MISSED MISCARRIAGE

Definition:

 In missed miscarriage, now or more commonly referred to as early pregnancy failure, the fetus
dies in utero but is not expelled.

 A missed miscarriage is usually discovered at prenatal examination when the fundal height is
measured and no increase in the size can be demonstrated, or when previously heard fetal heart
sounds cannot be heard.

 Women may find this term misleading because it suggests that if miscarriage is “missed,” then
the pregnancy can continue.

 If the pregnancy is not actively terminated, miscarriage usually occurs spontaneously within 2
weeks. There is a danger of allowing this normal course to happen, however, because
disseminated intravascular coagulation (DIC), a coagulation defect may develop if the dead (and
possibly toxic) fetus remains too long in the utero.

Signs & Symptoms:

 Vaginal spotting, perhaps slight cramping; no apparent loss of pregnancy

 A woman may have had symptoms of a threatened miscarriage (painless vaginal bleeding)

 May have had no prior clinical symptoms

Nursing Management:

 A sonogram can establish if the fetus is dead. Often the embryo actually died 4 to 6 weeks before
the onset of miscarriage symptoms or failure of growth was noted.

 After sonogram, a D&C most actually will be done. If the pregnancy is over 14 weeks, labor may
be induced by prostaglandin suppository or misoprostol (Cytotec) to dilate cervix, followed by
oxytocin stimulation or administration of mifepristone.

 Women may need support in accepting the reality of the situation and need counseling to accept
a future pregnancy because of fears that whatever force struck silently and strangely in one
pregnancy might strike again.

Drug Study: Misoprostol

 Indication & Dosage:

Cervical ripening before surgical termination of pregnancy in the 1st trimester

Adult: 400 mcg as a single dose 3-4 hr before surgery.
 Oral
Termination of pregnancy (49 days or less duration)
Adult: 400 mcg as a single dose 36-48 hr after mifepristone.

 Administration:

Should be taken with food

 Overdosage:

Symptoms: Sedation, tremor, convulsions, dyspnoea, abdominal pain, diarrhoea,

hypotension, bradycardia. Management: Symptom-directed and supportive

 Contraindication:

Women of childbearing potential. Pregnancy and lactation

 Special Precautions:

Conditions where hypotension might precipitate severe complications e.g.

cerebrovascular or CV disease. Inflammatory bowel disease. Patients prone to
dehydration. Elderly. Renal impairment.

 Adverse Drug Reactions:

Diarrhea, abdominal pain, dyspepsia, constipation, flatulence, nausea and vomiting;

abnormal vaginal bleeding, cramps, increased uterine contractility, headache.

 Drug Interaction:

May increase effects of oxytocin. Increased risk of misoprostol-induced diarrhoea with

magnesium-containing antacids.