Missed Abortion: Causes, Symptoms, Diagnosis & Management

Missed abortion, also known as silent miscarriage, is a type of early pregnancy loss where the fetus stops developing, but the body does not expel the pregnancy tissue immediately. This condition often goes unnoticed until an ultrasound reveals no fetal heartbeat.

What is a Missed Abortion?

A missed abortion (silent miscarriage) is a pregnancy loss where the fetus has died or failed to develop, but the body retains the pregnancy tissue. Unlike other forms of miscarriage, there is usually no heavy bleeding or pain.

• Difference from miscarriage: In a typical miscarriage, bleeding and cramping occur, while in missed abortion, symptoms may be absent.
• Gestational age: It commonly occurs in the first trimester (before 12 weeks of pregnancy).

Causes of Missed Abortion

Cause	Details / Risk Factors
Chromosomal abnormalities	Most common cause (up to 70% cases); abnormal genetic development.
Maternal health conditions	Uncontrolled diabetes, thyroid disease, PCOS.
Hormonal imbalance	Low progesterone levels affecting pregnancy support.
Uterine abnormalities	Fibroids, uterine septum, or scar tissue affecting implantation.
Lifestyle factors	Smoking, alcohol use, malnutrition, exposure to toxins.

Symptoms of Missed Abortion

Missed abortion often presents with no symptoms, which is why it is called a silent miscarriage. However, some women may notice:

• Light vaginal spotting
• Loss of pregnancy symptoms (nausea, breast tenderness)
• Absence of fetal heartbeat on ultrasound

Diagnosis of Missed Abortion

Diagnosis is usually made during a routine check-up or when pregnancy symptoms decline. Methods include:

• Ultrasound findings:
  • No fetal heartbeat
  • Empty gestational sac
  • Smaller crown-rump length (CRL) than expected
• Blood tests: Declining hCG levels
• Clinical evaluation: Lack of uterine growth

Management of Missed Abortion

Treatment depends on the patient’s condition and preferences:

1. Expectant Management (Wait-and-See)
   • Natural expulsion of pregnancy tissue within weeks
   • Suitable for stable patients with no infection
2. Medical Management
   • Medications like Misoprostol ± Mifepristone
   • Induces uterine contractions for expulsion
3. Surgical Management
• Dilation and Curettage (D&C)
• Manual Vacuum Aspiration (MVA)
• Recommended if heavy bleeding, infection, or patient preference

Complications if Untreated

• Severe infection (sepsis)
• Excessive bleeding
• Fertility issues if untreated complications arise
• Emotional and psychological distress

Prevention and Emotional Support

• Preconception care with folic acid supplementation
• Managing chronic diseases (thyroid, diabetes, PCOS)
• Avoiding smoking, alcohol, and drugs
• Genetic counseling in recurrent pregnancy loss
• Psychological support and counseling for emotional recovery

Frequently Asked Questions (FAQs)

Q1: What is missed abortion in pregnancy?

Missed abortion (silent miscarriage) is when the fetus stops developing but the body does not expel the tissue, often detected on ultrasound without symptoms.

Q2: How is missed abortion diagnosed on ultrasound?

It is diagnosed when no fetal heartbeat is detected, the gestational sac appears empty, or the crown-rump length is smaller than expected.

Q3: Can missed abortion happen without bleeding?

Yes, many cases of missed abortion have no bleeding or pain, making it a silent miscarriage.

Q4: What is the best treatment for missed abortion?

Treatment depends on patient preference and condition. Options include expectant management, medical management with Misoprostol, or surgical D&C/MVA.

Q5: Can missed abortion be prevented?

Not all cases can be prevented, but risk can be reduced through healthy lifestyle, prenatal vitamins, and managing chronic conditions.

Conclusion

Missed abortion is an emotionally difficult but medically manageable condition. With timely diagnosis, appropriate treatment, and emotional support, women can recover both physically and psychologically. Proper follow-up care is essential to ensure health and future fertility.