eMedicine Specialties > Obstetrics and Gynecology > General Gynecology

Missed Abortion: Follow-up

Author: James L Lindsey, MD, Consulting Staff, Department of Obstetrics and Gynecology, Santa Clara Valley Medical Center; Assistant Clinical Professor, Department of Obstetrics and Gynecology, Stanford University School of Medicine
Coauthor(s): Veronica R Rivera, MD, Staff Physician, Department of Obstetrics and Gynecology, Santa Clara Valley Medical Center
Contributor Information and Disclosures

Updated: Oct 9, 2008

Follow-up

Further Outpatient Care

  • Rho(D)-negative patients should receive anti-D immunoglobulin after a missed abortion.
  • Emotional support and education are important. Assist the patient through the grieving process.
  • For patients who experience a fetal death in the second trimester, allowing them to see, hold, or photograph the fetus as would be offered after later fetal death may be helpful (see Evaluation of Fetal Death).
  • Assure the patient that the prognosis for normal pregnancy in the future is excellent.

Complications

  • Complications are rare and are usually associated with the uterine evacuation process. Retained products of conception can occur after medical or surgical evacuation but are more common after medical treatment. Infection and blood loss can occasionally occur after evacuation.
  • If a fetal demise occurs and the dead fetus is carried for more than 4 weeks, fibrinogen levels can decrease and (rarely) cause bleeding problems.
  • Uterine perforation and uterine synechiae are very rare complications of uterine curettage.

Prognosis

  • Prognosis for future pregnancy is excellent. Most women do not have problems conceiving and carrying a future pregnancy. Approximately 80-90% of patients who have a single spontaneous abortion subsequently deliver a viable fetus with the next pregnancy.
  • For rare patients with missed abortion and 2 or more other early pregnancy losses, prognosis is somewhat poorer and further evaluation is needed. Such a workup would include searching for evidence of the antiphospholipid syndrome and thrombophilic disorders, and/or chromosomal karyotyping.

Patient Education

  • Depending on the patient, discussing in detail the pathophysiology of spontaneous abortion may be appropriate. Assure the patient that the pregnancy failure was not the result of some activity on her part.
  • In most cases, the patient's primary concern is her fertility. Prognosis for future pregnancy is excellent. Most women do not have problems conceiving and carrying a future pregnancy. Reassure the patient accordingly.
  • For excellent patient education resources, visit eMedicine's Pregnancy and Reproduction Center and Procedures Center. Also, see eMedicine's patient education articles Miscarriage, Abortion, and Dilation and Curettage (D&C).

Miscellaneous

Medicolegal Pitfalls

  • The primary medicolegal pitfall in the diagnosis and management of missed abortion is the failure to recognize an ectopic pregnancy. Usually, findings on the sonogram confirm that the pregnancy is intrauterine. However, in rare instances, a pseudosac consisting of retained blood clot exists and can be confused with a missed abortion. In cases in which the sonogram does not clearly show a well-developed sac, ectopic precautions should be continued until evacuated products of conception are documented by pathologic examination. In the case of pregnancy resulting from artificial reproductive technology, a coexisting ectopic pregnancy should always be a consideration.
  • A second medicolegal pitfall is misdiagnosis of an early normal pregnancy as a missed abortion. This eventuality can be prevented by use of serial ultrasonographic studies.
 


More on Missed Abortion

Overview: Missed Abortion
Differential Diagnoses & Workup: Missed Abortion
Treatment & Medication: Missed Abortion
Follow-up: Missed Abortion
Multimedia: Missed Abortion
References
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References

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  3. Bagratee JS, Khullar V, Regan L, et al. A randomized controlled trial comparing medical and expectant management of first trimester miscarriage. Hum Reprod. Feb 2004;19(2):266-71. [Medline].

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  16. [Best Evidence] Petrou S, Trinder J, Brocklehurst P, Smith L. Economic evaluation of alternative management methods of first-trimester miscarriage based on results from the MIST trial. BJOG. Aug 2006;113(8):879-89. [Medline].

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Further Reading

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Keywords

blighted ovum, anembryonic pregnancy, anembryonic gestation, pregnancy failure prior to 20 weeks gestation, spontaneous abortion, early pregnancy failure, fetal demise, mifepristone, Mifeprex, RU 486, RU-486, RU486, misoprostol, fetal chromosomal abnormalities, maternal disease, embryonic anomalies, placental abnormalities, uterine anomalies, ectopic pregnancy, intrauterine pregnancy

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Contributor Information and Disclosures

Author

James L Lindsey, MD, Consulting Staff, Department of Obstetrics and Gynecology, Santa Clara Valley Medical Center; Assistant Clinical Professor, Department of Obstetrics and Gynecology, Stanford University School of Medicine
James L Lindsey, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, American Society for Colposcopy and Cervical Pathology, and California Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Veronica R Rivera, MD, Staff Physician, Department of Obstetrics and Gynecology, Santa Clara Valley Medical Center
Veronica R Rivera, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Suzanne R Trupin, MD, Clinical Professor of Obstetrics and Gynecology, University of Illinois College of Medicine-Champaign; CEO and Owner, Women's Health Practice; CEO and Owner, Hada Cosmetic Medicine and Midwest Surgical Center
Suzanne R Trupin, MD is a member of the following medical societies: American Association of Gynecologic Laparoscopists, American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, American Medical Association, Association of Reproductive Health Professionals, International Society for Clinical Densitometry, and North American Menopause Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Richard S Legro, MD, Professor, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, Pennsylvania State University College of Medicine; Consulting Staff, Milton S Hershey Medical Center
Richard S Legro, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Society for Reproductive Medicine, Endocrine Society, Phi Beta Kappa, and Society of Reproductive Surgeons
Disclosure: Nothing to disclose.

CME Editor

Frederick B Gaupp, MD, Consulting Staff, Department of Family Practice, Hancock Medical Center
Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians
Disclosure: Nothing to disclose.

Chief Editor

Michel E Rivlin, MD, Professor, Coordinator of Quality Assurance/Quality Improvement, Department of Obstetrics and Gynecology, University of Mississippi School of Medicine
Michel E Rivlin, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Mississippi State Medical Association, and Royal College of Surgeons of Edinburgh
Disclosure: Nothing to disclose.

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