eMedicine Specialties > Obstetrics and Gynecology > General Gynecology

Missed Abortion

Author: James L Lindsey, MD, Staff Physician, Santa Clara Valley Medical Center, Affiliated Clinical Associate Professor, Stanford School of Medicine, Department of Obstetrics and Gynecology, Santa Clara Valley Medical Center
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

Introduction

Background

Missed abortion refers to the clinical situation in which an intrauterine pregnancy is present but is no longer developing normally. This can manifest as an anembryonic gestation (empty sac or blighted ovum) or with fetal demise prior to 20 weeks' gestation. The gestation is termed a missed abortion only if the diagnosis of incomplete abortion or inevitable abortion is excluded (ie, the cervical os is closed). Before widespread use of ultrasonography, the term missed abortion was applied to pregnancies with no uterine growth over a prolonged period of time, typically 6 weeks. Some authorities think that more specific descriptive terms should be used; however, the term missed abortion is still widely used among clinicians and is a commonly used indexing term for MEDLINE and other resources.

For further information, see Medscape's Pregnancy Resource Center.

Pathophysiology

Causes of missed abortion are generally the same as those causing spontaneous abortion or early pregnancy failure. Causes include anembryonic gestation (blighted ovum), fetal chromosomal abnormalities, maternal disease, embryonic anomalies, placental abnormalities, and uterine anomalies. Virtually all spontaneous abortions are preceded by missed abortion. A rare exception is expulsion of a normal pregnancy because of a uterine abnormality.

Frequency

United States

Frequency closely correlates with frequency of failed pregnancy in general. In clinically recognized pregnancies, spontaneous abortion occurs in up to 15% of cases. The rate is much higher for preclinical pregnancies. Diagnosis is made much more frequently because of increased use of early ultrasonography.

Mortality/Morbidity

  • Associated morbidity is similar to that associated with spontaneous abortion and includes bleeding, infection, and retained products of conception.
  • Previously, before the diagnosis of fetal demise could be made and before the condition could be treated easily, disseminated intravascular coagulation (DIC) syndrome associated with prolonged retention of a dead fetus (>6-8 wk) was reported. With early diagnosis and treatment, DIC is extremely rare.

Race

Incidence is similar among all races.

Age

Pregnancy failure rates increase with age and rise significantly in women older than 40 years.

Clinical

History

History is of limited value. Obtaining information about when and how the pregnancy was first diagnosed, any human chorionic gonadotropin (hCG) tests or prior ultrasounds, and if abatement of symptoms of pregnancy has occurred may help the diagnosis of missed abortion.

Physical

  • Physical examination is of limited value.
  • A uterus that is small for dates or not increasing in size suggests missed abortion.
  • Vaginal bleeding is suggestive of missed abortion.
  • Loss of fetal heart tones or inability to obtain heart tones at the appropriate time leads to suspicion of the diagnosis.

Causes

Causes of missed abortion are generally the same as those causing spontaneous abortion or early pregnancy failure. Causes include anembryonic gestation (blighted ovum), fetal chromosomal abnormalities, maternal disease, embryonic anomalies, placental abnormalities, and uterine anomalies.

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

  1. Nanda K, Peloggia A, Grimes D, Lopez L, Nanda G. Expectant care versus surgical treatment for miscarriage. Cochrane Database Syst Rev. 2006;(2):CD003518. [Medline].

  2. American College of Obstetrics and Gynecology. Early Pregnancy Loss. The American College of Obstetrics and Gynecology, Compendium of Selected Publications. 1995.

  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].

  4. Callen PW. Ultrasound in Obstetrics and Gynecology. 4th ed. Philadelphia, Pa: WB Saunders; 2000.

  5. Cho FN, Chen SN, Tai MH, Yang TL. The quality and size of yolk sac in early pregnancy loss. Aust N Z J Obstet Gynaecol. Oct 2006;46(5):413-8. [Medline].

  6. Creinin MD, Schwartz JL, Guido RS, Pymar HC. Early pregnancy failure--current management concepts. Obstet Gynecol Surv. Feb 2001;56(2):105-13. [Medline].

  7. Demetroulis C, Saridogan E, Kunde D, Naftalin AA. A prospective randomized control trial comparing medical and surgical treatment for early pregnancy failure. Hum Reprod. Feb 2001;16(2):365-9. [Medline].

  8. Graziosi GC, Mol BW, Ankum WM, Bruinse HW. Management of early pregnancy loss. Int J Gynaecol Obstet. Sep 2004;86(3):337-46. [Medline].

  9. Hemminki E. Treatment of miscarriage: current practice and rationale. Obstet Gynecol. Feb 1998;91(2):247-53. [Medline].

  10. Hurd WW, Whitfield RR, Randolph JF, Kercher ML. Expectant management versus elective curettage for the treatment of spontaneous abortion. Fertil Steril. Oct 1997;68(4):601-6. [Medline].

  11. Lelaidier C, Baton-Saint-Mleux C, Fernandez H, et al. Mifepristone (RU 486) induces embryo expulsion in first trimester non-developing pregnancies: a prospective randomized trial. Hum Reprod. Mar 1993;8(3):492-5. [Medline].

  12. Luise C, Jermy K, May C, et al. Outcome of expectant management of spontaneous first trimester miscarriage: observational study. BMJ. Apr 13 2002;324(7342):873-5. [Medline].

  13. Morin L, Van den Hof MC. SOGC clinical practice guidelines. Ultrasound evaluation of first trimester pregnancy complications. Number 161, June 2005. Int J Gynaecol Obstet. Apr 2006;93(1):77-81. [Medline].

  14. Neilson JP, Hickey M, Vazquez J. Medical treatment for early fetal death (less than 24 weeks). Cochrane Database Syst Rev. Jul 19 2006;3:CD002253. [Medline].

  15. Ngoc NT, Blum J, Westheimer E, et al. Medical treatment of missed abortion using misoprostol. Int J Gynaecol Obstet. Nov 2004;87(2):138-42. [Medline].

  16. 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].

  17. Pridjian G, Moawad AH. Missed abortion: still appropriate terminology?. Am J Obstet Gynecol. Aug 1989;161(2):261-2. [Medline].

  18. 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. May 27 2006;332(7552):1235-40. [Medline].

  19. 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. May 27 2006;332(7552):1235-40. [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, Staff Physician, Santa Clara Valley Medical Center, Affiliated Clinical Associate Professor, Stanford School of Medicine, Department of Obstetrics and Gynecology, Santa Clara Valley Medical Center
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: Nothing to disclose.

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, 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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