Which of the following abortion occurs when the foetus has died or failed to develop, but the body has not expelled the pregnancy tissue?

Appeared in: BTSC 3 August 2025

Explanation

A missed abortion is defined by the death of a fetus (fetal demise) where the products of conception are not expelled from the uterus.
The term 'missed' or 'silent' is used because the woman may have no symptoms, such as bleeding or pain, to indicate that the pregnancy has ended.
On clinical examination, the cervical os is found to be closed.
Diagnosis is typically confirmed by ultrasound, which shows an empty gestational sac or a fetus without cardiac activity.

Why Other Options Were Wrong

Option A: In a complete abortion, all products of conception have been fully expelled from the uterus, and the cervix is closed. This is the opposite of the scenario described in the question, where the tissue is retained.
Option B: A threatened abortion involves vaginal bleeding in early pregnancy while the fetus is still viable and the cervix is closed. The pregnancy may still continue to term. The key difference is that the fetus has not died.
Option D: An inevitable abortion is characterized by vaginal bleeding accompanied by the opening (dilation) of the cervix. This indicates that the process of miscarriage has begun and cannot be stopped. The key feature is the open cervix, signaling that expulsion is imminent or in progress.

Related Visual

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Classification of Spontaneous Abortion as background academic context rather than a clinical decision trigger.
Nurses play a crucial role in providing emotional support and education to women experiencing a missed abortion. The diagnosis can be shocking and distressing, especially due to the lack of symptoms.
Management options for a missed abortion include expectant management (waiting for the body to expel the tissue), medical management (using medications like misoprostol to induce expulsion), or surgical management (dilation and curettage). The nurse must be prepared to explain these options and care for the patient accordingly.
What if the patient with a missed abortion develops a fever, foul-smelling discharge, and abdominal pain? This would suggest a septic abortion, a medical emergency. The priority would shift to immediate administration of broad-spectrum IV antibiotics and surgical evacuation of the uterus to prevent systemic infection and sepsis.

How to Approach the Question

First, carefully read the question stem and identify the key clinical features described: 1) the fetus has died, and 2) the pregnancy tissue has not been expelled.
Next, review the definitions of each type of abortion provided in the options.
Match the clinical picture from the stem to the correct definition. 'Complete' means everything is out. 'Threatened' means the fetus is still alive. 'Inevitable' means expulsion is happening now (open cervix).
By elimination, the only term that fits the description of fetal death without expulsion is 'Missed Abortion'.

Concept Tested & Keywords

Concept Tested: Classification of Spontaneous Abortion
Stem keywords: abortion, foetus died, failed to develop, not expelled, pregnancy tissue
Lead-in keywords: Which

Question ID

QEiQmGsGq1XGk7pshMzjsB

Reference Book

E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) p. 8397-8399

E6 Gynecology Williams p. 152-181

E6 Obstetrics Williams p. 3

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