Incomplete Abortion

An incomplete abortion involves vaginal bleeding, cramping (contractions), cervical dilatation, and incomplete passage
of the products of conception. A woman experiencing incomplete abortion frequently describes passage of clots or
pieces of tissue, and reports vaginal bleeding. The cramping may be rhythmic or labor-like, although less intense than
a full-term labor. At this point, the baby has already died and has either been passed or is part of the retained tissue.
Treatment focuses on helping the woman to complete the miscarriage process by expelling any retained tissue, and
emotional and physical healing.

Pathophysiology

A spontaneous abortion is a process that can be divided into 4 stages—threatened, inevitable, incomplete, and
complete. The 4 stages of abortion form a continuum. Most studies do not differentiate separately between the
epidemiology and pathophysiology of each entity.

The combination of oxidative stress, a more hypoxic environment, and defective placentation may lead to increased
serum ischemia-modified albumin (IMA) concentrations, which in turn, may play a role in the pathophysiology of early
pregnancy loss.

Miscarriage is the spontaneous loss of a pregnancy before the 20th week. About 10 to 20 percent of known
pregnancies end in miscarriage. But the actual number is likely higher because many miscarriages occur so early in
pregnancy that a woman doesn't realize she's pregnant.

Miscarriage is a somewhat loaded term — possibly suggesting that something was amiss in the carrying of the
pregnancy. This is rarely true. Most miscarriages occur because the fetus isn't developing normally.

Miscarriage is a relatively common experience — but that doesn't make it any easier. Take a step toward emotional
healing by understanding what can cause a miscarriage, what increases the risk and what medical care might be
needed.

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Book: Mayo Clinic Guide to a Healthy Pregnancy

Symptoms

Most miscarriages occur before the 12th week of pregnancy.

Signs and symptoms of a miscarriage might include:

Vaginal spotting or bleeding

Pain or cramping in your abdomen or lower back

Fluid or tissue passing from your vagina

If you have passed fetal tissue from your vagina, place it in a clean container and bring it to your health care provider's
office or the hospital for analysis.
Keep in mind that most women who experience vaginal spotting or bleeding in the first trimester go on to have
successful pregnancies.

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Causes

Abnormal genes or chromosomes

Most miscarriages occur because the fetus isn't developing normally. About 50 percent of miscarriages are associated
with extra or missing chromosomes. Most often, chromosome problems result from errors that occur by chance as the
embryo divides and grows — not problems inherited from the parents.

Chromosomal abnormalities might lead to:

Blighted ovum. Blighted ovum occurs when no embryo forms.

Intrauterine fetal demise. In this situation, an embryo forms but stops developing and dies before any symptoms of
pregnancy loss occur.

Molar pregnancy and partial molar pregnancy. With a molar pregnancy, both sets of chromosomes come from the
father. A molar pregnancy is associated with abnormal growth of the placenta; there is usually no fetal development.

A partial molar pregnancy occurs when the mother's chromosomes remain, but the father provides two sets of
chromosomes. A partial molar pregnancy is usually associated with abnormalities of the placenta, and an abnormal
fetus.

Molar and partial molar pregnancies are not viable pregnancies. Molar and partial molar pregnancies can sometimes
be associated with cancerous changes of the placenta.

Maternal health conditions

In a few cases, a mother's health condition might lead to miscarriage. Examples include:

Uncontrolled diabetes

Infections

Hormonal problems

Uterus or cervix problems

Thyroid disease

What does NOT cause miscarriage

Routine activities such as these don't provoke a miscarriage:

Exercise, including high-intensity activities such as jogging and cycling.

Sexual intercourse.

Working, provided you're not exposed to harmful chemicals or radiation. Talk with your doctor if you are concerned
about work-related risks.

More Information

Blighted ovum: What causes it?

Risk factors

Various factors increase the risk of miscarriage, including:

Age. Women older than age 35 have a higher risk of miscarriage than do younger women. At age 35, you have about a
20 percent risk. At age 40, the risk is about 40 percent. And at age 45, it's about 80 percent.

Previous miscarriages. Women who have had two or more consecutive miscarriages are at higher risk of miscarriage.

Chronic conditions. Women who have a chronic condition, such as uncontrolled diabetes, have a higher risk of
miscarriage.

