A missed miscarriage, also called a silent miscarriage, is the termination of pregnancy with no sign of immediate spontaneous expulsion of the embryo or foetus. Hence the name of this type of miscarriage, as the expulsion of the embryo or foetus takes place days or weeks after it occurs. If the gestational sac remains in the pregnant woman’s body after a certain period of time, whether completely or partially, doctors can carry out pharmacological or surgical procedures to expel it permanently from the pregnant woman’s uterus.
This type of miscarriage can only be fully confirmed by ultrasound or hCG (human chorionic gonadotropin hormone) analysis. In fact, while there are well-known situations in which the embryo does not develop properly or pregnancy loss occurs before 22 weeks – miscarriages have a prevalence of around 25% – the risk of missed miscarriage in percentage terms is less than 1% of all pregnancies.
Risk factors and causes of missed miscarriage
- Advanced maternal age: for example, if a pregnancy occurs after the age of 40. From this age onwards, women have a higher risk of miscarriage compared to younger women.
- Gestational anaemia: Anaemia during pregnancy is a relatively common condition that can adversely affect not only the course of pregnancy and delivery, but also the foetus or newborn. In addition to increasing the risk of miscarriage, it can also lead to premature delivery or intrauterine growth restriction.
- Urinary tract infection (UTI): As more blood flows through the kidneys and bladder capacity is reduced, urine may flow back into the ureters, which can contribute to the development of urinary tract infections during pregnancy. In this case, if left untreated, UTIs can in some cases lead to miscarriage.
- Previous miscarriages: Women who have had two or more consecutive miscarriages have an increased risk of missed miscarriage.
Although these factors are predisposing, they do not mean that pregnancy loss will always occur if they exist. Many pregnancies progress without complications even if these risk factors are present.
Symptoms or signs of missed miscarriage
The symptoms of a missed miscarriage can vary and very often do not manifest in the way that most miscarriages do. This is due to one basic fact: there is no expulsion of the embryo from the woman’s body. To a certain extent, the body acts as if the pregnancy is still in progress. This type of miscarriage is not likely to cause heavy bleeding or severe pain, sometimes there are only very mild symptoms. Other symptoms, such as vaginal discharge or leakage of amniotic fluid, are also not very noticeable.
In other words, the diagnosis for missed miscarriage is revealed in a special way, usually during a visit to the doctor and by means of an ultrasound examination. During this examination, the gynaecologist usually finds the following signs of a silent miscarriage:
- Foetal heart failure.
- Cervical closure.
- Lack of uterine enlargement.
- Decrease in the symptoms of a pregnancy.
- Decreased hCG hormone levels.
What is the best treatment for a missed miscarriage?
The management of a missed miscarriage can vary depending on the situation and the woman’s preferences. Treatment options include:
- Expectant management: In many cases, the woman’s body will naturally expel the foetal tissue days or weeks later if the pregnancy does not progress. In these cases, the doctor may opt for expectant management, which means letting the body complete the process naturally.
- Dilation and curettage: If the body does not expel all of the foetal tissue naturally, curettage may be performed. This is a medical procedure in which the cervix is dilated and the tissues inside the uterus are removed. It is usually carried out under sedation.
- Medication: In some cases, medication may be given to help the body expel the foetal tissue and bring the miscarriage to an end.
- Vacuum aspiration: Instead of curettage, a vacuum aspiration procedure can be performed to remove the remains of the pregnancy from the uterus.
To sum up…
Missed miscarriage is a psychologically difficult experience for women and also for their partners. It is therefore crucial to approach this issue with empathy and understanding, providing emotional and physical support to those who suffer from it.
If a woman experiences symptoms of missed abortion, it is essential that she seek medical attention for a proper diagnosis and treatment. Although the exact causes may vary, it is essential to remember that it is often not preventable, that a woman’s body usually recovers physically over time, and that it is possible to conceive again after a miscarriage in most cases.
