Disease Description (Causes and Symptoms)
- Definition: A missed abortion is a condition in which the fetus has died inside the uterus, but the cervix remains closed, leaving the deceased pregnancy tissue in the uterus for several days to several weeks.
- Causes and pathophysiology: In many cases, chromosomal abnormalities or malformations of the early embryo or fetus are presumed to be the cause. When tissue remains in the uterus after embryonic death, substances released from the placenta and pregnancy tissue may cause blood coagulation disorders (in severe cases, DIC), and the risk of inflammation and bleeding increases if the tissue remains for a prolonged period.
- Main symptoms: Often asymptomatic. Alternatively, vaginal bleeding (abnormal vaginal bleeding), dysuria and abdominal pain, failure of the uterus to enlarge in accordance with gestational age, and regression of breast changes may occur. If the tissue remains for a prolonged period, a tendency to bleed, such as bleeding after trauma or bleeding gums, may occur.
Treatment Methods
- Diagnostic approach: Check for fetal heartbeat and growth using ultrasound (primarily transvaginal ultrasound). If necessary, make a definitive diagnosis by combining previous test results (prior ultrasound and changes in β-hCG) with clinical findings.
- Treatment options
- Expectant management (observation): A method of waiting for spontaneous expulsion, which may be chosen when symptoms are mild and the risks of infection and bleeding are low. Monitor for signs of bleeding, pain, and infection during the observation period.
- Medical treatment (induction): Use misoprostol alone or in combination with other agents to induce uterine contractions and expel the pregnancy tissue. This can be performed on an outpatient basis, but surgical treatment may be necessary if it fails.
- Surgical treatment: Remove retained tissue through dilation and curettage (D&C) or suction curettage (vacuum aspiration). This is chosen when immediate removal is necessary, when medical treatment has failed, or when the patient wants prompt completion.
- Supportive treatment
- Administer Rh immunoglobulin (RhIg) to mothers who are Rh-negative (as recommended in obstetric care).
- If bleeding or infection is suspected, provide conservative treatment, antibiotic treatment, and hemostatic and supportive care such as blood transfusion.
- Psychological support: Emotional shock, depression, and anxiety are common after a miscarriage, so counseling and psychological support are recommended.
- Precautions and complications
- Cases requiring immediate emergency treatment: Heavy bleeding (dizziness or fainting), high fever or foul-smelling vaginal discharge (infection), severe abdominal pain, symptoms of low blood pressure, and others.
- Complications: Infection (endometritis), heavy bleeding, blood coagulation disorders (DIC—particularly possible when tissue remains for a prolonged period), intrauterine adhesions (Asherman syndrome, mainly after repeated curettage), and, rarely, effects on fertility (in most cases, the likelihood of a subsequent natural pregnancy is high).
- Follow-up: Check whether blood β-hCG levels are decreasing or use ultrasound to check for retained tissue in the uterus. Determine the follow-up visit schedule according to clinical symptoms and test results.
- Lifestyle management: Rest, take prescribed pain relievers and medications, and limit sexual intercourse and vaginal douching until the risks of bleeding and infection have subsided (follow the doctor's instructions).
Checklist Before an Outpatient Visit (Including Preparations and Sample Questions)
- Preparations and information
- A list of medications currently being taken (including prescription medicines, over-the-counter medicines, herbal medicines, and supplements)
- Recent test and ultrasound results (printouts or photos if possible), the first day of the last menstrual period (LMP), and information about gestational age
- Blood type and Rh status (if known)
- Symptom records: Time bleeding began and its pattern (compared with the amount of menstrual bleeding), pain severity (pain scale), presence or absence of fever or foul-smelling discharge, and a diary of symptom changes
- Previous obstetric history (previous miscarriages, surgeries, infertility treatment, and others)
- Contact information and whether a support person (companion) will be present
- Be prepared for items the doctor may ask about during the outpatient visit: Onset and progression of symptoms, presence of fever, recent medication use (especially anticoagulants), previous ultrasound results, and others
Examples of General Questions to Ask the Doctor
- What are the side effects and risks of this medication (or procedure)?
- Which treatment (observation, medication, or surgery) is recommended in my case, and why?
- What is the recovery period after treatment, and when can I return to my daily activities?
- Are there any precautions or recommended tests when planning a future pregnancy?
Examples of Condition-Specific Questions
- My blood type is Rh-negative. Do I definitely need Rh immunoglobulin? When should it be administered?
- Based on the ultrasound findings, when is it considered a “complete miscarriage,” and why do you recommend surgery immediately instead of observation (waiting)?
(If necessary, consult your healthcare provider to receive a specific plan tailored to your medical history and test results.)