Overview of Incomplete Miscarriage

Doctor examining pregnant woman at home
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What does it mean if you have an incomplete miscarriage? What are the symptoms, and what treatments can be used to manage this condition? What do you need to know as you make your decision about these approaches?

A miscarriage is labeled "incomplete" if bleeding has begun and the cervix is dilated, but tissue from the pregnancy still remains in the uterus. Most of the time, a miscarriage that is incomplete at the time of diagnosis will run its course without further intervention. But sometimes the body has trouble passing the tissue from the pregnancy, and the miscarriage remains incomplete until a woman seeks treatment.

An incomplete miscarriage diagnosis is not the same as a missed miscarriage. In that case, the pregnancy is nonviable and the fetus is no longer developing, but the cervix remains closed and no bleeding has begun.

Symptoms of Incomplete Miscarriage

The main symptoms of incomplete miscarriage are bleeding and cramping, similar to other types of miscarriage. You may also notice a disappearance of early pregnancy symptoms (such as morning sickness or breast tenderness). If you experience bleeding or abdominal pain in pregnancy, consult your healthcare provider.

Treatment Options

Treatment for an incomplete miscarriage usually entails one of the following:

  • Watchful waiting—which means waiting to see if the body passes the products of conception naturally
  • A surgical procedure called dilation and curettage (D&C)
  • Medical management with Cytotec (misoprostol)

Which Approach Is Best?

Research shows that these three methods have similar rates of effectiveness for a first-trimester incomplete miscarriage, so a woman's preference is strongly considered, along with a careful and thoughtful discussion with her physician.

Watchful Waiting and Expectant Management

With watchful waiting, you will be carefully monitored as an outpatient. Quite often, the body naturally passes the products of conception without problems. This is the least invasive and most inexpensive approach.

For those who choose expectant management, there is a higher risk of incomplete miscarriage, and hence, a greater risk of needing a D&C later. There is also an increased risk of excessive bleeding, and this can be dangerous if heavy and persistent. When bleeding is excessive, a D&C is indicated. Sometimes if bleeding cannot be rapidly controlled with surgery, a blood transfusion may be needed. 

D&C Surgery

A D&C may be chosen either due to a woman's wishes, or to avoid or stop heavy bleeding. With a D&C, an obstetrician/gynecologist uses small instruments or medications to open up the cervix and access the uterus. Once inside the uterus, the physician uses a curette to scrape the sides of the uterus and gather retained products of conception.

This is done most often under general anesthesia. Although a D&C is, for the most part, a safe procedure, there are potential risks (as in any type of surgery). These can include:

  • Bleeding
  • Complications of anesthesia
  • Cervical damage
  • Incomplete evacuation of the products of conception
  • Perforation of the uterus
  • Infection
  • Scar tissue or adhesions on the uterine wall, which can result in a rare condition called Asherman's syndrome. Asherman's syndrome, in turn, may sometimes result in recurrent miscarriages, infertility, or preterm births (but this is rare).

Women who continue to bleed days after a D&C or notice foul discharge should notify their physician immediately. Other worrisome signs after D&C include persistent pain and cramping.

Medical Management

Cytotec (misoprostol) is a medication that can be given to women vaginally or by mouth. Cytotec was first designed to treat ulcers, but is now used quite often to manage obstetric conditions. Side effects may include pain, nausea and vomiting, and diarrhea.

Overall, the success rate of Cytotec is around 80% to 99% of pregnancies of a gestational age of 13 weeks or less. For some women, the treatment will not be effective, and a D&C will then be needed. Overall, medical management has the advantage of having a lower risk of causing uterine adhesions, but a slightly increased risk of blood loss.

Some women prefer this option as a sort of compromise choice. It is not as invasive as surgery, but may speed the process of miscarriage along faster than watchful waiting. Some parents appreciate the opportunity to take action instead of waiting.

Coping With Incomplete Miscarriage

In addition to the physical concerns, this can be an emotionally devastating time. Losing a baby to miscarriage is a major loss, and people go through the stages of grief as with any other loss.

If you are facing the grief of miscarriage with a partner, make sure to include him or her in your decision-making. Research shows that men and women both grieve following a miscarriage, but may express this grief in different ways. This can lead to friction at an already difficult time. Let this be a time for you to grow closer rather than apart.

A Word From Verywell

If you are experiencing an incomplete miscarriage, discuss your management options carefully with your doctor and express your wishes and concerns. It is important that you feel supported in your treatment choice. The best treatment is the one which feels most acceptable to you. Take the time to learn about incomplete miscarriage and make sure all of your questions are answered.

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