OBSTETRICS AND GYNECOLOGY■ Missed abortion: In utero death of the fetus prior to 20 weeks gestation
with retention of the products for a prolonged period of time
SYMPTOMS
Women usually present with a history of amenorrhea followed by vaginal
bleeding and pelvic pain.
EXAM
■ Cervix may be open or closed.
■ Visualization of products of conception confirms a miscarriage and excludes
ectopic pregnancy except in unstable patients or patients on fertility
treatment.
DIAGNOSIS
■ Vaginal exam to assess if the cervix is open
■ Ultrasound with quantitative β-hCG to exclude ectopic pregnancy
■ Blood type and Rh factor determination to determine need for Rhogam
■ Urinalysis to exclude infection as a cause of miscarriage
TREATMENT
■ Rh-negative women should receive Rh(D)immune globulin 300 μg, or 50 μg
if <13 weeks gestation.
■ Most patients with threatened abortion may be discharged with return pre-
cautions and OB follow-up.
■ Patients with either incomplete or complete abortion with persistent
bleeding should be offered dilation and curettage.
■ Septic abortion mandates dilation and curettage and broad spectrum anti-
biotics (cefoxitin and doxycycline, ampicillin and sulbactam, or imipenem
and cilastatin).
Rh INCOMPATABILITYPATHOPHYSIOLOGY
■ Approximately 15% of individuals are Rh negative.
■ In Rh-negative women with an Rh-positive fetus, maternal exposure to
even small amounts of fetal blood can result in the production of maternal
antibodies to the foreign Rh antigen.
■ The formation of maternal Rh antibodies exposes the current and subse-
quent pregnancies to antibody-induced hemolytic disease of the newborn.
CAUSES
■ Trauma
■ Vaginal bleeding
■ Spontaneous or induced abortion
■ Obstetric procedures
■ Transfusions of Rh-positive blood may sensitize an Rh negative woman,
even if she is not pregnant.
DIAGNOSIS/TREATMENT
■ Rh(D) immune globulin 300 μg for Rh-negative pregnant patients with
possible exposure to fetal blood.
Complications of a missed
abortion include infection and
coagulopathy.Septic abortion is a leading
cause of maternal mortality in
the developing world, mostly
as a result of illegal and
unsterile abortions.