Symptoms and Treatment of An Incomplete Miscarriage

What Treatment Options are Available for an Incomplete Miscarriage?

A woman sitting on bathroom floor
What treatments are available for an incomplete miscarriage?. Getty Images/Michael Poehlman

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

Incomplete Miscarriage - Definition

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—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 Options for 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

    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 - Expectant Management

    With watchful waiting, a woman is carefully monitored as an outpatient. Quite often, the body naturally passes the products of conception without problems. This is the least invasive approach and also has a cost advantage for those who are concerned.

    For those who choose expectant management, there is a higher risk of incomplete miscarriage, and hence, a greater risk of needing an unplanned D&C in time. 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. 

    Surgical Management - D&C for an Incomplete Miscarriage

    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 (OB-GYN) uses small instruments or medications to open up the cervix and access the uterus.

    This is done most often under general anesthesia. 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
    • 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 again, this is rare)

      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.

      Learn more about the benefits and risks of a D&C after miscarriage.

      Medical Managment - Cytotec for an Incomplete Miscarriage

      In terms of medical management, Cytotec (misoprostol) is a medication that can be given to women vaginally, by mouth, against the cheek, or under the tongue. 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 percent for 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 in-between choice. It is not as invasive as surgery, but women feel like they are doing something to speed up the process.

      Learn more about Cytotec (misoprostol) for managing miscarriage.

      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. Unless you have a clear reason to choose one treatment option over another, the best choice is the treatment which feels most acceptable to you personally. Usually a decision doesn't need to be made immediately. Take the time to learn about incomplete miscarriage and make sure all of your questions are answered.

      In addition to issues with medically managing an incomplete miscarriage, 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. You may wish to check out some tips on coping with miscarriage that have helped others facing a similar 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 both 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.

      Sources:

      Hooker, A., Aydin, H., Brolmann, H., and J. Huirme. Long-Term Complications and Reproductive Outcome after the Management of Retained Products of Conception: A Systematic Review. Fertility and Sterility. 2016. 105(1):156-64.e1-2.

      Kim, C., Barnard, S., Neilson, J., Hickey, M., Vazquez, J., and L. Dou. Medical Treatments for Incomplete Miscarriage. Cochrane Database of Systematic Reviews. 2017. 1:CD007223.

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