A Case Report on 29-Year-Old Female Intrauterine Pregnancy 11 Weeks Gestational Age with No Fetal Cardiac Pulsations

Abstract

Background: Early first-trimester pregnancy loss affects 10-20% of clinically recognized pregnancies. Missed abortion, a type of embryonic pregnancy loss, requires timely diagnosis, appropriate management, and psychological support to reduce its emotional impact. Case Presentation: A 29-year-old woman confirmed pregnancy with a home β-hCG test. Serial β-hCG levels increased from 124.50 to 257.80 mIU/mL over 48 hr. Initial ultrasonography at 5-6 weeks showed a gestational sac (mean sac diameter 1.06 cm) with a yolk sac but no fetal pole. A repeat scan two weeks later demonstrated a fetal pole (crown-rump length 0.84 cm, corresponding to 6 weeks 5 days) without fetal cardiac activity, confirming a missed abortion. Management and Outcome: Although medical termination was advised, the couple opted for expectant management. Five days later, mild vaginal bleeding prompted repeat ultrasonography, which confirmed persistent nonviability and a subchorionic haemorrhage. The patient received 200 µg misoprostol but developed severe abdominal pain and heavy vaginal bleeding within 2 hr, requiring emergency hospitalization. Surgical evacuation by Dilation and Curettage (D&C) was successfully performed.Conclusion: This case highlights the unpredictable course of medical management in missed abortion and the potential need for emergency surgical intervention. It also emphasizes the importance of individualized management, close follow-up, and comprehensive psychological counselling to support patients and their partners following early pregnancy loss.

Keywords: Early pregnancy loss; Ultrasound scan; Fetal cardiac pulsations; Obstetrician and gynecologist