A missed abortion, or silent miscarriage, occurs when an embryo or fetus dies but is not expelled from the uterus. The placenta continues to release hormones, so pregnancy symptoms may persist despite no fetal heartbeat. Causes include chromosomal abnormalities, infections, or uterine defects. Diagnosis involves ultrasound, hCG monitoring, or cervical examination. Treatment options are medical management with misoprostol or surgical dilation and curettage. Complications may include infection or hemorrhage. Prevention focuses on modifiable risk factors like smoking, nutrition, and environmental exposures.

1. Missed abortion
Prepared by
Jwan Kareem Salh
Msc .Student

2. Definition
Abortion is the ending of a pregnancy by removal or expulsion of an embryo
or fetus An abortion that occurs without intervention is known as
a miscarriage or "spontaneous abortion" and occurs in approximately 30% to
40% of pregnancies. When deliberate steps are taken to end a pregnancy, it is
called an induced abortion .

4. Missed abortion
• Also known as a missed abortion or a silent miscarriage, occurs when
a fetus is no longer alive, but the body does not recognize
the pregnancy loss or expel the pregnancy tissue. As a result, the
placenta may continue to release hormones, so may continue to
experience signs of pregnancy.
• About 80% of miscarriages occur in the first 12 weeks
of pregnancy (the first trimester).

5. Clinical features
• Vaginal bleeding
• Heavy cramping
• Expulsion of fetal tissue
• Subsidence of pregnancy symptoms
• Uterus becomes smaller in size

6. Cont…
• Cervix feels firm with closed internal os
• Non audibility of the fetal heart sound even with Doppler
ultrasound
• Pregnancy test becomes negative

7. causes
The causes of missed abortion are not fully known. About 50
percent of miscarriages happen because the embryo has the wrong
number of chromosomes.
• An endocrine or an autoimmune disorder.
• A heavy smoker.
• Physical trauma .

8. Cont..
• Anembryonic gestation (blighted ovum)
• Maternal disease
• Embryonic anomalies
• Placental abnormalities.
• Uterine anomalies.

9. When should woman see a doctor?
should always see a doctor if suspect any kind of miscarriage. Call
doctor if have any miscarriage symptoms, including:
vaginal bleeding
abdominal cramps or pain
discharge of fluid or tissue

10. Risk factors
• being an older parent
• previous abortion
• exposure to tobacco smoke
• obesity
• diabetes
• thyroid problems
• drug or alcohol use.

11. Diagnosis
• Ultrasound before 20 weeks’ gestation. Usually when they cannot
detect a heartbeat at a prenatal checkup.
• Monitor the level of the pregnancy hormone hCG in blood over a
couple days.
• Checking to see if the cervix is open or closed.

12. Medical Management
• Prostaglandin E1 (Misoprostol) Sublingual misoprostol of 600 ug or vaginal
misoprostol of 800 ug may be a good choice for the first dose
• Expulsion usually occurs within 48 hours
• 6th or 12th hourly misoprostol tablets given vaginally.
• Antibiotics are given

13. Surgical management
• Dilation and curettage (D&C) surgery may be necessary to remove
remaining tissue from the uterus. doctor may recommend a D&C
immediately following diagnosis of a missed abortion, or they may
recommend it later if the tissue doesn’t pass on its own or with the
use of medication.

14. Complications
• Retaining the products for long time can lead to sepsis.
• DIC [disseminated intravascular coagulation] – (very rare) in
gestations exceeding 16 week.
• Uterine hemorrhage
• Infection
• Uterine perforation

15. Cont…
• Incomplete Miscarriage
• Asherman Syndrome
• Recurrent Miscarriages

16. Nursing Interventions
1.If bleeding is profuse, place the woman flat in bed on her side and monitor
uterine contractions and fetal heart rate through an external monitor.
2.Also measure intake and output to establish renal function and assess the
woman’s vital signs to establish maternal response to blood loss.
3.Measure the maternal blood loss by saving and weighing the used pads.
4.Save any tissue found in the pads because this might be a part of the products
of conception.

17. Prevention
Non-modifiable risk factors
• Preventing a miscarriage in subsequent pregnancies may be enhanced with
assessments of:
•Immune status.
•Chemical and occupational exposures
•Anatomical defects.
•Pre-existing or acquired disease in pregnancy
•Polycystic ovary syndrome.
•Previous exposure to chemotherapy and radiation

18. Cont…
Modifiable risk factors
• Maintaining a healthy weight and good pre-natal care can reduce the
risk of miscarriage
• Some risk factors can be minimized by avoiding the following:
• Smoking
• Cocaine use
• Alcohol
• Poor nutrition
• Occupational exposure to agents that can cause miscarriage
• Medications associated with miscarriage
• Drug abuse