What are the signs of an incomplete abortion?

What are the signs of an incomplete abortion?

Have you ever pondered on “what are the signs of an incomplete abortion?”

Sometimes it so happens that when you have had an abortion only part of the tissues or products of conception are expelled out of the uterus and some bits of it remain within the uterus.

Such partial expulsion of the products of conception is called an incomplete abortion. So let us try to answer the question of

How can one know if the abortion was incomplete? What are the signs of an incomplete abortion?

We will throw light on the above matters and much more through this article.

So read on to know all about symptoms and signs of incomplete abortion, diagnosis of incomplete abortion, complications associated with incomplete abortion, management of incomplete abortion etc.

How does incomplete abortion occur?

Incomplete abortion may occur spontaneously or may be induced.

Spontaneous abortion may lead to incomplete abortion if all of the tissues from pregnancy fail to pass outside of the uterus despite the cervix remaining dilated.

Medically induced abortions are done with the help of drugs which dilate the cervix and produce uterine contractions so as to expel the fetus and the other supporting tissues of pregnancy

Mifepristone and misoprostol is a medical abortion procedure used up to the first 7 to 9 weeks of pregnancy. It is also referred to as RU­486 or the abortion pill

A physical exam is first given in order to determine eligibility for this type of medical abortion procedure.

You are not eligible if you have any of the following: ectopic pregnancy, ovarian mass, IUD, corticosteroid use, adrenal failure, anemia, bleeding disorders or use of blood thinners, asthma, liver or kidney problems, heart disease, or high blood pressure.

You will be given antibiotics to prevent infection. Mifepristone is given orally during your first visit. Mifepristone blocks progesterone from the uterine lining, causing the lining to break down, preventing the ability to continue a pregnancy.

Misoprostol tablets are taken orally or inserted vaginally for about 24 to 48 hours after taking the mifepristone.

Home use of Misoprostol vaginally or orally by women herself can be done.

This helps to prevent an additional visit of the woman to the hospital.

It enables the woman to complete the drug protocol for better effectiveness and reduce chances of drug failure. The tablets will cause contractions and expel the fetus.

This process may take a few hours or as long as a few days. The drugs used in a medical abortion will cause bleeding that is much heavier than a menstrual period. There may be severe cramping. Nausea, vomiting, fever, and chills may occur.

Your doctor also may prescribe stronger pain medication if needed. It can take several days or weeks for the abortion to be complete. A physical exam is given two weeks later to ensure the abortion was complete and to check for complications. Occasionally even medical abortions lead to the incomplete expulsion of the products of pregnancy and lead to incomplete abortion.

What is retained products of conception?

Retained products of conception are the tissues of pregnancy remaining within the uterine cavity, those which have not been expelled successfully. They are evidence of an incomplete abortion.

The doctor will look for any retained products of conception even following a medical abortion to confirm complete abortion.

What points to an incomplete abortion? What are the signs of incomplete abortion?

  • Prolonged or heavy bleeding following abortion, be it spontaneous or medically induced is suggestive of an incomplete abortion. Vaginal bleeding may be associated with the continued passage of bits of tissue or clots. Though minimal bleeding may persist for a few weeks following an abortion, you may need to alert your doctor in case the bleeding is profuse.
  • Abdominal cramps may be present during spontaneous and medical abortion, but if intermittent pain persists beyond a few days, the possibility of an incomplete abortion must be looked into. There may occur severe pain in the abdomen on touching in the presence of retained products of conception.
  • Fever may be present if the retained products of pregnancy have been within the uterus for a considerably longer duration. It may be the sign of impending infection or inflammation.

A woman who has had an abortion recently must seek immediate medical treatment if she has a foul-smelling vaginal discharge as it may be pointing towards infection caused due to retained products of conception as a consequence of incomplete abortion.

Now that you have learned as to how incomplete abortion occurs and the signs that point towards incomplete abortion, we will find out how your doctor will confirm whether your abortion has been completed.

How do you know if your abortion was successful?

Usually, after an abortion, your doctor may want to see you in the abortion clinic again within a week or 10 days of the abortion. It is important for you not to miss the appointment.

