What Is Incomplete Miscarriage?

Doctor examining pregnant woman at home
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What Is Incomplete Miscarriage?

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.

Symptoms

The main symptoms of an incomplete miscarriage are similar to other types of miscarriage, and include:

  • Backache or back pain
  • Abdominal pain or cramping
  • Disappearance of early pregnancy symptoms (such as morning sickness or breast tenderness)
  • Vaginal bleeding

If you experience bleeding or abdominal pain in pregnancy, consult your healthcare provider.

Diagnosis

To diagnose an incomplete miscarriage, your health care provider will use a combination of tests, including:

  • Chromosomal tests
  • Fetal heart scanning
  • Pelvic exam
  • Quantitative hCG blood test
  • Ultrasound

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.

Causes and Risk Factors

While anywhere between 50% and 70% of all miscarriages are caused by random genetic problems in the developing baby, there are other causes and risk factors linked with miscarriage, including:

  • Abnormal uterine shapes
  • Amniocentesis
  • Exposure to environmental and workplace hazards (high levels of radiation or toxic agents)
  • Hormonal irregularities
  • Improper implantation of fertilized egg in the uterine lining
  • Maternal and paternal age
  • Previous miscarriage
  • Incompetent cervix
  • Lifestyle factors (smoking, drinking alcohol, using drugs)
  • Immune system disorders
  • Kidney disease
  • Congenital heart disease
  • Uncontrolled diabetes
  • Thyroid disease

Treatment

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)

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), including:

  • Bleeding
  • Cervical damage
  • Complications of anesthesia
  • Incomplete evacuation of the products of conception
  • Infection
  • Perforation of the uterus
  • Scar tissue or adhesions on the uterine wall, which can result in a rare condition called Asherman's syndrome

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:

  • Diarrhea
  • Nausea
  • Pain
  • Vomiting

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

In addition to dealing with the physical concerns, you will need to care for yourself emotionally during this time. Here are a few coping strategies to keep in mind.

Give Yourself Time to Grieve

Losing a baby to miscarriage is a major loss, and as with any other loss, you may go through the following stages of grief:

  • Denial and isolation
  • Anger
  • Bargaining
  • Depression
  • Acceptance

Involve Your Partner

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.

Seek Support

In addition to seeking support from a mental health professional, there are numerous nonprofit organizations that aim to spread awareness of pregnancy and infant loss and offer support services.

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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Article Sources
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  5. American Pregnancy Association. After a Miscarriage: Surviving Emotionally.

  6. Volgsten H, Jansson C, Svanberg AS, Darj E, Stavreus-evers A. Longitudinal study of emotional experiences, grief and depressive symptoms in women and men after miscarriage. Midwifery. 2018;64:23-28. doi:10.1016/j.midw.2018.05.003

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