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Missed miscarriage

Last revised by Dr Yuranga Weerakkody on 05 Mar 2022

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:

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 

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Cases and figures

  • Case 1
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  • Case 2
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