What To Know About Incomplete Miscarriage

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, and the miscarriage remains incomplete until the person seeks treatment. If the tissue isn't removed, the incomplete miscarriage can cause heavy bleeding, prolonged bleeding, or an infection.

Here's what to know about incomplete miscarriage, including symptoms, diagnosis, and treatment options.

Symptoms of an Incomplete Miscarriage

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

• Backache or back pain
• Abdominal pain or cramping
• Vaginal bleeding, including blood clots

Diagnosis of an Incomplete Miscarriage

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

• Fetal heart scanning
• Pelvic exam
• hCG blood test
• Ultrasound

An incomplete miscarriage diagnosis is not the same as a missed miscarriage. With a missed miscarriage, the pregnancy is not viable and the embryo or fetus is no longer developing, but the cervix remains closed and no bleeding has begun.

Causes and Risk Factors

While it is believed that approximately 50% of all early miscarriages are caused by random genetic problems in the embryo or fetus, there are other causes and risk factors linked with miscarriage, including:

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

Treatment for an Incomplete Miscarriage

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

• Watchful waiting or expectant management
• Procedural management with dilation and curettage (D&C)
• Medical management with misoprostol

Research shows that these three methods have similar rates of effectiveness for a first-trimester incomplete miscarriage, so the pregnant person's preference is strongly considered, along with a careful and thoughtful discussion with their health care provider.

Expectant management

With expectant management, 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 chance of needing a D&C later. There is also an increased risk of excessive bleeding, and this can be dangerous if it's heavy and persistent. When bleeding is excessive, a D&C is often necessary. If bleeding cannot be rapidly controlled with surgery, a blood transfusion may be needed.

Dilation and curettage (D&C)

A D&C may be chosen to treat an incomplete miscarriage either due to the pregnant person's wishes or to prevent or stop heavy bleeding. With an incomplete miscarriage, the cervix is usually already open so the health care provider doesn't need to dilate your cervix with small instruments or special medications.

Once inside the uterus, the physician uses suction and an instrument called a curette to scrape the sides of the uterus and gather retained products of conception, including fetal and placental tissues.

The procedure is most often done under general anesthesia. Although a D&C is considered a safe procedure, there are potential risks, including:

• Bleeding
• Cervical damage
• Complications of anesthesia
• Infection
• Scar tissue or adhesions on the uterine wall (which can result in a rare condition called Asherman syndrome)

Medical management

Misoprostol (Cytotec) is a medication that can be given vaginally or by mouth. The drug causes the uterus to contract and expel the pregnancy tissue. Misoprostol was first designed to treat ulcers but is now commonly used to manage obstetric conditions.

Side effects of misoprostol may include:

• Diarrhea
• Headache
• Nausea
• Pain
• Shivering/chills
• Vomiting

Overall, the success rate of misoprostol is around 80% to 99% for pregnancies of a gestational age of 13 weeks or less.

For some people, treatment with misoprostol will not be effective and a D&C will then be needed. Overall, medical management has the advantage of a lower risk of uterine adhesions, but a slightly increased risk of blood loss.

Some people prefer this option as a sort of compromise choice. It is not as invasive as a D&C and the miscarriage can be completed at home but the medication may speed the process of miscarriage along faster than expectant management. Some people appreciate the opportunity to take action instead of waiting.

Coping With an Incomplete Miscarriage

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

A miscarriage can be a major loss, and as with any other loss, you may go through the stages of grief:

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

Involve your partner

If you are facing the experience of miscarriage with a partner, make sure to include them in your decision-making. Research shows that both partners 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.

Get support

In addition to seeking support from a mental health professional, there are numerous nonprofit organizations that offer support services for pregnancy loss.