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Treatment for a failed miscarriage

Medical expert of the article

Obstetrician-gynecologist, reproductive specialist
, medical expert
Last reviewed: 08.07.2025

In a non-developing pregnancy (missed abortion), the embryo (fetus) dies without the appearance of signs of a threatened miscarriage. Most often, this type of termination of pregnancy is observed in cases of habitual miscarriage, hyperandrogenism, autoimmune disorders, etc. Clinically, the size of the uterus is smaller than the gestational age, the fetal heartbeat is not detected, subjective signs of pregnancy are reduced, and sometimes there may be periodic spotting.

The diagnosis is confirmed by ultrasound examination. When treating patients with a long-term retention of the fertilized egg in the uterine cavity (4 weeks or more), coagulopathic complications are possible.

When managing such patients, it is necessary to study the hemostasis system, determine the blood group and Rh factor, and have everything necessary to stop coagulopathic bleeding. At a pregnancy term of up to 12-14 weeks, a one-stage removal of the ovum is possible (vacuum aspiration should be preferred). Specific methods can be used to remove a dead fetus in the second trimester of pregnancy: intravenous administration of large doses of oxytocin according to the method of B.L. Gurtovoy, intra-amniotic administration of prostaglandin F2a, intravaginal administration of prostaglandin E suppositories. Regardless of the chosen method of termination of pregnancy, to improve the opening of the cervix, it is advisable to introduce laminaria into the cervical canal at night before emptying the uterus.

In the case of a prolonged spontaneous abortion (incipient, incomplete), penetration of microflora from the vagina into the uterine cavity is possible, followed by the development of chorioamnionitis, amnionitis, and endometritis. An infected (febrile) abortion may cause generalized septic diseases. Depending on the degree of spread of the infection, uncomplicated infected (the infection is localized in the uterus), complicated infected (the infection does not go beyond the small pelvis), and septic (the process takes on a generalized character) abortion are distinguished. The clinical course of an infected abortion is determined mainly by the degree of spread of the infection.

The mechanism of spontaneous termination of pregnancy may vary depending on the cause of termination of pregnancy. In some cases, uterine contractions occur first, which cause detachment of the ovum. In other cases, uterine contractions are preceded by the death of the ovum. Sometimes detachment of the ovum and uterine contractions occur simultaneously.

In case of a failed abortion, non-developing pregnancy after the death of the fertilized egg, uterine contractions do not occur. The dead fertilized egg is not expelled from the uterus and undergoes secondary changes, the amniotic fluid is gradually absorbed. If the uterine contractions are insufficient to expel the dead fertilized egg, then its slow detachment occurs, which is accompanied by prolonged, profuse bleeding, leading to anemia. Such an abortion is called protracted.

In case of isthmic-cervical insufficiency, abortion most often begins with premature rupture of amniotic fluid. The fertilized egg descends into the dilated cervical canal, the membranes become infected and open. Miscarriage usually occurs quickly and painlessly. However, there is also such a variant of termination of pregnancy in case of isthmic-cervical insufficiency, when as a result of prolapse of the amniotic sac and its infection, the amniotic fluid flows out and a spasm of the cervical canal occurs, which sometimes lasts for a long time, and it is quite difficult to complete a miscarriage in these conditions.

To monitor the course of pregnancy in patients with habitual miscarriage, diagnostic tests are currently used, which allow one to indicate certain disorders in the course of pregnancy long before the appearance of clinical signs of threatened miscarriage.


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