When the fetus is dead and retained inside the uterus for a variable period, it is called missed abortion or silent miscarriage. The cause of prolonged retention of the dead fetus in the uterus is not clear. Beyond 12 weeks, the retained fetus becomes macerated. The liquor amnii gets absorbed and the placenta becomes pale thin and may be adherent. Before 12 weeks, the pathological process differs when the ovum is more or less completely surrounded by the chorionic villi.
Clinical features -
- Continuation of pain in lower abdomen.
- Persistence of vaginal bleeding.
- Brownish vaginal discharge.
- Non audibility of fetal heart sound.
- Absence of fetal motion.
- Immunological test for pregnancy becomes negative.
Management -
Clinical features -
- Continuation of pain in lower abdomen.
- Persistence of vaginal bleeding.
- Brownish vaginal discharge.
- Non audibility of fetal heart sound.
- Absence of fetal motion.
- Immunological test for pregnancy becomes negative.
Management -
Uterus is less than 12 weeks :-
Vaginal evacuation can be carried out without delay. This can be effectively done by suction evacuation or slow dilatation of the cervix by laminaria tent followed by dilatation and evacuation
(D & E) of the uterus under general anaesthesia.
Uterus more than 12 weeks :-
i) Oxytocin - To start with 10-20 units of oxitocin in 500 ml of normal saline.
ii) Prostaglandins - It is more effective than oxytocin in such cases. Prostaglandin Ei analogue (misoprostol) tablet is inserted into the posterior vaginal fornix every 4 hours for a maximum 5 times.
(D & E) of the uterus under general anaesthesia.
Uterus more than 12 weeks :-
i) Oxytocin - To start with 10-20 units of oxitocin in 500 ml of normal saline.
ii) Prostaglandins - It is more effective than oxytocin in such cases. Prostaglandin Ei analogue (misoprostol) tablet is inserted into the posterior vaginal fornix every 4 hours for a maximum 5 times.
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