Incomplete Abortion 

Definition

Incomplete abortion occurs when some products of conception remain in the uterine cavity after a miscarriage. It is characterized by persistent bleeding, lower abdominal pain, and an open cervix, indicating that the pregnancy has not been fully expelled.

Etiology / Risk Factors

• Spontaneous miscarriage due to chromosomal abnormalities

• Infections (e.g., chorioamnionitis)

• Trauma or uterine anomalies

• Poorly managed threatened or inevitable abortion

• Previous uterine surgery (e.g., cesarean, curettage)

Signs and Symptoms

1. Lower abdominal pain

   • Cramping, persistent

2. Vaginal bleeding

   • Slight to profuse, may include clots or products of conception

3. Fundal height

   • Smaller than expected for gestational age

4. Cervical examination

   • Dilated cervix

   • Products of conception may be palpable within the cervix

Investigations

1. Full Blood Count (FBC)

   • Assess for anaemia due to ongoing bleeding

2. Blood group and cross-match

   • Prepare for possible transfusion

Optional: Ultrasound to confirm retained products and rule out complications

Management

Supportive Care

• Apply ABCD principles: Airway, Breathing, Circulation, Dehydration

• IV fluids: Ringers Lactate (RL) or Normal Saline (NS) 2 liters

• Blood transfusion if significant anemia or ongoing hemorrhage

Surgical / Procedural Management

• Manual Vacuum Aspiration (MVA):

  • Preferred if gestation <12 weeks

• Manual evacuation / curettage:

  • Required if gestation >12 weeks or retained placenta

Pharmacological Treatment

• Uterotonics to aid expulsion:

  • Oxytocin 10 IU IM OR

  • Misoprostol 600 µg PO

• Post-evacuation antibiotics:

  • Amoxicillin 500 mg PO every 8 hours for 5 days

  • Metronidazole 400 mg PO every 8 hours for 5 days

• Analgesia:

  • Paracetamol 1 g PO every 8 hours for 5 days

Referral Criteria

• Persistent bleeding after initial evacuation

• Unavailability of MVA or surgical services

• Hemodynamic instability or signs of infection

• Escort patient to hospital level care with a nurse if referral required

Patient Education and Counselling

• Contraception: Discuss and provide post-abortion contraception options

• Signs of complications: Teach patients to report heavy bleeding, fever, foul-smelling discharge, or severe abdominal pain

• Emotional support: Acknowledge grief and provide counseling resources

Summary / Key Points

1. Incomplete abortion = retained products of conception + persistent bleeding + open cervix

2. Cramping pain and PV bleeding are hallmark symptoms

3. MVA or manual evacuation is the mainstay treatment depending on gestational age

4. Supportive care: IV fluids, blood transfusion if needed, analgesia, and uterotonics

5. Post-procedure care: Antibiotics, analgesia, contraception counseling

6. Referral for persistent bleeding or unavailable services