Why incomplete abortion

Your symptoms should start to improve quickly and the risks of more serious complications should be eliminated. However, you should still watch out for any signs of infection or other problems and contact your doctor if you have any concerns. The contents on this site is for information only, and is not meant to substitute the advice of your own physician or other medical professional.

What is an Incomplete Abortion? How Common is Incomplete Abortion? The chances of having an incomplete abortion after a medical termination are approximately: 1. How common is abortion and who has it? What is a Threatened Abortion? Ultrasonography is crucial in identifying the status of the pregnancy and verifying that the pregnancy is intrauterine.

When transvaginal ultrasonography reveals an empty uterus and the quantitative serum hCG level is greater than 1, mIU per mL 1, IU per L , an ectopic pregnancy should be considered.

A uterus found to be empty on ultrasound examination may signal a completed spontaneous abortion, but the diagnosis is not definitive until ectopic pregnancy is excluded.

If an ultrasound examination finds an intrauterine pregnancy, ectopic pregnancy is unlikely, although heterotopic pregnancy has been reported i. Cervical abnormalities e. When the clinical examination reveals a dilated cervix, spontaneous abortion is inevitable. However, cervical evaluation is not reliable for distinguishing between complete and incomplete abortion. A missed spontaneous abortion usually is diagnosed by routine ultrasonography or when an ultrasound scan is obtained because the symptoms and physical signs of pregnancy are regressing.

Figure 1 presents an algorithm for diagnosing spontaneous abortion. Algorithm for the diagnosis of spontaneous pregnancy loss. Spontaneous pregnancy loss: evaluation, management, and follow-up counseling. Prim Care ; Chromosomal abnormalities are a direct cause of spontaneous abortion. One meta-analysis 9 found that a chromosomal abnormality occurs in 49 percent of spontaneous abortions. Autosomal trisomy was the most commonly identified anomaly 52 percent , followed by polyploidy 21 percent and monosomy X 13 percent.

Structural abnormalities of individual chromosomes e. Risk factors for spontaneous abortion are listed in Table 3. One study 15 that examined the influence of stress on early pregnancy loss failed to find a clear association. Marijuana use, likewise, has not been proven to increase the risk for spontaneous abortion.

Chronic maternal diseases: poorly controlled diabetes, celiac disease, autoimmune diseases particularly antiphospholipid antibody syndrome. Maternal infections: bacterial vaginosis; mycoplasmosis, herpes simplex virus, toxoplasmosis, listeriosis, chlamydia, human immunodeficiency virus, syphilis, parvovirus B19, malaria, gonorrhea, rubella, cytomegalovirus. Medications: misoprostol Cytotec , retinoids, methotrexate, nonsteroidal anti-inflammatory drugs.

Toxins: arsenic, lead, ethylene glycol, carbon disulfide, polyurethane, heavy metals, organic solvents. Information from 1 and 10 through Dilatation and curettage is the traditional treatment for spontaneous abortion; manual vacuum aspiration is another surgical option. Prompt surgical evacuation of the uterus has been recommended in the past because of the risk for infection and concerns about coagulation disorders that result from retained products of conception.

Many recent studies 16 — 24 have examined the outcomes of expectant and medical management for women with spontaneous abortions. Prompt surgical evacuation of the uterus is the treatment of choice when the patient is unstable because of heavy bleeding or has evidence of a septic abortion.

Patient choice is another reason to proceed with surgical evacuation. Some women may have already completed a spontaneous abortion by the time they present for clinical evaluation. If the ultrasound examination shows an empty uterus and evaluation of the expelled tissue confirms the presence of products of conception, no further action is needed; in these instances, patients have a completed spontaneous abortion and can be managed expectantly.

Many studies 17 — 24 have compared expectant management, medical therapy, and surgical management for women with incomplete spontaneous abortion. Expectant management proved to be successful, with no need for surgical intervention in 82 to 96 percent of women. In women with missed spontaneous abortions, expectant management has a variable but generally lower success rate than medical therapy, ranging from 16 to 76 percent.

One study 25 found that patients had an 80 percent success rate after using mcg of misoprostol, administered intravaginally and repeated after four hours, if necessary. Intravaginal administration of misoprostol causes less diarrhea than oral administration.

Patient preferences should be considered when choosing a treatment for spontaneous abortion. Physicians should discuss the available options and the evidence to support each option with the patient. There is evidence to suggest that women who are given the opportunity to choose a treatment option have better subsequent mental health than women who are not allowed to choose their therapy.

An algorithm for managing women with spontaneous abortion is presented in Figure 2. Algorithm for the management of spontaneous pregnancy loss. Physicians should recognize the psychologic issues that affect a patient who experiences a spontaneous abortion.

