One of the most important phases in the life of a woman is pregnancy. Raising a healthy child is a dream of every couple but the choice of giving birth solely depends upon the woman. If she doesn’t feel confident about bringing the baby into this world, she can get an abortion done and terminate her pregnancy. However, pregnancy can only be terminated if it is at an early stage i.e. in its first trimester. A first trimester pregnancy begins on the last day of your menstrual period and lasts until the end of 12th week. There are two procedures to conduct an abortion: medicated and surgical. Medicated abortion can be done only in the first trimester whereas a surgical one can be carried out in the second trimester as well. In some cases, a spontaneous abortion known as miscarriage can occur within 20 weeks of pregnancy. Apart from spontaneous abortion, there are four different types of miscarriage or abortion:
In this article, we’ll discuss about Incomplete Abortion in detail and tell you how you can get it treated.
What is an Incomplete Abortion and How Does it Occur?
An incomplete abortion is a type of abortion in which there is expulsion of parts of the products of conception. It occurs when the pregnancy is less than 20 weeks. It results in heavy bleeding, often with blood clots, and requires treatment if the patient reports excessive menstrual cramping and pain. The cases of incomplete abortion have been seen in women who performed a medicated abortion when the pregnancy had advanced. Women usually make use of the profound abortion kit, MTP Kit which contains the two vital medicines Mifepristone 200mg and Misoprostol 200mcg which are required for abortion. However, MTP Kit is successful in cases where the pregnancy is in its first trimester and the woman is no more than 9-10 weeks pregnant. As the pregnancy advances, the efficacy of these medicines decrease. Thus, if a woman who’s 15-16 weeks pregnant makes use of the MTP Kit, chances are that the abortion won’t be successful and will end up in an incomplete abortion.
Several other causes of incomplete abortion are:
- A problem with the placenta.
- Presence of damaged sperm and egg cells.
- Any kind of chromosomal disorders or genetic abnormalities in the fetus.
- Some external factors can also lead to an incomplete abortion. These include the person being too fat or malnourished, having collisions or falls, suffering from diabetes, poor lifestyle which includes smoking and drug addiction, pregnancy at the age of more than 35 years, and high blood pressure. These often cause the fetus to fall at the age of second trimester.
Let’s discuss the the problems that a woman might face during an incomplete abortion.
What happens during an Incomplete Abortion?
As mentioned earlier, during an incomplete abortion, there are some products of conception that get expelled out of the body while some remain inside.
Following are the clinical features that indicate what exactly happens during incomplete abortion:
- Severe vaginal bleeding, often with blood clots.
- A variable period of amenorrhea (less than 12 weeks). Amenorrhea is the abnormal absence of your menstruation cycle.
- Accompanied by severe cramping and lower abdominal pain.
- A history of passage of products of conception (POC).
- Severe pallor during examination of the patient which can ultimately lead to a person going in hemorrhagic shock.
- The cervix is dilated (opened up) and products of conception are found within the cervical canal on per speculum examination. Products of conception and blood clots can be found lying in the vaginal cavity.
- Uterus is soft and bulky but less than the period of amenorrhea.
A majority of women after experiencing severe cramping and menstrual bleeding get themselves treated. However, the doctor needs to examine properly before he/she can arrive to a conclusion.
How is the Problem Diagnosed and Treated?
After you reach out to the doctor with extreme pain and bleeding, he/she will provide you a waiting period of several days with a doctor’s monitoring until all the pregnancy tissue is shed and comes out naturally. Several medications may be given by the doctor to stimulate the uterus. This helps in pushing the remnants of the pregnancy tissue out. This procedure is only helpful if there aren’t any complications involved. During this process, side-effects such as nausea, vomiting, fatigue, headache, and diarrhea can occur.
The sure shot way of treating incomplete abortion is the action of curettage. The Dilation & Curettage (D&C) procedure helps in the removal of the rest of the pregnancy tissues. This is usually done by the doctor if your condition becomes severe and he/she needs to act upon it immediately.
If you are getting a treatment for yourself, chances are that your health insurance company will ask for an ICD-10-CM code for your incomplete spontaneous abortion. And so, O03.4 is the ICD-10-CM Code that is reported for an uncomplicated incomplete abortion. It is generally used by doctors and health insurance companies to indicate a diagnosis for reimbursement purposes.
Let’s now discuss the treatment procedure in detail.
What is the Dilation & Curettage (D&C) Procedure?
Before we get straight to the D&C procedure, let’s shed some light on the woman’s reproductive system. The uterus which is a part of the reproductive system contains the growing fetus. The cervix forms the neck of the uterus. The vagina is the canal through which conception and birth take place. A soft lining known as endometrium protects the fetus during pregnancy.
The D&C procedure is carried out when the patient reports excessive menstrual bleeding. Other problems that can occur are uterine infection, bleeding after intercourse, incomplete miscarriage or presence of polyps. Polyps are small pieces of extra tissue growing on the inside of the uterine wall.
This is how the D&C procedure is performed:
- A sedative is given to you which is intended to be taken orally. An Intravenous (IV) line is put in.
- You are then transferred to an operating table where your feet are raised and separated and placed in canvas slings. This gives the doctor unobstructed access to the uterus.
- The area is cleaned and draped with towels exposing only the vulva.
- The doctor/surgeon then inserts a gloved hand inside your vagina and presses the lower abdomen to check the size and location of the uterus.
- A metallic or plastic speculum is used to expand the vagina. This allows access to the cervix.
- A forcep is then used to grab the front lip of the cervix. This causes the uterus to open a little.
- The length of the uterus is measured carefully and a sample of the tissue is taken from the cervical canal.
- The cervix is dilated (or opened) with the help of a few large metal rods known as dilators. As the cervix dilates and expands sufficiently, a spoon shaped instrument called curette is used to scrape up the lining of the uterus. In some cases, a vacuum curette is used to suck the tissues out of the uterus.
- Finally, when the complete uterine lining is removed, all the instruments are withdrawn. The tissues are then sent for analysis.
You are then transferred to the recovery room wherein the doctor monitors you to check for complications and heavy bleeding that may occur. You may feel drowsy for several hours due to the sedatives that had been given to you. You may experience mild cramping and light bleeding for a few days. Your doctor may prescribe you Ibuprofen to relieve you from cramping. Your cervix takes time to get back to normal, and so, you should avoid putting anything in your vagina. If you plan to have sexual intercourse with your partner, consult your doctor first.
If you live in an area where you can be prosecuted for getting an abortion done, you should tell your doctor that you had a miscarriage. The cause of an incomplete abortion cannot be traced back.
How Soon Can You Get Pregnant Again?
After the treatment of incomplete abortion is done, you can plan your pregnancy immediately. You can still give birth to a healthy baby. However, doctors recommend waiting for the next period to occur. The uterus needs to build a new lining after the D&C procedure, and so, your period may not come on time. You can plan your next pregnancy after you go through at least one menstrual cycle. Follow up with your doctor and discuss your condition in detail.