What is an incomplete abortion?
An incomplete abortion occurs when your body does not completely get rid of the products of a pregnancy after you’ve had an induced abortion (also known as a medical abortion) or have a miscarriage. (1, 2).
Signs of an incomplete abortion
If you think you may have had an incomplete abortion, it is important to look out for these physical signs typically associated with an incomplete abortion:
- lower abdominal or pelvic pain;
- moderate to severe vaginal bleeding; and
- pain radiating to the lower back, genitalia, or buttocks (1, 2).
What should I do if I think my abortion was incomplete?
If you think your abortion was incomplete, it is best to consult a health-care provider who can properly diagnose your condition. If an incomplete abortion is confirmed, there are several treatment options, including both surgical and medical management.
How do you diagnose an incomplete abortion?
Health-care providers can identify an incomplete abortion via a blood test or ultrasound. The blood test measures human chorionic gonadotropin (hCG), which is a hormone associated with pregnancy. If you have had an incomplete abortion, this level will be low. An ultrasound will look for products of conception that are still present in the uterus (1).
How do I treat an incomplete abortion?
The method used to treat an incomplete abortion will depend on your clinical condition and personal preferences. There are 3 main methods for treating an incomplete abortion:
- Expectant management. Health professionals may recommend waiting and seeing if the body naturally passes the remaining tissue on its own, without medical or surgical treatment. It’s a common and safe approach, especially in early pregnancy, where the body often completes the process without complications.
- Medical management. Medical management involves taking misoprostol, an abortion drug. Misoprostol works by binding to the muscles and causing contractions in the uterus, therefore, helping the uterus to expel its contents (4).
- Surgical management. This is often also referred to as vacuum aspiration, and it is done in the clinic. With vacuum aspiration, your health-care provider will use a vacuum to gently suck the contents out of your uterus. There are two types of surgical management: manual vacuum aspiration and electric vacuum aspiration. These methods are similar as both apply suction to remove tissue from the uterus (3).
The World Health Organization (WHO) recommends several treatment options for incomplete abortions, but these options vary depending on the gestational age.
Pregnancies less than 14 weeks
For pregnancies less than 14 weeks, the following treatment options are possible:
- vacuum aspiration; and
- medical management using misoprostol.
There are two ways of using misoprostol for incomplete abortion management: oral and sublingual. An oral medication is one that you take by mouth and swallow directly. A sublingual medication is one that you place under the tongue and hold the medication for a period of time or until it dissolves. The dosing for each route of administration is different. The WHO recommends taking either 600μg of oral misoprostol OR 400μg of misoprostol sublingually (2).
Pregnancies greater than or equal to 14 weeks
For pregnancies that are greater than or equal to 14 weeks, the WHO recommends medical management using misoprostol. Individuals can repeat a 400μg dose of misoprostol every three hours. It is available sublingually (under the tongue), vaginally (via the vagina), or buccally (between the cheek and gum) (2).
What can I expect after treatment for an incomplete abortion?
If you’ve undergone treatment for an incomplete abortion, you can expect irregular bleeding or spotting for up to two weeks after the procedure. You can use pads to both manage and monitor the bleeding. With misoprostol use, you can expect heavy bleeding for up to four days.
Additionally, you may experience cramping as early as 30 minutes after taking misoprostol. Cramping from misoprostol or vacuum aspiration can last for a few weeks. The cramps may be like those that you would experience during a normal period, or they may be stronger. This happens because your uterus is shrinking back to its original size before the pregnancy (3,5).
Misoprostol can cause additional side effects, including fever and chills. However, the fever should not last longer than 24 hours. Additionally, it can cause gastrointestinal side effects, such as nausea, vomiting, and diarrhea. Nausea and vomiting will typically resolve within two to six hours. Diarrhea should resolve within a day. Finally, misoprostol can also cause a skin rash, although it shouldn’t last more than a few hours (5).
The best way to recover from treatment is to rest as much as possible. However, you can resume your day-to-day activities as normal the following day if you feel okay. Additionally, you can manage your pain with over-the-counter medicine such as ibuprofen (Advil) or acetaminophen (Tylenol). Always follow the administration directions on the label (3).
