Symptoms and Treatment of An Incomplete Miscarriage

A woman's preference is important in managing an incomplete miscarriage.

A woman sitting on bathroom floor
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A miscarriage is labeled "incomplete" if the 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—a nonviable pregnancy in which the baby is no longer developing, but the cervix remains closed and no bleeding has begun.

Symptoms of an Incomplete Miscarriage

The main symptoms of incomplete miscarriage are bleeding and cramping. In the majority of cases, a miscarriage that is incomplete at the time of the initial diagnosis will complete without intervention should the woman wish to avoid surgery like a D&C to remove the products of conception. Sometimes, however, tissue remains in the uterus without the body passing it naturally, and a surgical or medical approach is indicated. 

Treatment of an Incomplete Miscarriage

Treatment for women who experience an incomplete miscarriage entails one of the following three approaches:

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

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.

That being said, sometimes one approach is indicated over another. For example, bleeding is more common with watchful waiting, 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. 

With a D&C, an OB-GYN 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. Curettes can either be sharp or use suction.

Although D&C , is for the most part, a safe procedure, there are potential risks involved (as in any type of surgery).

Here are some possible complications of D&C:

  • bleeding
  • cervical damage
  • perforation of the uterus
  • infection
  • scar tissue or adhesions on the uterine wall, which can result in Asherman's syndrome

Women who continue to bleed days after D&C or notice foul discharge should notify their physician immediately.

Other worrisome signs after D&C include persistent pain and cramping.

In terms of medical management, misoprostol can be given to women vaginally, by mouth, against the cheek, or under the tongue. Some women prefer this option, as a sort of in-between choice. It is not as invasive as surgery, but women feel like they are doing something to speed up the process. 

A Word From Verywell

 If you or a loved one are experiencing an incomplete miscarriage, please 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.

Sources:

American Pregnancy Association. (August 2016). Miscarriage

Nanda K, Lopez LM, Grimes DA, Peloggia A, Nanda G. Expectant care versus surgical treatment for miscarriage.  Cochrane Database Syst Rev. 2012 Mar 14;(3):CD003518.

Neilson JP, Gyte GM, Hickey M, Vazquez JC, Dou L. Medical treatments for incomplete miscarriage. Cochrane Database Syst Rev. 2013 Mar 28;(3):CD007223.

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