Definition:-
When the fetus is dead and retained inside the uterine cavity for a variable period. It is called missed abortion or silent abortion.
Causes:- Causes the missed abortion generally are the same as those causing spontaneous abortion at early pregnancy failure. Causes include enembryonic gestation (blighted ovum), fetal chromosomal abnormalties maternal disease, embryonic anomalies placenta abnormalities at uterine anomalies.
Symptoms:-
- Vaginal bleeding.
- Abdominal cramps or pain.
- Discharge or fluid or tissue.
- Lack of pregnancy symptoms.
- Malaise.
- Pyrexia.
- Anorexia.
Complications:-
- Profuse bleeding.
- Sepsis or placental polyp.
- Infection.
- Hyperpyrexia.
- Blood coagulation.
- Uterine inertia.
- Retained placenta.
- Post partum hemorrhage (PPH).
Diagnosis:-
- Vaginal bleeding history.
- Ultrasonography.
- Radiological test.
- FHS check-up.
- Serum HCG level check-up.
- Pregnancy test.
- Internal examination of Uterus and Cervix Vagina.
Management:-
Uterus is less than 12 weeks:-
Expectant management:- Many women expel the conceptus spontaneous.
Medical management:- Prostaglandin, Misoprostol, 800 mg, vaginally in the posterior fornix is given the repeated after 24 hours if needed. Usually occurs within 48 hours. Suction evacuation of dilatation and evacuation is done either as a definitive treatment or it can be during the operation should be kept in mind.
Uterus more than 12th weeks:-
The some principles of the management as advocated in the intrauterine fetal death are to be followed induction is done by the following methods.
Prostaglandins, are more effective than oxytocin in such cases. The methods used are.
Oxytocin, 10-20 unit of oxytocin in 500 ml of normal saline at 30 drops per minute is started. If fails, escalating dose of oxytocin to the maximum of 200 mlU0/min, may be used with with monitoring.
Many patients need surgical evacuation following medical treatment. Following medical treatment ultrasonography should be done to document empty uterine cavity. Otherwise evacuation of the retained products of conception (ERPC) should be done.
Dilatation and evacuation:-
Is done once the cervix becomes soft with use of PGE1, otherwise cervical canal is dilated using the mechanical dilators or by laminaria, tent. Evacuation of the uterine cavity is done thereafter slowly.
Prevention:-
- Don’t smoke and stay away from second hand smoke.
- Regularly exercise.
- Manage stress.
- Eat healthy wells-balanced meals.
- Keep your weight within normal limits.
- Be sure to take at least 400 mcg of folic acid every day. Beginning at least one to two months before conception if possible.
I hope that you liked this article………..!!
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By GS India Nursing, Lucknow, India……….!!