Incomplete Miscarriage
Definition:
An incomplete abortion is a subtype of spontaneous abortion, along with inevitable and missed abortion. Other types of spontaneous abortion are threatened abortion and complete abortion. This article will focus on incomplete abortion, which is described as partial loss of products of conception within the first 20 weeks of pregnancy. Patients will present with vaginal bleeding with lower abdominal and/or pain and cramping. Threatened abortion is vaginal bleeding with a closed cervical os and viable pregnancy. Inevitable abortion is vaginal bleeding with an open cervical os and viable pregnancy. Complete abortion is vaginal bleeding with either an open or closed cervical os with complete loss of products of conception.
The overall incidence of spontaneous abortion is 10% to 15%. It is divided into early, <12 weeks, and late, >13 weeks. The causes of abortion are usually unknown but most commonly are attributed to fetal chromosomal abnormalities and the rest due to modifiable etiologies and risk factors. Treatment of incomplete abortion includes expectant, medical, and/or surgical treatment. Complications are rare but can be serious such as sepsis from the retained product, hemorrhagic shock, and uterine rupture. The prognosis for these patients is generally good with a proper workup, close obstetric follow-up, and patient education.
Causes
In general, incomplete abortions are not preventable, in which 50% of cases are from chromosomal abnormalities. Other cases are due to modifiable etiologies and risk factors such as age, maternal diseases (diabetes, hypertension, renal disease, thyroid issue, polycystic ovary syndrome, lupus, thrombophilia), under or overweight, abnormal uterine, teratogen exposure (drug, alcohol, caffeine, radiation), and infections (human immunodeficiency virus, sexually transmitted infections, etc). Other less known and reported cases are from prior elective medical or illegal abortions, poor or no prenatal care, and lower abdominal or pelvic trauma.
Complications
Complications include severe hemorrhage or sepsis from an incomplete septic abortion. Prompt surgical management is indicated when the patient is unstable. It is also important to rule out ectopic pregnancy, presenting with vaginal bleeding and lower abdominal and/or pelvic pain. There are several other complications that can arise after the management of incomplete abortion including death, uterine rupture, uterine perforation, subsequent hysterectomy, multisystem organ failure, pelvic infection, cervical damage, vomiting, diarrhea, infertility, and/or psychological effects.
Patients can present with different forms of shock, including hemorrhagic, septic, and cervical. Infection following an incomplete abortion is low.
Symptoms
The main symptoms of an incomplete miscarriage include:
- Prolonged and heavy vaginal bleeding
- Abdominal pain or cramping
- Loss of pregnancy symptoms
- Incomplete early miscarriage: morning sickness and breast tenderness
- Incomplete late miscarriage: fetal movement
If you have discharged any pregnancy tissue from your vagina, place it in a clean container and bring it to your gynecologist to have it analyzed.
Risk factors
Any form of miscarriage regardless of the cause can lead to an incomplete miscarriage if the body is unable to expel all the pregnancy tissues out of the womb. Common causes of miscarriage include:
- Immunological factor (Anti-embryonic antibodies present in mother’s body)
- Endocrine factor (Hormonal irregularities)
- Chromosomal abnormality
- Cervical insufficiency
- Uterine abnormalities
- Incorrect implantation position of fertilized egg
- Infection
However, one notable risk factor is the use of abortion pills. Abortion pills are taken to women who wish to have a miscarriage early in the pregnancy. There is a very high chance that you will have an incomplete miscarriage if you choose to take the abortion pill.
Diagnosis
There are several tests to diagnose an incomplete miscarriage. Your gynaecologist will most likely check the following:
- Fetal heartbeat. The fetal heartbeat can be detected after the 6th gestational week. Hence, a check for the fetal heartbeat will confirm if the pregnancy has ended.
- Ultrasound. An ultrasound can check if the miscarriage is an incomplete one. If it is incomplete, the ultrasound will reveal that the pregnancy sac and other materials are still present in the uterus.
Treatment
In the case of an incomplete miscarriage, you should not immediately scrap your womb to clear all the pregnancy tissues. You should opt for a hysteroscopy to safely remove the fetus and the remaining pregnancy tissues to prevent any damage to your uterus.
This thorough examination will allow for a quick and accurate diagnosis of the root cause of the miscarriage. Antai hospital provides a one-stop service for patients, from hysteroscopy to all the checks mentioned above. This one-stop service will ensure that patients can safely clear their womb, get diagnosed, and receive appropriate treatments in the shortest time possible.