If you face any of the problems such as heavy or prolonged bleeding, persistent abdominal cramps or fever following an abortion you should seek medical help.

When you follow up with your doctor after a spontaneous or medically induced abortion, the doctor will look for any evidence of retained products of conception within your uterus.

How to look for retained products of conception?

Your doctor will look for evidence of any retained products of conception by performing a transvaginal ultrasonography on you.

If there are retained bits of tissue and have had an incomplete abortion, you may need further care.

If you are wondering whether the retained products need to be cleared off; yes it is very important important

What can be done if abortion is incomplete?

Mostly abortion which was incomplete at the time of detection may run its course and get completed in a few days time by emptying the uterus of the products of pregnancy. But some women may need further intervention to completely evacuate the uterus.

  • Initially, the strategy of watchful waiting is generally adopted. During this period the woman is closely monitored and followed up. Any negative signs are closely looked for.
  • Another dose of abortion pills may be tried after an interval. It may succeed in evacuating the uterus of some women with retained products of conception.
  • If medical methods fail to evacuate the uterus completely, the woman may have to undergo dilatation and curettage which is an invasive procedure.

What are the complications of an incomplete abortion?

The complications of an incomplete abortion are mainly related to the retained products of conception within the uterus left for a considerable duration.

  • Infection of the uterine cavity may occur due to long time retained products of conception. The tissues of pregnancy retained in the uterine cavity serve as a favorable medium for the growth and spread of micro-organisms which result in infection.If the retained tissues are promptly cleared, chances of infection are reduced and the normal defense mechanism of a healthy uterine lining is restored.
  • Sepsis-Infection of the uterus may progress and spread to the bloodstream leading to severe or life-threatening septicemia if not treated promptly.Even the slightest of signs of infection such as fever or severe abdominal pain on touch should be taken seriously and treated appropriately. Antibiotics should be initiated so as to curtail the spread of infection.
  • Anemia due to blood loss. The woman may become severely anemic due to prolonged and heavy vaginal bleeding owing to incomplete abortion. If blood loss is not curtailed by prompt intervention, the woman may require blood transfusions to improve her hemoglobin levels.If the woman is becoming anemic, dilatation and curettage will be the ideal step of management so as to evacuate retained products of conception and to effectively control bleeding.
  • Disseminated intravascular coagulation

The retained tissues of conception trigger inflammation and blood clotting mechanism. The blood clotting mechanism ensues and continues in an uncontrolled manner.

Small blood clots form within the blood vessels. Due to uncontrolled blood clotting, the factors required for clotting get depleted. Depletion of blood clotting factors leads to an increased tendency to bleed from the uterine blood vessels which were already open owing to the abortion process.

The gross imbalance between clotting and bleeding tendency may prove life-threatening.

Are there any home remedies for cleaning the uterus in case of an incomplete abortion?

Please beware of false and misleading information regarding home remedies for incomplete abortion.

Even in this era of advanced lifestyle, matters pertaining to abortion care remain to be a stigma and people hesitate to come out in open and seek professional advice regarding safe abortion practices and abortion care.

In a scenario of persistent heavy bleeding or abdominal pain beyond 10-14 days following an abortion, it is mandatory to seek medical help.

There are no proven methods to clear the uterus of the retained tissues of conception using home remedies or traditional methods.

Most importantly the diagnosis of an incomplete abortion cannot be confirmed unless you undergo an ultrasound examination at your doctor’s clinic. A diagnosis of an incomplete abortion cannot be presumed just in the presence of the above symptoms.

Resorting to unsafe methods at ones home may cost a woman her life. Without reliable ways to tell if the uterus has gotten completely evacuated and by application of crude and unsterile practices, home remedies may prove dangerous.

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!

References:

  1. Weeks A, Alia G, Blum J, Winikoff B, Ekwaru P, Durocher J, Mirembe F. A randomized trial of misoprostol compared with manual vacuum aspiration for incomplete abortion. Obstetrics & Gynecology. 2005 Sep 1;106(3):540-7.
  2. Curettage in incomplete abortion. Is it required?