Heavy bleeding after medical management of a missed abortion

Background. The detection of a morbidly adherent placenta (MAP) in the first trimester is rare. Risk factors such as multiparity, advanced maternal age, prior cesarean delivery, prior myomectomy, placenta previa, or previous uterine evacuation place patients at a higher risk for having abnormal placental implantation. If these patients have a first trimester missed abortion and fail medical management, it is important that providers have a heightened suspicion for a MAP. Case. A 24-year-old G4P3003 with 3 prior cesarean deliveries underwent multiple rounds of failed medical management for a missed abortion. She had a dilation and curettage that was complicated by a significant hemorrhage and ultimately required an urgent hysterectomy. Conclusion. When patients fail medical management for a missed abortion, providers need to assess the patient’s risk factors for a MAP. If risk factors are present, a series of specific evaluations should be triggered to rule out a MAP and help further guide management. Early diagnosis of a MAP allows providers to coordinate a multidisciplinary treatment approach and thoroughly counsel patients. Ensuring adequate resources and personnel at a tertiary hospital is essential to provide the highest quality of care and improve outcomes.

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Potential predictors of surgical evacuation following early medical abortion: a prospective study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20212666 ◽

2021 ◽

Vol 10 (7) ◽

pp. 2768

Author(s):

Ritu Bansal ◽

Naimaa K. Chaudhary ◽

Asha Sharma

Keyword(s):

Risk Factors ◽

Gestational Age ◽

Medical Management ◽

Medical Abortion ◽

Missed Abortion ◽

Number Of Patients ◽

Depth Analysis ◽

Surgical Evacuation ◽

Potential Risk Factors ◽

Time Of Presentation

Background: Medical management is the safer, effective and more convenient method for the management of missed abortion. Owing to the risk and complications, medical management is offered to all the women presenting with missed abortions. Yet after all possible efforts a large number of patients land up into surgical evacuation. This study is conducted for the in-depth analysis of the patient's presenting complaints and their risk factors to establish the correlation of these factors with failed medical abortion. This would help in the establishment of easily identifiable subgroups for whom medical management would be a success. Methods: This is a prospective observational study conducted at St. Stephen’s hospital Delhi during September 2019-June 2020. 55 women with missed abortion attending the gynaecological clinic and emergency, were recruited based on inclusion and exclusion criteria. After taking informed and written consent, all cases were administered misoprostol by vaginal route for medical management. Patients were followed up for 24 hours and looked for the outcome.Results: We found that multiparity, advanced gestational age and previous caesarean deliveries were the predictors of uterine evacuation following failed medical management. Higher chances of complete abortion were seen among multiparous and among the patients who had bleeding at the time of presentation. Failure of medical management was seen in around 70% cases with more than 9 weeks gestational age. Lesser side effects are observed with 400 mcg misoprostol dosing.Conclusions: Nulliparous patients and the patients presenting with bleeding at the time of presentation had more complete abortion. Multiparity and previous caesarean delivery is associated with failed medical management. After studying the potential risk factors, every patient can be counselled about the chances of completion of medical management.

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