Medical treatment for early fetal death (less than 24 weeks)

RHL practical aspects by Weeks A

FIRST CONTACT (PRIMARY CARE) LEVEL

The diagnosis of early fetal death requires ultrasound. In low-resource settings few primary health-care centres are equipped with facilities to make such a diagnosis. Women presenting with symptoms suggestive of early fetal death (bleeding, absent fetal movements or a small-for-gestational-age uterus) should either be referred for an ultrasound or asked to return when they develop increased vaginal bleeding and uterine cramps. Waiting in this way (expectant management) is now known to be safe and does not increase the risk on infection (1). Once the cervical os is open, the miscarriage becomes inevitable (or incomplete) and the woman can be treated with misoprostol, manual vacuum aspiration (MVA) or surgical evacuation. Large randomized trials suggest that treatment with misoprostol (at a dose of 600 µg orally as a single dose) is also effective in the management of early fetal death (2).

If a woman presents with a confirmed diagnosis of early fetal death, then this review shows that misoprostol is an effective and safe alternative to surgical evacuation. Although the optimal dose for use in the first trimester is not yet clear, 800 µg vaginally, repeated after three days, has been shown to be effective in 79% of women within days (or 87% by day 30) in the study by Gilles (3). Misoprostol can be used safely at home or in settings without immediate access to surgical evacuation In the second trimester (from 10-24 weeks), a lower dose such as 200 µg vaginally repeated every 12 hours as used by Jain (4) is recommended. Most authors recommend that misoprostol should be used with great caution in women with a previous caesarean scar.

REFERRAL HOSPITAL (SECONDARY CARE) LEVEL

As for primary care.

AT HOME OR IN THE COMMUNITY

As for primary care.

References

  • Nanda K, Peloggia A, Nanda G, Grimes D. Expectant care versus surgical treatment for miscarriage. The Cochrane Library Issue 3, 2006;Chichester, UK: John Wiley & Sons.
  • Weeks AD, Alia G, Blum J, Winikoff B, Ekwaru P, Durocher J, et al. A randomized trial of misoprostol versus manual vacuum aspiration for incomplete abortion. Obstet Gynecol 2005;106:540-547.
  • Nanda K, Peloggia A, Nanda G, Grimes D. Expectant care versus surgical treatment for miscarriage. The Cochrane Library Issue 3, 2006;Chichester, UK: John Wiley & Sons.
  • Nanda K, Peloggia A, Nanda G, Grimes D. Expectant care versus surgical treatment for miscarriage. The Cochrane Library Issue 3, 2006;Chichester, UK: John Wiley & Sons.

This document should be cited as: Weeks A. Medical treatment for early fetal death (less than 24 weeks): RHL practical aspects (last revised: 4 January 2007). The WHO Reproductive Health Library; Geneva: World Health Organization.

Share

Related documents

About the author