An inevitable concern for all pregnant women in the first trimester, missed abortion is haunting, causes a lot of anxiety, and raises many questions for all expecting mothers. It’s even worse for those who have already experienced the traumatic event of a miscarriage. The fear of the nightmare happening again leads thousands of women to despair at every sign, cramp, and in many cases, even to psychological symptoms caused by this fear. It makes them seek emergency care multiple times to confirm that their baby is okay.

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What is a missed abortion?

It’s considered a missed abortion when it is confirmed that the embryo has died but remains inside the uterus, and there is no spontaneous expulsion1 after 30 days following the diagnosis. It normally happens between the 6th and 10th week. The embryo can stay lifeless inside the uterus for weeks, even months. It is confirmed through an ultrasound exam, where the absence of fetal heartbeat is checked. It can also be confirmed by a blood lab test. The levels of HCG begin to drop, indicating that gestational development has ended. Missed abortion is different from spontaneous abortion, in which the embryo, gestational sac, and all contents are naturally expelled from the uterus. In a missed abortion, expulsion may still occur naturally over the days. If it does not occur within a month, medical intervention to remove it2 is necessary. This can be done via curettage or manual uterine aspiration (MUA). The diagnosis can be made in several ways. A missed abortion is not necessarily an embryonic death where there was a heartbeat that stopped. The diagnosis can be for an embryo that appeared but did not have a heartbeat, or an empty gestational sac that was waiting for an embryo that didn’t form. If it is not expelled after 30 days, it is classified as a missed abortion.

Symptoms of missed abortion

Even though confirmation by tests is necessary, it’s possible to suspect a missed abortion from some signs. The signs are subtle, but they may be an indicator to see your obstetrician for an evaluation. But it’s important to note that missed abortion can be completely silent. In some cases, a woman can go for several weeks without noticing any signs. However, if you observe the following symptoms, see your doctor right away.

  • Bright red or brown bleeding;
  • Pelvic pain;
  • Disappearance of pregnancy symptoms (nausea, vomiting, frequent urination);
  • Lack of growth in uterine size or belly.

Causes of missed abortion

The causes of missed abortion need to be looked at on a case-by-case basis, since there are several factors that can trigger it3. The main causes include: woman’s age, uterine malformations, chromosomal defects in the embryo, thyroid disorders, uncontrolled diabetes , or even blood clotting or immune problems. Poor lifestyle habits and addictions, such as the use of drugs, smoking, and drinking alcohol are also risk factors. Women who go through a missed abortion can usually become pregnant naturally again after the period recommended by their gynecologist. Just because it happened in this pregnancy does not mean it will happen in future ones. The best course is to have thorough follow-up, discover the causes, and treat them so you can have a healthy, uneventful pregnancy.

Risks

If a missed abortion is not properly treated, or if the diagnosis is delayed, there is a risk of serious infection. These infections can even cause damage to the fallopian tubes, leading to infertility, or may even trigger sensitivity in the Rh system, making future pregnancies more difficult. When it is not the first time that a miscarriage occurs, whether spontaneous or missed, it is necessary to investigate possible causes for this to be happening. Some cases are simple, such as deficiencies in proteins, collagen, or enzymes. Others may involve blood clotting problems, which need specific treatment before a woman is ready for a new pregnancy. There are also risks associated with the curettage procedure. For this reason, the first option is usually to try for the body to expel the fetus naturally. This can occur naturally or with the help of medications such as oxytocin, which causes contractions. If expulsion of the embryo and all material inside the uterus does not occur this way, curettage is recommended. In this procedure, the uterine walls are scraped, which can lead to some areas sticking together, raising the risk of developing intrauterine synechiae. This scarring after scraping can also make it more difficult for a woman to become pregnant again, since an embryo may have trouble implanting in order to develop. Another major risk of curettage is uterine perforation.

Treatment for missed abortion

After confirmation of embryonic death by ultrasound, the recommended treatment can vary from case to case. One of the first options is expectant management—letting the body naturally expel the fetus and all tissue contained in the uterus, without hospitalization. This approach can last up to 30 days. With this method, careful monitoring is essential to prevent the woman from developing infections. Another option is to admit the patient and use medications to induce uterine contractions, so the embryo and tissue can be eliminated. The third option is usually indicated when the first two do not produce results. It can also be by patient request or, depending on case severity, a doctor’s recommendation. This is curettage. Curettage is a procedure to clean and empty the uterus. A scraping procedure ensures that all tissue is eliminated. Manual aspiration can also be performed, using a syringe to extract all tissue. In some cases, both procedures are used to ensure all tissue is removed.

Emotional trauma from abortion

An abortion can cause serious psychological harm in a woman’s life. The loss is already difficult, and it can be even worse due to the distress of having to undergo the process if it is a missed abortion. That’s why extra care and caution are necessary at this moment, along with family support, which is vital for overcoming the loss. Many women speak about the trauma caused by the moment of loss, and especially by the curettage procedure. Besides all the pain of the experience, sometimes it’s made worse by lack of professionalism and empathy from doctors and nurses, who may treat patients in this situation with complete disrespect or lack of compassion. In case of medical abuse or disrespect, do not stay silent—REPORT IT! Also read: Luteal Phase – The Importance of Hormones in Pregnancy