominal cramping or expulsion of the fetal tissue.
4. Nausea
5. Vomiting
6. Clear fornices
7. Cervix is soft even the internal OS is closed

Investigation

1. Urine test for pregnancy conform to Ultrasound Doppler examination to determine the
2. presence or absence of fetal heart sound
3. Plain abdominal radiography may reveal scattered skeletal shadows.
4. Platelet count and blood clotting time tests

Complication

1. Risk of infection/ danger of sepsis
2. Blood coagulation disorder
3. Psychological stress and trauma

Management

1. First, the patient should be admitted to the hospital for removal of the retained products within the uterus.
2. If the missed abortion diagnosis is confirmed, the uterus must be evacuated.
3. Check and record the maternal vital signs.
4. Reassure and support the mother.
5. Before evacuation, a blood test for hemoglobin, grouping, cross match, clotting time, and bleeding time should be performed.
6. The uterus is evacuated, and the method used depends on the size of the uterus and the gestation time.
7. Uterus smaller than 12 weeks.
   - Vaginal evacuation can be performed immediately. 
   - Suction evacuation or gradual dilatation and curettage under antibiotic cover can be used to accomplish this.
8. Uterus larger than 12 weeks: The following approaches are used for induction:
   - Cervical maturation with prostaglandin gel ( it is more effective than oxytocin in such cases)
   - Oxytocin infusion through an IV drip
9. Post-abortion care

• The evacuated conception products are examined to guarantee full expulsion.
• Tetanus toxoid injections should be administered.
• Anti-D gamma globulin injection is administered to Rh-negative mothers.
• Haematinics are used to treat anemia.
• Antibiotics are used to keep infections at bay.
• Analgesic is used to relieve pain.

Blood Mole or Tuberous mole (Corneous mole)

Most missed abortions continue with the formation of a blood mole. The smooth brownish red mass is entirely encompassed by the capsule decidua. The fetus and placenta are surrounded by blood within the capsular decidua. These moles often form before the 12th week and remain in the uterus for a month. A carneous mole is a firm, hard mass that remains after the fluid is removed from the blood and the flesh.

Signs and Symptoms

1. History of a variable period of amenorrhea
2. Bleeding per vagina and brownish discharge
3. No pain
4. Internal OS is closed
5. Cervix felt soft
6. Fornices are clear
7. Bleeding from the cervical canal

Investigation

1. History taking
2. Physical examination
3. USG
4. Doppler examination

Complication

1. Sepsis
2. Psychological distress and trauma

Management

1. Encourage the patient to do the required investigations and examinations.
2. Daily vital signs monitoring and recording
3. Closely monitor and document bleeding, clotting, and fibrin degradation.
4. Perform manual vacuum evacuation to remove the conception's residual product.
5. IV infusion begins with the patient's state and is followed by oxytocin to control bleeding.

References

• ToWomenHealth. http://2womenshealth.com/Missed-Abortion.htm
• SlideShare. https://www.slideshare.net/crisbertc/types-of-abortion
• Prezi. 17 February 2011. https://prezi.com/7avru5nzs1en/types-of-abortion-management-nurses-perspective/
• NCBI. 22 June 1930. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC381898/?page=3
• Tuitui R. 2002, A textbook of Midwifery A (Antenatal), 3rd edition, Vidyarthi Pustak Bhandari (Publisher and Distributor), Bhotahity, Kathmandu