Missed Abortion
This clinical presentation is diagnostic of a missed abortion (also termed embryonic demise or missed miscarriage), characterized by embryonic death without spontaneous expulsion of conception products. 1, 2
Diagnostic Criteria Met
The patient fulfills definitive diagnostic criteria for missed abortion based on the 2025 Society of Radiologists in Ultrasound consensus guidelines:
- Crown-rump length of 9 weeks (approximately 22-23 mm) with absent cardiac activity is diagnostic of embryonic/fetal demise, as any embryo ≥7 mm CRL without cardiac activity confirms demise 1, 2
- Closed cervical os indicates retained products of conception without active expulsion 2, 3
- Absence of vaginal bleeding distinguishes this from incomplete or inevitable abortion 2, 4
- Intrauterine gestational sac rules out ectopic pregnancy 1
Why Other Options Are Incorrect
Threatened Abortion (Option D)
- Definitively excluded because threatened abortion requires both a viable embryo with cardiac activity AND a closed cervical os 2, 4
- This patient has confirmed embryonic death (no heartbeat), making threatened abortion impossible 4, 5
Inevitable Abortion (Option C)
- Ruled out because inevitable abortion requires cervical dilatation with or without bleeding 2, 4
- This patient has a closed cervical os, which excludes inevitable abortion by definition 3, 5
Septic Abortion (Option A)
- No clinical evidence of infection (no fever, purulent discharge, maternal tachycardia, or uterine tenderness mentioned) 2
- Septic abortion can complicate any abortion type but requires signs of infection to diagnose 2, 4
Clinical Significance and Management Implications
Active evacuation is required, not expectant management, due to increased risks of:
- Intrauterine infection (38% with expectant management vs 13% with active treatment) 2
- Coagulopathy with prolonged retention 2
- Postpartum hemorrhage (23.1% with expectant management vs 11% with active treatment) 2
Critical management steps include:
- Surgical evacuation via vacuum aspiration or dilation and evacuation (D&E) is the definitive treatment 2, 4
- Rh immunoglobulin (50 mcg) must be administered if the patient is Rh-negative to prevent alloimmunization, as 32% of spontaneous abortions involve fetomaternal hemorrhage 2
- Do not delay treatment waiting for fever or other infection signs, as symptoms may be subtle at early gestational ages 2
The modern terminology "embryonic demise" or "diagnostic of early pregnancy loss" is preferred over outdated terms like "blighted ovum" 1, 2