Incomplete Abortion (Incomplete Miscarriage)

Types of early pregnancy loss

An incomplete abortion can also follow an induced abortion if not all tissue is expelled, especially after medication abortion.

Causes

Most early pregnancy losses happen because of chromosomal problems in the pregnancy, which nothing the parent did could have caused or prevented. Ordinary activities, exercise, work, sex and stress do not cause miscarriage. See miscarriage.

Symptoms

• vaginal bleeding, often heavier than a period
• passing clots or grayish tissue
• cramping lower abdominal pain or lower back pain
• bleeding that continues rather than settling
• pregnancy symptoms fading

Diagnosis

• pelvic examination: an open cervix, sometimes with tissue visible
• transvaginal ultrasound: shows tissue in the uterus and excludes an ongoing pregnancy
• hCG blood tests: help when ultrasound findings are unclear, and to rule out ectopic pregnancy
• blood count if bleeding is heavy
• blood group and Rh status: Rh-negative people may be offered anti-D (Rh immunoglobulin) in certain situations, per current guidance

Treatment options

ACOG and WHO consider three approaches safe and effective. The choice depends on your preference, bleeding, and clinical situation.

Expectant management

Waiting for the tissue to pass naturally. Many incomplete miscarriages complete within 1 to 2 weeks. You will be given pain relief advice and clear guidance on when to seek help.

Medical management

Misoprostol is taken by mouth, under the tongue or vaginally to make the uterus contract and expel the remaining tissue. It is effective in most incomplete miscarriages, usually within 24 hours. Side effects include cramping, heavier bleeding, nausea, diarrhea and chills.

Uterine aspiration

A quick procedure using suction to empty the uterus:

• manual vacuum aspiration can be done in a clinic with local anesthetic
• electric vacuum aspiration in an operating room, with sedation or anesthesia

It is preferred when bleeding is heavy, infection is suspected, or a person wants a quick, predictable resolution. Risks are low, including infection, bleeding and, rarely, uterine injury or scarring.

Pain relief and self-care

• ibuprofen or acetaminophen (paracetamol), following the label dose or as prescribed
• a heating pad on the belly
• pads rather than tampons until bleeding stops, to reduce infection risk
• rest as needed. Most people return to usual activities within days

Complications

• heavy bleeding needing treatment or transfusion
• infection of retained tissue (septic abortion)
• retained tissue needing further treatment (retained products of conception)
• rarely, intrauterine scarring (Asherman syndrome) after procedures

Recovery and future pregnancy

• bleeding usually settles over 1 to 2 weeks
• the next period typically comes in 4 to 6 weeks
• ovulation can return within 2 weeks, so use contraception if you do not want to conceive
• there is no medical need to wait before trying again once you feel ready, unless advised otherwise
• most people go on to have a healthy pregnancy
• after 2 or 3 losses, testing may be offered

Grief after pregnancy loss is real and can affect partners too. Support from loved ones, counseling or pregnancy loss organizations can help.

Frequently asked questions

What is an incomplete abortion?

It is the medical term for a pregnancy loss before 20 weeks in which some pregnancy tissue remains in the uterus. "Abortion" in this medical sense includes spontaneous miscarriage. It is also called an incomplete miscarriage.

What are the symptoms of an incomplete miscarriage?

Symptoms include ongoing vaginal bleeding, cramping, passing clots or tissue, and lower back pain. Bleeding may be heavy and continue longer than expected. An ultrasound confirms that tissue remains in the uterus.

How is an incomplete miscarriage treated?

Options are waiting for the tissue to pass naturally, taking misoprostol to help the uterus empty, or a suction procedure. All are safe. The choice depends on bleeding, signs of infection and personal preference.

How long does it take for an incomplete miscarriage to pass?

With expectant management, many incomplete miscarriages complete within 1 to 2 weeks. Misoprostol usually works within 24 hours. A suction procedure empties the uterus immediately.

What happens if an incomplete miscarriage is not treated?

Often the body completes the process itself. However, retained tissue can cause prolonged heavy bleeding or infection. Follow-up is important, and fever, foul discharge or heavy bleeding need urgent care.