Incomplete Miscarriage: Symptoms and Treatment Options

Q: Incomplete Miscarriage: Symptoms and Treatment Options

1. <br>Failure or incomplete miscarriage rates： According to gestational weeks, the success rate of RU486 is between 80% to 90%, with a higher failure rate as the fetus grows larger. <br>Subsequent administration of uterotonics may help expel remaining tissue, but there is still

Incomplete abortion after medical abortion?

Hello, I would like to inquire about my situation.
I received my first dose on April 13 and experienced mild abdominal pain.
On April 15, before my follow-up appointment, I passed a large blood clot.
After taking the second dose during my follow-up, I began to experience severe abdominal pain and passed the remaining tissue, while continuing to take contraction medication.
On April 18, during another follow-up ultrasound, I was still experiencing bleeding and was advised to continue taking medication for another week.
On April 25, another ultrasound indicated that it was still not completely cleared, and there was suspicion that the placenta had not detached yet.
I was instructed to continue taking contraction medication until May 6, and if it was still not cleared, I would need surgery.
Is this normal? I found information suggesting that the process should take 1 to 2 weeks.
Will continuous contractions and bleeding cause harm to my body? Would it be better for me to proceed directly to surgery? Thank you for your response.

Eva, 30~39 year old female. Ask Date: 2024/04/26

Dr. Liu Fuping reply Obstetrics and Gynecology

1.
Failure or incomplete miscarriage rates: According to gestational weeks, the success rate of RU486 is between 80% to 90%, with a higher failure rate as the fetus grows larger.
Subsequent administration of uterotonics may help expel remaining tissue, but there is still a chance of failure, which may ultimately require surgical intervention.
The success rate of surgery is high, and it does not require a waiting period; however, there are risks associated with anesthesia and potential surgical complications.
There is no one-size-fits-all treatment; it is essential for you to discuss with your healthcare provider the treatment option that you currently prefer.
For instance, if you want to minimize the waiting time and discomfort, you may need to accept some surgical risks.
2.
Large studies indicate that less than 1% of women will require blood transfusions or emergency surgery due to excessive bleeding.
Therefore, it is important to remind women to monitor their bleeding after taking RU486.
If they experience heavy bleeding, rapid heartbeat, dizziness, or altered consciousness, they should seek medical attention promptly.
Mild bleeding may only result in some minor symptoms of anemia.
Thank you.

Reply Date: 2024/04/26

More Info

Incomplete miscarriage, also known as a missed miscarriage or retained products of conception, occurs when a pregnancy ends but some tissue remains in the uterus. This can lead to ongoing symptoms such as bleeding and cramping. Your experience, as described, suggests that you are undergoing a medically managed miscarriage, which can sometimes take longer than expected.

Symptoms of Incomplete Miscarriage
The symptoms you are experiencing, including abdominal pain and heavy bleeding with the passage of blood clots, are common in cases of incomplete miscarriage. Other symptoms may include:
- Persistent pelvic pain
- Fever or chills (indicating possible infection)
- Foul-smelling vaginal discharge
- Continued heavy bleeding beyond what is typical for a menstrual period

Treatment Options
The treatment for an incomplete miscarriage can vary based on several factors, including how much tissue remains in the uterus, the duration of the pregnancy, and your overall health. Here are the common treatment options:
1. Expectant Management: This involves waiting for the body to expel the remaining tissue naturally. This can take days to weeks, and while it is a non-invasive option, it may not always be effective.

2. Medical Management: This involves taking medications, such as misoprostol, to help the uterus contract and expel the remaining tissue. It seems you have already been prescribed this medication. It is not uncommon for this process to take longer than expected, especially if there is a significant amount of tissue remaining.

3. Surgical Management: If medical management does not result in complete expulsion of the tissue, or if you are experiencing severe symptoms, a surgical procedure such as dilation and curettage (D&C) may be recommended. This procedure involves scraping the uterine lining to remove any remaining tissue.

Is It Normal for This Process to Take Longer?
It is not unusual for some women to experience prolonged bleeding and cramping during an incomplete miscarriage. While many women may complete the process within 1-2 weeks, others may take longer. Factors that can influence the duration include:
- The amount of tissue remaining
- Individual variations in how the body responds to medication
- Hormonal factors

Risks of Prolonged Bleeding and Cramping
Prolonged bleeding and cramping can lead to complications such as:
- Infection: If tissue remains in the uterus, it can become infected, leading to fever, chills, and foul-smelling discharge.

- Severe Blood Loss: Continuous heavy bleeding can lead to anemia or require a blood transfusion.

- Emotional Distress: The physical symptoms can also contribute to emotional distress, which is common after a miscarriage.

Should You Consider Surgery?
If you continue to experience heavy bleeding and pain, or if your ultrasound shows that tissue remains, it may be prudent to discuss surgical options with your healthcare provider. Surgery can provide a definitive resolution to the incomplete miscarriage and may alleviate the physical and emotional burden you are experiencing.

Conclusion
It is essential to maintain open communication with your healthcare provider throughout this process. If you have concerns about the duration of your symptoms or the effectiveness of your current treatment, do not hesitate to reach out for further evaluation. Your health and well-being are paramount, and your provider can help guide you through the best course of action based on your specific situation.

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