What is missed abortion?
Missed abortion happens when the embryo ceases to develop, but the body does not immediately expel it. This can be a difficult and emotional experience. In contrast to other types of miscarriage, where immediate symptoms like bleeding or cramping are present, missed abortion typically has no immediate signs.
- Approximately 10% to 20% of all spontaneous abortions fall under the category of missed abortions.
- Roughly 15% of women will face a misscarriage at some point in their lives.
- The majority of missed abortions occur during the first 12 weeks of pregnancy.
Causes of Missed Abortion:
- Chromosomal Abnormalities: Approximately half of missed abortions are because of chromosomal abnormalities resulting from errors during cell division. This causes developmental problems and avoids proper embryo growth.
- Uterine Issues: Conditions like fibroids, a bicornuate uterus (a uterus with two horns), or uterine hypoplasia (a small or underdeveloped uterus) can disrupt the embryo’s implantation and growth.
- Cervical Incompetence: In cases where the cervix opens prematurely, it may also contribute to missed abortion.
- Hormonal Imbalances: Hormonal disorders, such as diabetes mellitus, polycystic ovary syndrome (PCOS), thyroid conditions, and other endocrine disorders, can impact pregnancy.
- Autoimmune Disorders: Conditions like systemic lupus erythematosus (SLE) may provoke the immune system to attack the developing embryo, resulting in miscarriage.
- Infections: sexually transmitted infections (STIs) like syphilis, cytomegalovirus, toxoplasmosis, and mycoplasma can adversely affect the embryo, leading to miscarriage.
- Blood Clotting Disorders: thrombophilias and other blood clotting disorders can disrupt blood flow to the placenta, causing miscarriage.
- Additional Factors: Severe maternal trauma, uncontrolled hypertension, cancer, or heart disease can also lead to missed abortion.
Sometimes reason of missed abortion is not identifiable. It is important to consult a gynecologist nearby for appropriate diagnosis and support.
Symptoms of Missed Abortion:
- Disappearance of early Symptoms of Pregnancy: One of the initial signs of a missed abortion could be the sudden disappearance of common early pregnancy symptoms like nausea, vomiting, breast tenderness. Early symptoms of pregnancy arise from hormonal changes and their absence may indicate a problem.
- Light Spotting or Bleeding: Occasional spotting or light bleeding may signal a missed abortion. While some light bleeding can be expected in early pregnancy, it is crucial to monitor it and consult a gynecologist if it happens.
- Lower Abdomen Pain: cramping, discomfort or pain lower abdomen can occur in miscarriage. This cramping is generally less severe, but it should be checked if it coincides with other symptoms.
- Absence of Fetal Heartbeat on Ultrasound: A vital sign of a missed abortion is the absence of fetal heartbeat on ultrasound examination. This is most accurate method for diagnosis of missed abortions.
- Decreased HCG Levels: Human chorionic gonadotropin (HCG) is a hormone generated during pregnancy. A notable drop or lack of increase in HCG levels observed through blood tests may point to a miscarriage.
How to Diagnose Missed Abortion:
- Ultrasound Examination: The ultrasound is the most dependable technique for diagnosing missed abortion. In this procedure, the doctor checks for a fetal heartbeat and evaluates the embryo’s development. In instances of missed abortion, the lack of a heartbeat or an improperly developed fetus for the gestational age can confirm the diagnosis.
- Human Chorionic Gonadotropin (HCG) Blood Tests for Missed Abortion: HCG is a hormone manufactured during pregnancy. In a healthy pregnancy, HCG levels typically double every 48-72 hours. If these levels plateau or decrease significantly, it could indicate a missed abortion. Serial HCG blood tests over several days can help track these variations.
- Pelvic Examination: If the uterus is not growing as anticipated for the gestational age, it may suggest some problem. This finding should be further investigated.
- Progesterone Levels: Low progesterone levels along with other tests can be helpful in diagnosis
Treatment Options for Missed Abortion:
Treatment choice is advised based upon medical history, preferences, and the specific circumstances of the pregnancy.
- Expectant Management: Tissue is expelled from the uterus naturally. It might be appropriate for some individuals but close observation is required.
- Medical Management: Medications such as misoprostol and occasionally mifepristone are utilized to induce contractions and facilitate the expulsion of pregnancy tissue. These medications are administered under a doctor’s supervision.
- Surgical Management: Surgical options consist of
- dilation and curettage (D&C)
- vacuum aspiration.
These procedures involve dilating the cervix and removing the pregnancy tissue from the uterus. Surgical management is frequently recommended if there are indications of infection, heavy bleeding, or the patient desires a swifter resolution.
“Going through a missed abortion can be overwhelming. Support from family, friends, and mental health resources is vital.”
Planning Your Next Pregnancy
Deciding when to attempt your subsequent pregnancy is a personal choice and should be discussed with your gynecologist. Your gynecologist gives advice based on your medical history, the reasons for the missed abortion, and your physical and emotional state.
How much to wait before planning next pregnancy after missed abortion:
- Wait Time: wait for 2 to 3 menstrual cycles (approximately 2 to 3 months) before trying to conceive again. This lowers the possibility of complications.
- Physical Recovery: Complete physical recovery from any medical procedures or treatments should be ensured before attempting further.
Other preparations:
- Emotional Wellbeing: Give yourself adequate time to heal emotionally.
- Health Checkup: have a comprehensive medical examination to identify any underlying health related issues that could have contributed to the missed abortion. This may involve tests for hormonal imbalances, infections, or blood clotting disorders.
- Lifestyle Factors: To maintain a healthy lifestyle, consume a balanced diet, maintain a healthy weight, avoid smoking and alcohol, and manage stress effectively.
Follow-Up Care: Regular follow-up visits help in monitoring health and support to prepare for next pregnancy.
Minimizing Risks:
- Folic Acid Supplements: Take folic acid supplements before conception according to the advice of an obstetrician to lower the risk of neural tube defects.
- Lifestyle Factors: Maintain a healthy lifestyle and attend all antenatal checkups to ensure a safe pregnancy.
Remember to prioritize your well-being and allow yourself the necessary time to recover physically and emotionally. If you have any concerns or inquiries, don’t hesitate to contact your gynecologist for assistance and support.
