A 10-week missed abortion is managed medically with mifepristone 200 mg followed by misoprostol 800 mcg vaginally 48 hours later. On follow-up at 2 weeks, ultrasound shows retained products of conception (RPOC) without signs of infection. The appropriate next step is:

• A Immediate surgical evacuation (MVA/D&C)
• B A second dose of vaginal misoprostol ✓
• C Expectant management for a further 2 weeks if asymptomatic
• D Serum hCG measurement to exclude GTN before further management

Explanation

For incomplete medical abortion with RPOC and no infection or hemodynamic instability, a second dose of misoprostol (800 mcg vaginally) is an evidence-based first option before resorting to surgical evacuation. NICE and WHO guidelines support repeat misoprostol for incomplete or failed medical management, achieving complete expulsion in an additional 50–70% of cases. Immediate surgical evacuation is reserved for infection, significant hemorrhage, or persistent RPOC after repeat misoprostol. hCG for GTN is warranted only if clinical suspicion exists.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.