The majority of women who have an abortion do not have complications. However, in very rare cases, problems can occur. Tissue can remain in the uterus from the uterine lining or parts of the pregnancy (from the fetus or placenta). In other words, you are no longer pregnant, but the abortion was incomplete because some of the products of conception have remained in your uterus.
So how do you know if your abortion is complete?
If you want to know if your abortion was successful or incomplete, you can perform three tests:
1. hCG blood test
An hCG (human chorionic gonadotropin) blood test detects this hormone in the blood, and it is only produced during pregnancy.
Why do clinicians order hCG blood tests after an abortion?
Some clinicians routinely check hCG levels early in pregnancy as part of normal prenatal care. Urine hCG tests, on the other hand, are most often used to confirm a pregnancy as they detect any amount of hormone in the urine.
There are two types of hCG tests:
- Qualitative: This measures the presence or absence of the hCG hormone in the blood.
- Quantitative: This measures the exact amount of hCG in the blood.
Clinicians usually request a quantitative hCG blood test when they need information about whether the hCG hormone is increasing or decreasing in the body.
This may be important if a person has vaginal bleeding or symptoms of miscarriage, has undergone an abortion, has a history of ectopic pregnancy, or has discomfort that could indicate an abnormal pregnancy.
How to know if the abortion is complete or not from blood test results
Since normal hCG levels vary widely from person to person, and isolated hCG levels (even low) don't provide much information, your clinician is the best person to tell you what your hCG levels mean.
It is also important to note that hCG levels can remain high for several weeks after an abortion.
About the hCG blood test:
No additional preparation or planning is required for an hCG blood test.
- You don’t need to be fasting before the blood test.
- The test can be completed any time of day (i.e. it does not have to be in the morning).
- The amount of water you drink before the blood test doesn't affect the results.
2. Ultrasound test
It is not necessary to have an ultrasound after a medical abortion; however, there can be situations in which someone may want to have one. An ultrasound can be useful to confirm that the abortion was successful and that the uterus is empty.
It is recommended to wait at least two weeks after the abortion to have an ultrasound, unless there are concerns that arise sooner. Concerns that may indicate an ultrasound is needed include persistent pregnancy symptoms, excessive bleeding, severe and prolonged pain, fever, and/or abnormal vaginal discharge.
Only around 2–3% of all first-trimester medical abortions are complicated by continuing pregnancy or retained products of conception (incomplete abortion). If an ultrasound shows some remaining parts of the pregnancy, surgical evacuation of the uterus (by aspiration) is not always recommended. Often, this will self-resolve in a healthy person with the next menstrual cycle, similar to when someone experiences a miscarriage. Surgical evacuation may be indicated in cases of continuing pregnancy or bothersome symptoms.
3. Urine test
Although the pregnancy hormone hCG decreases rapidly after an abortion, it can persist in the body for several weeks. You can take a urine pregnancy test at home four to five weeks after the abortion. If you do a urine pregnancy test at home before four weeks, the result may be a false positive since the pregnancy hormone is still present in your body.
What are the risks of having an incomplete abortion?
Incomplete abortions are more likely if the termination occurs later in the pregnancy. However, the risks remain tolerable.
The probability of an incomplete abortion after an abortion is approximately:
- 1.6% on the 77th day of pregnancy,
- 2.6% between the 78th and 83rd day, and
- 3.4% between the 83rd and 91st day.
Incomplete abortions are less likely to occur after a surgical termination of pregnancy because the clinician will have removed the contents of the uterus during the operation. However, rarely, if tissue is missing, an incomplete abortion may result.
Beware of signs of incomplete abortion
If you notice any of the following symptoms in the weeks after your abortion, you may have an incomplete abortion and should seek medical attention:
- Intense vaginal bleeding.
Bleeding may continue for several days, may stop and start, and last until your next period (usually within 4 to 6 weeks). However, the bleeding should slowly decrease over time.
- Intense, prolonged or worsening abdominal pain;
- persistent pregnancy symptoms like nausea, frequent urination or breast tenderness after 2 weeks.
- high fever developing more than 24 hours after using misoprostol;
An incomplete abortion can happen after a planned abortion or a miscarriage. The treatment is the same in both cases. It may get better on its own, or a health provider may recommend treatment with medication or a procedure called vacuum aspiration.
