eMedicine Specialties > Emergency Medicine > Obstetrics & Gynecology

Abortion, Missed: Follow-up

Author: Verena T Valley, MD, Associate Professor, Director of Ultrasound, Department of Emergency Medicine, University of Mississippi School of Medicine
Coauthor(s): Loretta Jackson-Williams, MD, PhD, Assistant Professor, Department of Emergency Medicine, University of Mississippi Medical Center; Christopher A Fly, MD, Assistant Professor, Department of Emergency Medicine, Medical College of Georgia
Contributor Information and Disclosures

Updated: Jun 15, 2006

Follow-up

Further Outpatient Care

  • In the case of expectant management, advise the patient to return to the ED or to contact an OB/GYN if severe cramping, bleeding, fever, and/or passage of tissue occur.
  • Ultrasound findings, in association with presence or absence of significant clinical bleeding, may aid in determination of urgent versus routine follow-up (see Images 2-3).

Transfer

  • Transfer patients with evidence of a coagulation disorder to a higher level of care.

Complications

  • Coagulation defects may be associated with a retained dead fetus.

Prognosis

  • The prognosis for a successful pregnancy depends upon the etiology of previous spontaneous abortion(s).
    • Correction of an endocrine abnormality in women with recurrent abortion has the best prognosis for a successful pregnancy (>90%).
    • In women with an unknown etiology of prior losses, the probability of achieving successful pregnancies is 40-80%.
    • The live-birth rate after documentation of fetal cardiac activity at 5-6 weeks of gestation in women with a history of 2 or more unexplained spontaneous abortions is approximately 77%.

Patient Education

Miscellaneous

Special Concerns

  • Offer grief counseling to all patients who have had a miscarriage.
 


More on Abortion, Missed

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

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  2. Bernaschek G, Rudelstorfer R, Csaicsich P. Vaginal sonography versus serum human chorionic gonadotropin in early detection of pregnancy. Am J Obstet Gynecol. Mar 1988;158(3 Pt 1):608-12. [Medline].

  3. Brown DL, Doubilet PM. Transvaginal sonography for diagnosing ectopic pregnancy: positivity criteria and performance characteristics. J Ultrasound Med. Apr 1994;13(4):259-66. [Medline].

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  5. Dickey RP, Olar TT, Curole DN, et al. Relationship of first-trimester subchorionic bleeding detected by color Doppler ultrasound to subchorionic fluid, clinical bleeding, and pregnancy outcome. Obstet Gynecol. Sep 1992;80(3 Pt 1):415-20. [Medline].

  6. Doubilet PM, Benson CB. Embryonic heart rate in the early first trimester: what rate is normal?. J Ultrasound Med. Jun 1995;14(6):431-4. [Medline].

  7. Esposito TJ. Trauma during pregnancy. Emerg Med Clin North Am. Feb 1994;12(1):167-99. [Medline].

  8. Hill JA. Sporadic and recurrent spontaneous abortion. In: Kistner RW, ed. Kistner's Gynecology: Principles and Practice. 6th ed. Mosby-Year Book;1995:33-365.

  9. Inbal A, Muszbek L. Coagulation factor deficiencies and pregnancy loss. Semin Thromb Hemost. Apr 2003;29(2):171-4. [Medline].

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  12. Levi CS, Dashefsky SM, Lyons EA. First trimester ultrasound. In: McGahan JP, Goldberg BB, eds. Diagnostic Ultrasound - A Logical Approach. Lippincott-Raven Publishers;1998:141.

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  16. Nyberg DA, Laing FC, Filly RA. Threatened abortion: sonographic distinction of normal and abnormal gestation sacs. Radiology. Feb 1986;158(2):397-400. [Medline].

  17. Pandya PP, Snijders RJ, Psara N. The prevalence of non-viable pregnancy at 10-13 weeks of gestation. Ultrasound Obstet Gynecol. Mar 1996;7(3):170-3. [Medline].

  18. Sairam S, Khare M, Michailidis G. The role of ultrasound in the expectant management of early pregnancy loss. Ultrasound Obstet Gynecol. Jun 2001;17(6):506-9. [Medline].

  19. Sauer MV. Pregnancy wastage and reproductive aging: the oocyte donation model. Curr Opin Obstet Gynecol. Jun 1996;8(3):226-9. [Medline].

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  21. Scroggins KM, Smucker WD, Krishen AE. Spontaneous pregnancy loss: evaluation, management, and follow-up counseling. Prim Care. Mar 2000;27(1):153-67. [Medline].

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Further Reading

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Keywords

miscarriage, blighted ovum, anembryonic pregnancy, fetal demise, spontaneous abortion, missed abortion, threatened abortion, complete abortion, incomplete abortion, inevitable abortion, pregnancy loss, utero death of the embryo, utero death of the fetus, chromosomal anomalies, septate uterus, luteal phase insufficiency, hypothyroidism, hypoprolactinemia, polycystic ovarian syndrome, anembryonic pregnancy, subchorionic hematoma, subchorionic hemorrhage, subchorionic bleeding, endovaginal ultrasound, transabdominal ultrasound

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Contributor Information and Disclosures

Author

Verena T Valley, MD, Associate Professor, Director of Ultrasound, Department of Emergency Medicine, University of Mississippi School of Medicine
Verena T Valley, MD is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Coauthor(s)

Loretta Jackson-Williams, MD, PhD, Assistant Professor, Department of Emergency Medicine, University of Mississippi Medical Center
Loretta Jackson-Williams, MD, PhD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Christopher A Fly, MD, Assistant Professor, Department of Emergency Medicine, Medical College of Georgia
Christopher A Fly, MD is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Medical Editor

Roy Alson, MD, PhD, FACEP, FAAEM, Associate Professor, Department of Emergency Medicine, Wake Forest University School of Medicine; Medical Director, Forsyth County EMS; Deputy Medical Advisor, North Carolina Office of EMS; Associate Medical Director, North Carolina Baptist AirCare
Roy Alson, MD, PhD, FACEP, FAAEM is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, National Association of EMS Physicians, North Carolina Medical Society, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Mark Zwanger, MD, MBA, Assistant Professor, Department of Emergency Medicine, Thomas Jefferson University
Mark Zwanger, MD, MBA is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and American Medical Association
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Pamela L Dyne, MD, Associate Professor, Program Director, Department of Medicine, Division of Emergency Medicine, University of California at Los Angeles School of Medicine
Pamela L Dyne, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

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