What type of abortion is characterized by fetal death with no tissue expulsion for an extended period, such as 8 weeks, at 10 weeks of gestation?

Missed Abortion (Aborto Retenido)

This clinical scenario describes a missed abortion (also termed "embryonic/fetal demise" or "aborto retenido"), defined as embryonic or fetal death without spontaneous expulsion of conception products. 1, 2

Diagnostic Classification

The Society of Radiologists in Ultrasound 2025 consensus guidelines establish that this presentation falls under "Diagnostic of Early Pregnancy Loss (EPL)" with the specific subcategory of embryonic/fetal demise when there is confirmed absence of cardiac activity with retained products of conception. 3 The key diagnostic features include:

• Crown-rump length ≥7 mm without cardiac activity, OR
• Mean sac diameter ≥25 mm without an embryo (anembryonic pregnancy), OR
• Absence of embryo ≥14 days after visualization of gestational sac 3, 2

The term "missed abortion" remains clinically acceptable, though modern terminology favors "embryonic/fetal demise" (with "fetal demise" specifically used at ≥11 weeks gestation). 3, 1 Avoid obsolete terms like "blighted ovum" or "nonviable pregnancy." 3, 4

Critical Management Considerations at 10 Weeks with 8-Week Retention

Active evacuation is mandatory—expectant management is absolutely contraindicated in this scenario. 1 The prolonged retention (8 weeks since fetal death) creates substantial maternal risks:

Immediate Risks Requiring Urgent Intervention

• Intrauterine infection risk increases significantly with time, particularly beyond 18 hours from diagnosis 1, 4
• Coagulopathy risk from retained products 1
• Maternal sepsis from prolonged tissue retention 1

Signs of Infection (Do NOT Wait for Fever)

Clinical symptoms of infection may be less overt at earlier gestational ages—do not delay treatment waiting for fever. 3, 1 Look for:

• Maternal tachycardia
• Purulent cervical discharge
• Fetal tachycardia (if applicable)
• Uterine tenderness 3, 1

If infection is suspected, initiate broad-spectrum antibiotics immediately and proceed with urgent evacuation. 1 Do not delay definitive treatment waiting for amniocentesis results or fever development. 1

Treatment Options at 10 Weeks Gestation

Surgical Evacuation (Preferred Method)

Suction dilation and curettage (D&C) is the safest option at this gestational age with prolonged retention, offering:

• Lower hemorrhage risk (9.1% vs 28.3% with medical management) 1
• Lower infection risk (1.3% vs 23.9% with medical management) 1
• Lower retained tissue requiring repeat procedure (1.3% vs 17.4% with medical management) 1
• Immediate resolution 2

Perform under ultrasound guidance to reduce uterine perforation risk. 2 Administer uterotonic agents during and after the procedure to minimize bleeding. 2

Medical Management (Alternative if Patient Prefers)

If the patient is hemodynamically stable without signs of infection and strongly prefers medical management:

• Vaginal misoprostol 800 mcg is more effective than oral administration 5, 6
• Success rate approximately 80% for missed abortion 7
• Vaginal route achieves higher success rates, shorter induction-to-expulsion intervals, and greater patient satisfaction compared to oral administration 6
• Alternative: 600 mcg sublingual misoprostol 5

However, given the 8-week retention period, surgical evacuation remains strongly preferred due to infection and coagulopathy risks. 1

Essential Pre-Procedure Workup

• Complete blood count to assess anemia and thrombocytopenia 2
• Blood type and Rh status: Administer 50 μg Rho(D) immunoglobulin if Rh-negative 1, 2
• Coagulation studies given prolonged retention 1
• Assess for signs of disseminated intravascular coagulation 1

Post-Procedure Follow-Up

• Serial hCG monitoring until return to non-pregnant state 2
• Ultrasound evaluation to confirm complete evacuation 2
• Histopathologic examination of tissue to confirm intrauterine pregnancy and rule out gestational trophoblastic disease 2, 4

Common Pitfalls to Avoid

• Never pursue expectant management with confirmed fetal demise and prolonged retention 1
• Do not delay evacuation waiting for fever or amniocentesis results if infection is suspected 3, 1
• Do not misdiagnose as incomplete abortion—careful ultrasound evaluation is essential to differentiate from ectopic pregnancy 1