Management of Incomplete Abortion
Medical management with misoprostol 800 μg vaginally as a single dose is the recommended first-line treatment for incomplete abortion, with approximately 90% effectiveness in achieving complete evacuation without surgical intervention. 1
Definition and Diagnosis
- Incomplete abortion is defined as the partial expulsion of products of conception with retained tissue in the uterus
- Diagnostic findings include:
- Heterogeneous material within the endometrial cavity, often with internal vascularity on ultrasound
- History of vaginal bleeding and cramping
- Partially dilated cervix on examination
- Passage of some tissue
Treatment Options
1. Medical Management (First-Line)
- Medication: Misoprostol 800 μg vaginally as a single dose 1
- Success rate: Approximately 90% 1, 2
- Advantages:
- Avoids surgical risks
- Can be administered in outpatient setting
- Less invasive
- High patient satisfaction 2
- Disadvantages:
2. Surgical Management
- Procedure: Vacuum aspiration preferred over sharp curettage 1, 4
- Indications:
- Heavy bleeding
- Signs of infection
- Patient preference
- Failed medical management 1
- Success rate: 93-100% 4, 3
- Advantages:
- Disadvantages:
- Risks of anesthesia
- Potential for uterine perforation
- Risk of intrauterine adhesions
- More painful than vacuum aspiration 4
3. Expectant Management
- Success rate: Lower than medical or surgical management
- Disadvantages:
- Unpredictable time until spontaneous evacuation
- Higher risk of incomplete evacuation requiring subsequent intervention
- Higher risk of infection and hemorrhage 1
- Not recommended as first-line approach due to these limitations
Follow-up and Monitoring
- Schedule follow-up visit in 7-14 days
- Perform transvaginal ultrasound to confirm complete evacuation
- Evaluate for complications:
- Infection (fever, malodorous discharge, uterine tenderness)
- Hemorrhage
- Retained products of conception
Special Considerations
Rh Status Management
- Administer anti-D immunoglobulin (50 μg) to all Rh-negative women with incomplete abortion 5, 1
- This is a well-established practice to prevent Rh sensitization
Antibiotic Prophylaxis
- Not routinely recommended for uncomplicated incomplete abortion
- Reserve for cases with signs of infection or high risk for infection
Comparative Effectiveness
The Cochrane review of medical treatments for incomplete miscarriage found that misoprostol had a slightly lower complete evacuation rate compared to surgical management (96% vs. 98%), but both methods had high success rates 2. However, misoprostol resulted in fewer surgical evacuations overall but more unplanned procedures 2.
Patient Satisfaction
Studies show high satisfaction rates with both medical and surgical management 2, 3. Interestingly, more women who received medical treatment would recommend it or choose it in the future despite experiencing more side effects 3.
Conclusion
For incomplete abortion, medical management with misoprostol 800 μg vaginally is the recommended first-line treatment due to its high effectiveness, safety profile, and non-invasive nature. Surgical management should be reserved for specific indications or when medical management fails.