Partial pregnancy loss occurs within the first 20 weeks of gestation. It is also called as incomplete miscarriage or incomplete abortion.  

Miscarriage causes heavy vaginal bleeding, tissue passage, lower abdominal, pelvic pain in the form of moderate to severe symptoms. 

Diagnosis through visualizing pregnancy tissue in cervical or during examination. Ultrasound shows abnormal tissue in endometrial canal in patient with signs of miscarriage. 

Insufficient fetal development at certain stages indicates incomplete pregnancy loss diagnosis. 

Miscarriage before 10 to 13 weeks of pregnancy known as early pregnancy loss. Incomplete abortion is miscarriage subtype where products of conception are not fully expelled from uterus. 

Physicians use inevitable miscarriage term for an open cervical with symptoms of bleeding and cramping. 

The incidence of incomplete miscarriage/abortion has not been well documented and studied. 

Spontaneous pregnancy loss incidence ranges from 10% to 15% in recognized pregnancies. 

Surgical and medical second-trimester abortion incomplete rates are 1% to 8%. 

34% of anembryonic gestations and 26% of pregnancies with embryonic demise had incomplete POC expulsion after 1 month. 

Pregnancy complications such as genetic abnormalities, infections, hormone imbalances, or maternal health issues can lead to abortion due to fetal death. 

Partial placental detachment causes maternal blood vessel exposure, that leads to vaginal bleeding from conception products. 

Retained tissue causes inflammation to release cytokines and mediators, that occurs uterine contractions and attempts to expel it. 

Decrease in pregnancy hormones can affect uterine contractions and completion of abortion process. 

Unknown cause of incomplete POC expulsion after miscarriage or induced abortion observed. 

Spontaneous miscarriage occurs from various causes, with 50% due to embryonic chromosomal abnormalities in early pregnancy. 

Induced abortion can lead to incomplete passage of products of conception. WHO defines unsafe abortion as a procedure done without proper skills or in substandard medical conditions. 

Some risk factors are:  

Maternal age 

Maternal comorbidities 

Structural uterine abnormalities 

Teratogen exposure  

Expectant management for incomplete pregnancy loss gives 90% complete expulsion of POC within 4 weeks. 

Surgery, expectant, medical management have excellent prognosis as definitive treatment. 

Conception is considered safe after immediate miscarriage. 

Live birth rates are higher for conceptions within 3 months post-pregnancy loss compared to those who postpone. 

Incomplete pregnancy loss presents with the passage of clots or tissue, but patients may not always be aware of it. 

Heavy bleeding in incomplete miscarriage lasts longer and is heavier than usual periods defined as soaking 1 to 2 pads/hour for 2 hours. 

Clinicians should ask about symptoms including cramps, pelvic pain, and vaginal bleeding, pad usage, and clot size. 

Pelvic examination  

Abdomen examination 

• Symptoms as: 
• Vaginal Bleeding  
• Signs of Infection 
• Hemodynamic Instability 
• Abdominal Pain 

Expectant management involves close monitoring of stable patients without contraindications to allow natural miscarriage progression if infection signs are absent. 

Up to 53% of patients with first-trimester incomplete miscarriage see complete POC expulsion within one week without further treatment. 

WHO recommends vaginal misoprostol 800 mcg once initially, with second dose after 3 to 7 days. 

Research shows 96.2% of women with incomplete abortion had complete abortion within 14 to 28 days with misoprostol. 

Patients must seek medical help if they soak 2 pads per hour for ≤2 hours or shows dizziness, lightheadedness, and fever. 

Rh(D)-immune globulin is recommended for Rh-negative patients to prevent alloimmunization after surgery but controversial for early pregnancy loss. 

A follow-up appointment with a gynecologist for ultrasound or β-hCG tests is needed to confirm complete expulsion of gestational sac. 

OB/GYN and Women\'s Health

The cleaning protocols should be strictly followed to prevent infections during surgery and to sterilize instruments/equipment. 

Maintain private, comfortable, and equipped space for patient examinations and treatments with respect for confidentiality. 

Take guidance from mental health professionals for emotional support and counseling. 

Healthcare providers should communicate clearly and compassionately with patients before/during process. 

Respect cultural beliefs and practices on pregnancy loss. Patient consent required for procedures. 

Proper education and awareness about abortion should be provided and its related causes with management strategies. 

OB/GYN and Women\'s Health

Misoprostol: 

It is a prostaglandin E1 analog that induces uterine contractions and helps to expel retained products. 

OB/GYN and Women\'s Health

Ibuprofen: 

It is used to manage pain and discomfort associated with uterine cramps and the expulsion process. 

OB/GYN and Women\'s Health

Surgery recommended for incomplete pregnancy loss in unstable patients, high hemorrhage risk, or failed expectant management. 

Surgery is the most effective treatment, and this can be done through uterine aspiration or suction curettage in a clinic. 

OB/GYN and Women\'s Health

In the initial assessment phase, evaluation of medical history, physical examination, and laboratory test should be conducted. 

Pharmacologic therapy is very effective in the treatment phase as it includes use of uterotonic agents and surgical intervention. 

In management and care phase, provide emotional support to help the patient deal with the experience of pregnancy loss. 

The regular follow-up visits with the gynecologist are scheduled to check the improvement of patients along with treatment response.