An incomplete abortion is an abortion that has only been partially successful. The pregnancy has ended, no fetus will develop, but the body has only expelled part of the tissue and products of pregnancy. The incidence of incomplete abortions could be either spontaneous or following induced termination of pregnancy. Products of conception (POC) remain in the uterus after induced abortion or miscarriage (also known as spontaneous abortion).POC is the medical term used for the tissues derived from the union of an egg and a sperm that needs to be expelled or extracted out of the uterus after an abortion.

There are several types of abortions:

• A spontaneous abortion otherwise called a miscarriage occurs when pregnancy fails to continue and POC passes from the body.
• A medical abortion uses prescribed medications. These medications help a woman pass the foetus and related tissue. The result is like a miscarriage with chances of incomplete abortion.
• A surgical abortion is the removal of the fetus and placenta from a woman’s uterus. The doctor typically uses a vacuum to extract the pregnancy material.
• A self-induced abortion is done by the mother. This term includes abortions done with legal, over-the-counter medication and those performed using unregulated indigenous methods. There is high risk of incomplete abortions with complications leading to maternal mortality in such cases.

Incomplete abortion caused spontaneously is otherwise called incomplete miscarriage. At times, not all of the pregnancy tissue contents of the womb come away on their own after a miscarriage. When some pregnancy tissue comes away by itself, but some remains in the womb, it is called an incomplete miscarriage. Miscarriage with retained products of conception is termed delayed when no or very little products of conception have been passed, and is termed incomplete when some products have been passed but some still remain in the uterus.

There are some warning signs which may indicate that a woman may be experiencing an incomplete miscarriage.

• Bleeding very heavily to the extent of soaking through a pad an hour.

•  Bleeding may become increasingly heavy rather than improving.
•  May pass clots as vaginal discharge.
• Severe abdominal pain, which may feel like crampy contractions.

Immediate visit to the hospital/clinic that can deal with complications of miscarriage is absolutely necessary because the tissue and blood that remains in the body can cause heavy bleeding or an infection. For incomplete or delayed miscarriages, medical management is decided depending on the Ultrasonography findings. Methods of management either through medication or surgery is based on the size of the retained products of conception such as the gestational sac and embryo remains.

Medical method of abortion (MMA) or medication abortion (MA) along with manual vacuum aspiration (MVA) is the safer methods of termination of pregnancy recommended by World Health Organization over traditional dilatation and curettage. Medication abortion using a combination of drugs is a safe, efficient, affordable, acceptable and approved method of MTP up to 9 weeks (63 days) of pregnancy. Termination of pregnancy with medications is legalized under the amended MTP act (2002).

The risk of incomplete abortion is minimal when medical abortion is applied properly and medication abortion may be an equally effective and safe method of abortion. The efficacy of medication abortion (MA) is highly dependent on the route and dosage of medication. Incomplete abortion is a known disadvantage of medication abortion reported in 0.2–3 % of cases. Main possible reasons are being self-administration or prescription by unregistered practitioners and lack of follow-up. This problem is worsened when there is improper selection of patient, dosage, route, timing or drugs used singly rather than in combination. Improper selection may be due to inadequate history regarding gestational age, lack of clinical, and ultrasound examination for gestational age as medication termination is less effective in pregnancies of 7–9 weeks and still higher chances of failure in pregnancies more than 9 weeks of gestation. Below is a list of symptoms that may indicate a problem after medical abortion.

Heavy Bleeding

In rare cases, some women bleed more than is safe after an abortion. The best way to tell if the bleeding is too much is to keep track of the number of pads being used and the number and size of any clots. To soak two maxi pads an hour for two hours in a row or to pass large clots or to feel light-headed indicate need for medical help.

Uterine Cramping

The main way that the uterus controls bleeding is to contract, squeezing the blood vessels shut. So, uterine cramping is quite normal after any kind of abortion but heavy bleeding can occur if the uterus relaxes too much (uterine agony) or if some fetal or placental tissue is retained in the uterus (incomplete abortion).

Pain

Persistent or severe pelvic pain may indicate a problem. It’s sign of concern if intense pain persists after having taken pain relievers. The most common cause of severe pain is an infection which can become lethal if left untreated. Post abortion pain may also be caused by retained fetal or placental tissue or clots (hematometra). If the tissue or clots don’t pass on their own, there may be a need for medication or a vacuum aspiration to empty the uterus.

Fever

Having sustained fever of 100.4° Fahrenheit or above could be a positive indication of an infection. Some medicines used for medical abortion can cause short-term fever. However, if the temperature remains elevated for several hours specially with severe pain, it is vital to get medical attention.

Continued Symptoms of Pregnancy

Symptoms of pregnancy such as nausea, bloating or breast tenderness typically resolve within a week or two following an abortion. If these symptoms persist, there are chances of still being pregnant. Home pregnancy tests are not useful because the woman can continue to test positive for four to six weeks after a complete abortion, due to pregnancy hormones that are still in the body. Also, if using a hormonal birth control method like the Pill, patch or vaginal ring right after the abortion, they can cause pregnancy-like symptoms particularly during the first few months of use.

Septic shock

Septic shock often occurs after an abortion. It strikes when pieces of POC remain in the body and gets infected after a spontaneous or induced abortion either medical or surgical. Self -induced abortions create possibilities of incomplete abortions and infections resulting in high risk septic conditions. In most cases, the infection stays in a specific area. However, in severe cases, the infection enters the bloodstream and travels throughout the body. This is called a systemic reaction. The resulting condition is called sepsis. Septic shock is a medical emergency. As sepsis weakens body’s immune responses, organs begin to fail. The condition is called septic shock when sepsis worsens so that the blood pressure drops dangerously low and is immune to treatment.

The following symptoms after a recent abortion may indicate septic shock:

• very high or very low body temperature
• heavy bleeding
• severe pain
• cool, pale arms and legs
• feelings of confusion, restlessness or fatigue
• shivering chills
• low blood pressure, especially when standing
• inability to urinate
• heart palpitations
• rapid, pounding heart rate
• difficult, rapid breathing with shortness of breath

It is extremely important to treat an incomplete abortion. The use of drugs to manage incomplete abortion is limited to pregnancies of up to 9 weeks. It may be extended up to a maximum period of 12 weeks to be followed up by surgical evacuation. The effectiveness of medicines that treat early incomplete abortion is not the same even at higher doses to treat incomplete abortions after 12 weeks of gestation. The more definite treatment for incomplete abortion beyond 9 weeks would be what is called a vacuum aspiration or curettage. An effort to reduce high maternal mortality ratio would be to improve post-abortion care for women who have had spontaneous or induced abortions.

Now that you are aware of what are the signs of incomplete abortion, you must seek immediate medical help if you notice any of the symptoms associated with it!