O03.4/O.03.9
GENERAL MEASURES
Counselling.
Evacuation of the uterus after the fetus has been expelled.
MEDICINE TREATMENT
If no cervical dilatation:
- Misoprostol, PV/SL/buccal, 200 mcg every 4–6 hours until expulsion of the products of conception.
- Duration of treatment must not exceed 5 doses over 24 hours.
Previous Caesarean delivery:
- Misoprostol, PV/SL/buccal 100 mcg every 4–6 hours until expulsion of the products of conception.
- Duration of treatment must not exceed 5 doses over 24 hours.
If cervical dilatation already present:
- Oxytocin, IV.
- Dilute 20 units in 1 L sodium chloride 0.9%, i.e. 20 milliunits/mL solution, and infuse at 125 mL/hour.
- Reduce rate if strong contractions are experienced.
Note: Check serum sodium if used for more than 24 hours because of the danger of dilutional hyponatraemia.
For analgesia:
- Morphine, IV, to a maximum dose of 10 mg (See MORPHINE, IV, for individual dosing and monitoring for response and toxicity).
If Rh-negative: (O36.0)
- Anti-D immunoglobulin, IM, 100 mcg as a single dose.
REFERRAL
- Uterine abnormalities.
- Recurrent miscarriages (3 consecutive spontaneous miscarriages).
- Suspected cervical weakness: mid-trimester miscarriage(s) with minimal pain and bleeding.
- Diabetes mellitus.
- Parental genetic defects and SLE or other causes of autoimmune disease.