Patient presents with missed abortion (missed miscarriage, spontaneous abortion, early pregnancy loss, fetal demise in utero).  Presenting complaint may include absent fetal movement, light vaginal spotting, resolution of pregnancy symptoms, or asymptomatic presentation discovered during routine ultrasound.  Crown-rump length (CRL) confirms embryonic or fetal demise with no cardiac activity.  Uterine size may be smaller than expected gestational age.  Quantitative beta-hCG levels may plateau or decline, but are not diagnostic on their own.  Differential diagnoses include threatened abortion, blighted ovum, and ectopic pregnancy.  Ultrasound findings are consistent with a nonviable intrauterine pregnancy.  Management options discussed with the patient include expectant management, medical management with misoprostol, or surgical management with dilation and curettage (D and C, suction curettage).  Patient's emotional state and preferences were considered in developing the plan of care.  Risks and benefits of each option were explained, including risks of infection, hemorrhage, and future fertility.  Patient will follow up for monitoring of hCG levels and to assess for complete passage of pregnancy tissue.  Patient education provided regarding symptoms to report, such as heavy bleeding, fever, or severe abdominal pain.  Referral to bereavement counseling services offered as needed.  ICD-10 code: R53.1.