Although the literature lacks good evidence to support psychologic counseling for women after a spontaneous abortion, it is thought that patients will have better outcomes if these issues are addressed. The patient and her partner may be dealing with feelings of guilt, and they typically will go through a grieving process and have symptoms of anxiety and depression.

Women who have a spontaneous abortion frequently struggle with guilt over what they may have done to cause or prevent the loss. Physicians should encourage the patient and her partner to allow themselves to grieve. The woman and her partner may grieve differently; specifically, they may go through the stages of grief in different orders or at different rates. They also should be aware that friends and family members may not recognize the magnitude of their loss.

Friends and family members may ignore the subject of miscarriage, or they may make well-meaning comments that try to minimize the event.

Connecting the couple with a counselor who has experience in helping couples cope with pregnancy loss may be beneficial. Many hospitals offer programs that provide follow-up care and literature to the woman and her partner.

Missed abortion is suspected if the uterus does not progressively enlarge or if quantitative beta -hCG is low for gestational age or does not double within 48 to 72 hours. Missed abortion is confirmed if ultrasonography shows any of the following:. For recurrent pregnancy loss Recurrent Pregnancy Loss Spontaneous abortion is noninduced embryonic or fetal death or passage of products of conception before 20 weeks gestation.

For threatened abortion, treatment is observation. No evidence suggests that bed rest decreases risk of subsequent completed abortion. For inevitable, incomplete, or missed abortions, treatment is uterine evacuation or waiting for spontaneous passage of the products of conception.

Evacuation usually involves suction curettage Instrumental evacuation In the US, abortion of a previable fetus is legal, although state-specific restrictions eg, mandatory waiting periods, gestational age restrictions exist. The later the uterus is evacuated, the greater the likelihood of placental bleeding, uterine perforation by long bones of the fetus, and difficulty dilating the cervix.

These complications are reduced by preoperative use of osmotic cervical dilators eg, laminaria , misoprostol , or mifepristone RU If complete abortion is suspected, uterine evacuation need not be done routinely.

After an induced or spontaneous abortion, parents may feel grief and guilt. They should be given emotional support and, in most cases of spontaneous abortions, reassured that their actions were not the cause. Formal counseling is rarely indicated but should be made available.

Confirm spontaneous abortion and determine its type based on clinical criteria, ultrasonography, and quantitative beta-hCG. Determining the cause may require extensive evaluation of both parents. Some causes can be treated. Overt and poorly controlled chronic disorders eg, hypothyroidism, hyperthyroidism, diabetes mellitus, hypertension. During pregnancy, risk is increased because Venous capacitance Venous or arterial thrombi may occur.

The pathophysiology is The association with hereditary thrombotic disorders is less clear but does not appear to be strong, except for possibly factor V Leiden mutation. Placental causes include preexisting chronic disorders that are poorly controlled eg, systemic lupus erythematosus [SLE], chronic hypertension.

Chromosomal abnormalities Overview of Chromosomal Anomalies Chromosomal anomalies cause various disorders. Anomalies that affect autosomes the 22 paired chromosomes that are alike in males and females are more common than those that affect sex chromosomes Evaluation for recurrent pregnancy loss should include the following to help determine the cause:.

Spontaneous abortion and recurrent pregnancy loss; etiology, diagnosis, treatment. Comprehensive Gynecology. Salhi BA, Nagrani S. Acute complications of pregnancy. Editorial team. Incomplete abortion: Only some of the products of conception leave the body. Inevitable abortion: Symptoms cannot be stopped and a miscarriage will happen. Infected septic abortion: The lining of the womb uterus and any remaining products of conception become infected. Missed abortion: The pregnancy is lost and the products of conception do not leave the body.

Other possible causes of miscarriage may include: Drug and alcohol abuse Clotting disorders Exposure to environmental toxins Hormone problems Infection Overweight Physical problems with the mother's reproductive organs Problem with the body's immune response Serious body-wide systemic diseases in the mother such as uncontrolled diabetes Smoking Around half of all fertilized eggs die and are lost aborted spontaneously, usually before the woman knows she is pregnant.

The risk for miscarriage is higher: In women who are older -- The risk increases after 30 years of age and becomes even greater between 35 and 40 years, and is highest after age In women who have already had several miscarriages.

Possible symptoms of miscarriage may include: Low back pain or abdominal pain that is dull, sharp, or cramping Tissue or clot-like material that passes from the vagina Vaginal bleeding, with or without abdominal cramps Some women may not have any symptoms at the beginning.

Exams and Tests. The following blood tests may be performed: Blood type if you have an Rh-negative blood type, you would require a treatment with Rh-immune globulin. Complete blood count CBC to determine how much blood has been lost. HCG qualitative to confirm pregnancy. HCG quantitative done every several days or weeks. White blood count WBC and differential to rule out infection.