A missed abortion is a type of miscarriage where the embryo or fetus has died, but the body has not naturally expelled the pregnancy tissue. This experience can be particularly distressing because, unlike other miscarriages, it often occurs without the typical symptoms of bleeding or cramping. Individuals may continue to experience signs of pregnancy, making the eventual diagnosis unexpected and confusing.
Understanding a Missed Abortion
A missed abortion is often called a “silent miscarriage” because it lacks common indicators like bleeding or pain. The body continues to produce hormones, leading to ongoing pregnancy symptoms, making the diagnosis shocking.
Chromosomal abnormalities in the developing embryo or fetus are a primary reason, preventing proper development. These issues usually occur by chance and are not caused by external factors like stress, exercise, or diet. Approximately 50% to two-thirds of first-trimester miscarriages, including missed abortions, are linked to these problems.
How a Missed Abortion is Diagnosed
A missed abortion is typically discovered during a routine prenatal ultrasound scan, often before 20 weeks of gestation. During the ultrasound, a healthcare professional may find no fetal heartbeat, or the embryo or gestational sac size may be inconsistent with expected gestational age, such as an empty sac or a smaller embryo without cardiac activity.
In some cases, especially in early pregnancy, doctors may also monitor human chorionic gonadotropin (hCG) levels in the blood. In a viable pregnancy, hCG levels typically double every 48 to 72 hours; if they do not rise as expected or decline, it signals non-progression.
Next Steps After Diagnosis
Once a missed abortion is diagnosed, healthcare providers discuss management options, which generally include expectant management, medical management, or surgical management. The choice depends on individual preference and medical circumstances.
Expectant Management
Expectant management involves waiting for the body to naturally pass the pregnancy tissue. This approach can be successful, with rates reported around 50% to over 65%, but it may take days to weeks. Individuals may experience cramping and bleeding heavier than a typical menstrual period.
Medical Management
Medical management uses medication to help the body expel the tissue. Misoprostol is common, often given orally or vaginally. Sometimes, mifepristone is administered first, followed by misoprostol, to increase effectiveness. This method induces cramping and bleeding to clear the uterus within hours to days.
Surgical Management
Surgical management involves a procedure to remove pregnancy tissue from the uterus. Dilation and Curettage (D&C) or vacuum aspiration are common options. These procedures are typically performed under anesthesia, involving cervical dilation to gently remove tissue using suction. Surgical management offers immediate resolution and may be recommended if other methods fail or if concerns like heavy bleeding or infection arise.
Support and Healing
Experiencing a missed abortion can have a profound emotional impact, leading to feelings of grief, sadness, shock, or anger. These emotions are a normal response to loss, and the healing process, both physical and emotional, takes time. Anxiety and depression are common, with some studies indicating elevated levels of these emotions.
Allowing oneself to grieve and seeking support is beneficial. Talking with trusted friends, family, or a partner can provide comfort. Professional support, like counseling or therapy, offers a safe space to process feelings. Many organizations provide resources and support groups for those who have experienced pregnancy loss.