Incomplete Miscarriage

What happens in an incomplete miscarriage

In a complete miscarriage, all the pregnancy tissue leaves the uterus and bleeding settles quickly. In an incomplete miscarriage, part of the tissue (placenta, sac or fetal tissue) remains. The uterus keeps contracting to try to expel it, causing ongoing cramping and bleeding. Retained tissue can also become infected.

Miscarriage in the first 13 weeks is common, ending about 10 to 15% of known pregnancies. Most are caused by chromosome problems in the developing pregnancy and are not caused by anything the person did.

Types of early pregnancy loss

Symptoms

• vaginal bleeding, often heavy, with clots
• cramping pain in the lower belly or back
• passing tissue
• symptoms that continue rather than easing after the passage of tissue
• pregnancy symptoms fading

Signs of infection include fever, chills, foul-smelling discharge and worsening pain.

Diagnosis

• Pelvic exam: often shows an open cervix and sometimes tissue in the cervical opening.
• Transvaginal ultrasound: shows remaining tissue in the uterus.
• hCG blood tests: help confirm the pregnancy has ended; when no pregnancy was ever seen in the uterus, serial levels help rule out an ectopic pregnancy.
• Blood count and blood group: to check for anemia and Rh status.

Treatment options

All three approaches are safe and effective for most people. The choice depends on bleeding, signs of infection, personal preference, and access to follow-up.

Vacuum aspiration is recommended for heavy bleeding, unstable vital signs or infection.

Other care

• Rh immune globulin: people with Rh-negative blood may be offered it to protect future pregnancies, depending on gestation and current guidance.
• Antibiotics if infection is present; septic miscarriage needs urgent treatment and removal of tissue.
• Pain relief: ibuprofen or acetaminophen (paracetamol), following the label dose, and heat pads.
• Tissue testing: sometimes sent to the lab, for example to rule out a molar pregnancy or after recurrent losses.

Recovery

• Bleeding usually settles within 1 to 2 weeks; spotting can continue a little longer.
• Use pads rather than tampons until bleeding stops, to reduce infection risk.
• Many clinicians suggest avoiding sex until bleeding stops.
• A urine pregnancy test 3 to 4 weeks later confirms the miscarriage is complete if waiting or medicine was used.
• Periods usually return within 4 to 6 weeks.
• Ovulation can occur before your first period, so use contraception if you do not want to conceive.

Trying again

Most people can try to conceive again as soon as they feel physically and emotionally ready. Waiting is not required for medical reasons in most cases. Most people who miscarry go on to have healthy pregnancies.

Emotional support

Grief, guilt and anxiety are common after miscarriage, for both partners. Support from family, friends, counselors and pregnancy loss support groups can help. Talk to your doctor if low mood persists.

Complications

• heavy bleeding needing transfusion (uncommon)
• infection of the uterus
• retained tissue needing further treatment
• rarely, scarring inside the uterus (Asherman syndrome) after repeated procedures

Frequently asked questions

What are the signs of an incomplete miscarriage?

Signs include ongoing vaginal bleeding, often with clots, cramping that does not ease, and passing some tissue. An ultrasound showing remaining tissue in the uterus confirms it. Fever or foul-smelling discharge suggest infection and need urgent care.

How long can an incomplete miscarriage take to pass naturally?

Many incomplete miscarriages complete within 1 to 2 weeks without treatment. Some take longer. If bleeding becomes heavy, infection develops or you prefer not to wait, medicine or a procedure can be used.

Is a D&C necessary after an incomplete miscarriage?

Not always. Waiting and misoprostol are effective for many people. A vacuum aspiration (D&C) is recommended if bleeding is heavy, there are signs of infection, or other options have not worked, and some people choose it for its speed and predictability.

Can retained tissue cause infection?

Yes. Tissue left in the uterus can become infected, causing fever, chills, worsening pain and foul-smelling discharge. This needs prompt treatment with antibiotics and removal of the tissue.

How soon can I get pregnant after an incomplete miscarriage?

Ovulation can happen as early as 2 weeks after the miscarriage. Most people can try again once bleeding has stopped and they feel ready. After a molar pregnancy, waiting until hCG monitoring is complete is advised.