**Question:** The best method of evacuation of a missed abortion in the uterus of more than 12 weeks:

**Core Concept:** Abortion is the involuntary expulsion of a fetus or intrauterine contents due to various reasons. Missed abortion refers to the loss of a fetus of more than 12 weeks' gestation, where the fetus or parts of the fetus have been expelled but the products of conception (foetus or foetal parts) have not been expelled. Evacuation is the surgical removal of these products of conception.

**Why the Correct Answer is Right:** In cases of missed abortion with products of conception retained in the uterus, surgical intervention is required to remove the products of conception. The correct method is dilatation and curettage (D&C), which is a minimally invasive procedure that dilates the cervix and uses a curette to remove the retained products of conception.

**Why Each Wrong Option is Incorrect:**

A. Hysterectomy (removal of the uterus) is an extensive surgical procedure, not suitable for retained products of conception.
B. Hysterotomy (incision in the uterus) is a major surgical intervention, not suitable for retained products of conception.
C. Manual vacuum aspiration (MVA) is a minimally invasive method used for first-trimester abortions, not suitable for missed abortions with retained products of conception.
D. Hysteroscopy is a minimally invasive procedure used for diagnosis and treatment of uterine abnormalities, not suitable for missed abortions with retained products of conception.

**Clinical Pearl:** For retained products of conception in missed abortions, dilatation and curettage (D&C) is the suitable minimally invasive procedure, while other options like hysterectomy, hysterotomy, manual vacuum aspiration, and hysteroscopy are not suitable for this indication.

**Correct Answer:** D&C