The Treatment of a Delayed Abortion

A delayed abortion is a condition that has different treatment options, the medical approach being the most widely used.
The Treatment of a Delayed Abortion

Last update: 01 June, 2023

Spontaneous abortion, or miscarriage, is one of the most common complications of pregnancy, affecting millions of women around the world. The treatment plan for this condition depends on the form of presentation and the severity of the clinical picture. Are you interested in knowing what the treatment for delayed abortion is? In the following article, we’ll tell you.

When we speak of abortion, we refer to the loss of the product of conception before it’s able to survive outside the womb. Studies estimate that more than 80% of abortions occur during the first 12 weeks of gestation, and of these, more than half are due to chromosomal abnormalities.

Delayed abortion occurs when the fetus isn’t spontaneously expelled after death. In this regard, it can continue inside the mother for weeks after death. The therapeutic approach can be expectant, medical, or surgical.

1. Expectant management

The expectant management of abortion is based on allowing the uterus to expel the remains of the fetus or embryo without any type of intervention. In this regard, the treating physician will be in charge of stabilizing the pregnant woman and will wait for the natural expulsion.

Some research suggests that watchful waiting shows a low success rate of around 39% compared to medical or surgical treatment. Similarly, this therapeutic option can increase the risk of infection, continued bleeding, and the need for surgical evacuation.

2. Medical management

A female patient talking to her OB-GYN.
The medical specialists in charge of treating abortion cases are obstetrician-gynecologists.

Medical treatment aims to administer medications vaginally or orally in order to stimulate the expulsion of the fetus and the placenta. This technique is often widely used in the management of different forms of miscarriage, including the treatment of delayed abortion and spontaneous abortion.

The drugs used for this procedure are prostaglandin E1 analogs. Misoprostol is the main representative of this group of drugs. They act as uterotonics, stimulating the contraction of the uterine smooth muscles and the expulsion of the remains of the abortion.

Studies affirm that misoprostol has shown an efficacy greater than 90% in the treatment of miscarriage with less than 12 weeks of gestation. Typically, 200 to 400 micrograms (µg) are used vaginally or orally in a single dose. Subsequent ultrasound control is necessary to certify uterine evacuation.

This medication can be administered alone or in combination with mifepristone, an antiprogestin useful in the safe treatment of abortion. Combination therapy includes 200 milligrams (mg) of mifepristone taken by mouth for one day, followed by 400 micrograms (µg) of misoprostol after 1 to 2 days.

Pregnant women should take into account that once the procedure has started, the expulsion of the remains can occur in the hours and even days that follow. Similarly, it’s possible that the expulsion of blood is greater than that of a typical menstruation for 3 days. In addition, the following side effects may occur:

  • Persistent abdominal pain
  • Flatulence and diarrhea
  • Nausea and vomiting
  • Headache
  • Fever

On the other hand, women can have severe drug allergy reactions. In rare cases, blood loss can be massive with loss of consciousness and the need for a blood transfusion.

3. Surgical treatment

Surgical treatment of delayed abortion is an invasive procedure whereby fetal and placental remains are removed directly from the uterine cavity. Despite its efficacy and speed in the resolution of the picture, it’s associated with a greater risk of cervical-uterine injury and infection.

Surgical options include manual vacuum aspiration (MVA) and instrumental uterine curettage (D&C). The use of both depends on the severity of the condition and the length of time of pregnancy. MVA is usually used in miscarriages with less than 12 weeks of gestation, while D&C is used after 12 weeks.

Manual vacuum aspiration is based on the extraction of uterine contents through the cervix using a vacuum aspiration cannula. It can be performed under paracervical anesthesia and is associated with a lower rate of complications, as well as a shorter hospital stay.

On the other hand, the instrumental uterine curettage consists of the evacuation of the uterus using a metal curette through the cervix. In this regard, the specialist will be in charge of scraping and debriding the fetal and placental remains manually. This procedure is more invasive and requires a longer hospital stay.

The doctor may indicate the use of non-steroidal anti-inflammatory drugs (NSAIDs) for postoperative pain control, such as ibuprofen. Some women may need the use of narcotic pain relievers to reduce pain, especially after 13 weeks of gestation.

4. Psychological therapy

A woman holding another woman's hand.
Miscarriages can be especially difficult for some women. Receiving mental therapy can make a significant difference in the mood and course of grief.

Abortion in any of its presentations is a traumatic event that affects each woman differently. The International Federation of Gynecology and Obstetrics (FIGO) estimates that 30 to 50% of women experience anxiety and 10 to 15% depression after undergoing an abortion.

In this regard, the treatment of delayed abortion must include psychological counseling by a professional as a priority. Cognitive and interpersonal therapies are very effective in controlling the symptoms of depression and anxiety. This way, the risk of other complications is greatly reduced.

The multidisciplinary approach is the key to recovery

Delayed abortion is a condition that has different treatment options. In general, the medical approach with uterotonics such as misoprostol is the most widely used therapeutic alternative. In this regard, watchful waiting and surgical treatment are used at the discretion of the treating physician.

Similarly, this type of abortion requires multidisciplinary management that allows all the mother’s needs to be covered. In addition, special emphasis should be placed on psychological support and the prevention of long-term complications. If you have any questions regarding this issue, don’t hesitate to consult your trusted doctor.

  • Ruíz A, Corredor E, García C, Madero J, et al. Embrioscopía en aborto retenido. Rev Colomb Obstet Ginecol. 2006  Sep;  57( 3 ): 207-210.
  • Sotiriadis A, Makrydimas G, Papatheodorou S, Ioannidis JP. Expectant, medical, or surgical management of first-trimester miscarriage: a meta-analysis. Obstet Gynecol. 2005 May;105(5 Pt 1):1104-13.
  • Errázuriz J, Stambuk M, Reyes F, Sumar F, et al. Efectividad del tratamiento médico con misoprostol según dosis administrada en aborto retenido menor de 12 semanas. Rev. chil. obstet. ginecol. 2014  ;  79( 2 ): 76-80.
  • Tratamiento médico del aborto. Ginebra: Organización Mundial de la Salud; 2018. Licencia: CC BY-NC-SA 3.0 IGO.
  • Ministerio de Salud Pública. Guía de Práctica Clínica (GPC): Diagnóstico y tratamiento del aborto espontáneo, incompleto, diferido y recurrente. Dirección Nacional de Normatización, 1ª Edición, Quito, Ecuador, 2013.
  • Benítez-Guerra Gidder, Medina Meléan Nora. Uso de prostaglandinas en obstetricia. RFM. 2006  Jun;  29( 1 ): 67-73.

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