Missed miscarriage
Citation, DOI, disclosures and article data
At the time the article was created Yuranga Weerakkody had no recorded disclosures.
View Yuranga Weerakkody's current disclosuresAt the time the article was last revised Yuranga Weerakkody had no recorded disclosures.
View Yuranga Weerakkody's current disclosures- Missed miscarriage
- Missed abortion
- Early fetal demise
- Early intrauterine fetal demise
- Early loss of pregnancy
A missed miscarriage, sometimes termed a missed abortion 3, is a situation when there is a non-viable fetus within the uterus, without symptoms of a miscarriage.
Radiographic features
Ultrasound
Ultrasound diagnosis of miscarriage should only be considered when either a mean gestation sac diameter is ≥25 mm with no obvious yolk sac or a fetal pole with a crown rump length of ≥7 mm without evidence of fetal cardiac activity.
Transvaginal ultrasound is the mainstay in the diagnosis of miscarriage. Once the diagnosis of miscarriage is made based on the above ultrasound criteria, the patient can then be offered different types of management depending on their clinical status and patient's choice.
Treatment and prognosis
Expectant management is possible, with a "wait and watch" approach can be offered after careful counseling to women who have met the inclusion criteria:
- patient's preference once miscarriage is diagnosed based on ultrasound findings
- incomplete miscarriage
For medical management, misoprostol is the drug of choice. Surgical management is dilatation and curettage. Inclusion criteria:
- patient's preference
- haemodynamically unstable
- persistent excessive bleeding
- evidence of infected retained tissue
- suspected gestational trophoblastic disease
- unsuccessful expectant or medical management
- recurrent miscarriage, to assess for cytogenetics
References
- 1. Bernard K & Cooperberg P. Sonographic Differentiation Between Blighted Ovum and Early Viable Pregnancy. AJR Am J Roentgenol. 1985;144(3):597-602. doi:10.2214/ajr.144.3.597
- 2. Harris R & Barth R. Sonography of the Gravid Uterus and Placenta: Current Concepts. AJR Am J Roentgenol. 1993;160(3):455-65. doi:10.2214/ajr.160.3.8430536
- 3. Trinder J, Brocklehurst P, Porter R, Read M, Vyas S, Smith L. Management of Miscarriage: Expectant, Medical, or Surgical? Results of Randomised Controlled Trial (Miscarriage Treatment (MIST) Trial). BMJ. 2006;332(7552):1235-40. doi:10.1136/bmj.38828.593125.55
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