A missed abortion is a perished pregnancy with none or very few symptoms.

Cause

The cause in most cases is unknown. About 20% of all pregnancies perish; therefore missed abortions are quite common.

Diagnosis

A missed abortion is diagnosed by an ultrasound scan.

Treatment and observation

The treatment consist’s of two steps, first you take the tablet Mifegyne 200 mg, this stops the pregnancy from developing.  12-24 hours later you begin step two. This consists of Cytotec tablets which softens the cervix and leads to contractions of the uterus causing the pregnancy to bleed out. After placing two Cytotec vaginal tablets, 80-90 % of all patients are expected to miscarry within 48 hours.

Benefits

There is no sedation and instrumentation of the uterus. If an evacuation (extraction) is inevitable, the Cytotec treatment will have softened the cervix in a way that makes the evacuation more gentle.

Disadvantages

It is inevitable that you will have painful contractions of the uterus. You will be given analgesics that will ease the pain.

Contraindications

The medical treatment with Cytotec cannot be used if you have the eye disease glaucoma.

Practical Approach

Start by emptying your bladder. After this it is recommended to take:

• 1 tablet Ibuprofen 600 mg (painkillers)
• 2 tablets Kodipar (painkillers)
• 1 tablet Ondansetron (prevents nausea and vomitting).

Afterwards lay down on a bed and place the tablets as far up the vagina as possible:

• 2 tablets Cytotec (0,2 mg).

Lay in bed for an hour to ensure that the tablets do not fall out. Afterwards you may return to normal activities. The effect of Cytotec will appear as a menstruation- or contraction-like pain and bleeding. If it hasn’t begun within 3-4 hours you must place another 2 tablets Cytotec (0,2 mg).

Side effects

The side effects will appear as nausea, diarrhea or a slight increase in temperature.

The hemorrhage, strength and precautions

When the pregnancy tissue is expelled, the bleeding will resemble a heavy menstruation with lumps and usually will subside after 2-3 hours. Should the bleeding unexpectedly be as heavy as soaking a pad within an hour for more than 2 hours straight, you should consult us by calling Ward 5032.

You can expect pain, when the uterus is contracting. This may continue for several hours. You can take painkillers every 6 hours. After, it is normal to bleed moderately for 2-3 weeks.

You must also react to the following symptoms:

• Malodorous discharge
• Severe pain
• Fever of more than 38 degrees.

Please consult our staff at Ward 5032.

Follow-up

One week after treatment you will receive an appointment for a follow-up. This will include a blood test and an ultrasound at ward 5032. Should there still be pregnancy tissue left in the uterus, a renewed medical treatment or an evacuation of the uterus in general anaesthetic can be considered.

It is normal to bleed more than an expected regular menstruation. The next menstruation can be expected within 3-6 weeks.

Other precautions

• Please avoid swimming pools, bathing in the sea and the bath for as long as the bleeding is on-going.
• Use only sanitary napkins, not tampons.
• It is recommended to use a condom during intercourse to lower the risk of infection.

Prognosis

One or two miscarriages counts as a normal occurrence and the chances for a normal pregnancy in the future are good. At a third confirmed miscarriage by an ultrasound scan, we can refer you to the Fertility Department at Rigshospitalet.

We recommend you await a normal menstruation before retrying to get pregnant. Otherwise there is a risk that the new pregnancy will perish.

Rhesus prophylaxis

If your blood type is negative and the pregnancy is estimated to be more than 8 weeks old, you need an injection with anti-D.