MISSED ABORTION

Clinical Features

As shown in Table

Investigations

  • As for threatened abortion
  • Ultrasound, where available, will confirm foetal death
  • Bleeding and clotting time in case disseminated intravascular coagulopathy (DIC) has developed.

Management

  • Admit the patient for definitive treatment.
  • If more than 12 weeks, induce with the prostaglandin tabs misoprostrol 400μg per vagina. Observe for spontaneous onset of abortion process, then examine for complete abortion; if incomplete do MVA.
  • Then if less than 12 weeks, evacuate the uterus with MVA or misoprostrol 800μg orally. Start on antibiotics PO doxycycline 100mg 12 hourly, PO metronidazole 400mg 8 hourly for 5 days, and PO ibuprofen 400mg 8 hourly for 3 days on discharge.
  • If complicated with DIC, fresh blood transfusion or fresh frozen plasma is lifesaving.

Patient Education