From the Guidelines
A missed abortion is now more accurately referred to as a type of Early Pregnancy Loss (EPL) where the pregnancy has not progressed, is in the process of expulsion, or has incompletely or completely passed, but the body has not yet expelled the pregnancy tissue. This condition occurs when an embryo or fetus has died in the uterus but the body has not recognized the pregnancy loss, and therefore has not expelled the pregnancy tissue 1. The woman may not experience typical miscarriage symptoms like bleeding or cramping, which is why it's often discovered during a routine ultrasound when no heartbeat is detected despite the pregnancy sac remaining in place.
Key Points
- Management options include expectant management (waiting for natural passage), medical management using medications like misoprostol, or surgical management through dilation and curettage (D&C) 1.
- Medical management typically involves taking misoprostol, which causes uterine contractions to expel the tissue, and may be preceded by mifepristone to increase effectiveness.
- Patients should expect cramping and bleeding, which may be heavier than a normal period, lasting 1-2 weeks.
- Follow-up is important to ensure complete passage of tissue, usually confirmed by ultrasound or declining pregnancy hormone levels.
- The term "missed abortion" is no longer preferred, and instead, the term "Early Pregnancy Loss (EPL)" with specific modifiers (concerning for, diagnostic of, in progress, incomplete, and completed) should be used to describe the condition 1.
Diagnosis and Management
The diagnosis of a missed abortion or EPL is typically made through ultrasound, and the management approach depends on the individual case and patient preferences. The most recent and highest quality study recommends using the term "Early Pregnancy Loss (EPL)" and its modifiers to describe the condition, rather than the outdated term "missed abortion" 1.
From the Research
Definition of Missed Abortion
A missed abortion is a type of early pregnancy failure where the fetus has died, but the body has not expelled the pregnancy tissue. This can be diagnosed using ultrasonography, which shows that the fetus has stopped developing, but the pregnancy tissue is still present in the uterus 2, 3, 4.
Medical Management of Missed Abortion
Medical management of missed abortion typically involves the use of medications such as misoprostol, a prostaglandin E1 analogue, to help expel the pregnancy tissue from the uterus. Misoprostol can be administered orally or vaginally, and its effectiveness can be improved by pretreatment with mifepristone, a progesterone receptor antagonist 2, 3, 4, 5.
Effectiveness of Mifepristone and Misoprostol
Studies have shown that the combination of mifepristone and misoprostol is effective in managing missed abortion, with success rates ranging from 50% to 88% 2, 3, 4, 5. The effectiveness of this regimen can be influenced by factors such as gestational age, parity, and the presence of other medical conditions 6.
Key Points
- Missed abortion is a type of early pregnancy failure where the fetus has died, but the body has not expelled the pregnancy tissue.
- Medical management of missed abortion typically involves the use of misoprostol, with or without pretreatment with mifepristone.
- The combination of mifepristone and misoprostol is effective in managing missed abortion, with success rates ranging from 50% to 88%.
- Factors such as gestational age, parity, and the presence of other medical conditions can influence the effectiveness of this regimen.