Uterine or cervical problems. Certain uterine abnormalities or weak cervical tissues (incompetent cervix) might
increase the risk of miscarriage.

Smoking, alcohol and illicit drugs. Women who smoke during pregnancy have a greater risk of miscarriage than do
nonsmokers. Heavy alcohol use and illicit drug use also increase the risk of miscarriage.

Weight. Being underweight or being overweight has been linked with an increased risk of miscarriage.

Invasive prenatal tests. Some invasive prenatal genetic tests, such as chorionic villus sampling and amniocentesis,
carry a slight risk of miscarriage.

Complications

Some women who miscarry develop a uterine infection, also called a septic miscarriage. Signs and symptoms of this
infection include:

Fever

Chills

Lower abdominal tenderness

Foul-smelling vaginal discharge

Prevention

Often, there's nothing you can do to prevent a miscarriage. Simply focus on taking good care of yourself and your
baby:
Seek regular prenatal care.

Avoid known miscarriage risk factors — such as smoking, drinking alcohol and illicit drug use.

Take a daily multivitamin.

Limit your caffeine intake. A recent study found that drinking more than two caffeinated beverages a day appeared to
be associated with a higher risk of miscarriage.

If you have a chronic condition, work with your health care team to keep it under control.

Diagnosis

Your health care provider might do a variety of tests:

Pelvic exam. Your health care provider might check to see if your cervix has begun to dilate.

Ultrasound. During an ultrasound, your health care provider will check for a fetal heartbeat and determine if the
embryo is developing normally. If a diagnosis can't be made, you might need to have another ultrasound in about a
week.

Blood tests. Your health care provider might check the level of the pregnancy hormone, human chorionic
gonadotropin (HCG), in your blood and compare it to previous measurements. If the pattern of changes in your HCG
level is abnormal, it could indicate a problem. Your health care provider might check to see if you're anemic — which
could happen if you've experienced significant bleeding — and may also check your blood type.

Tissue tests. If you have passed tissue, it can be sent to a lab to confirm that a miscarriage has occurred — and that
your symptoms aren't related to another cause.

Chromosomal tests. If you've had two or more previous miscarriages, your health care provider may order blood tests
for both you and your partner to determine if your chromosomes are a factor.

Possible diagnoses include:

Threatened miscarriage. If you're bleeding but your cervix hasn't begun to dilate, there is a threat of miscarriage. Such
pregnancies often proceed without any further problems.

Inevitable miscarriage. If you're bleeding, cramping and your cervix is dilated, a miscarriage is considered inevitable.

Incomplete miscarriage. If you pass fetal or placental material but some remains in your uterus, it's considered an
incomplete miscarriage.

Missed miscarriage. In a missed miscarriage, the placental and embryonic tissues remain in the uterus, but the embryo
has died or was never formed.

Complete miscarriage. If you have passed all the pregnancy tissues, it's considered a complete miscarriage. This is
common for miscarriages occurring before 12 weeks.

Septic miscarriage. If you develop an infection in your uterus, it's known as a septic miscarriage. This can be a severe
infection and demands immediate care.
Antiphospholipid (AN-te-fos-fo-LIP-id) syndrome occurs when your immune system mistakenly creates antibodies that
make your blood much more likely to clot.

This can cause dangerous blood clots in the legs, kidneys, lungs and brain. In pregnant women, antiphospholipid
syndrome also can result in miscarriage and stillbirth.

There's no cure for antiphospholipid syndrome, but medications can reduce your risk of blood clots.

Symptoms

Signs and symptoms of antiphospholipid syndrome can include:

Blood clots in your legs (DVT). Signs of a DVT include pain, swelling and redness. These clots can travel to your lungs
(pulmonary embolism).

Repeated miscarriages or stillbirths. Other complications of pregnancy include dangerously high blood pressure
(preeclampsia) and premature delivery.

Stroke. A stroke can occur in a young person who has antiphospholipid syndrome but no known risk factors for
cardiovascular diseases.

Transient ischemic attack (TIA). Similar to a stroke, a TIA usually lasts only a few minutes and causes no permanent
damage.

Rash. Some people develop a red rash with a lacy, net-like pattern.

Less common signs and symptoms include:

Neurological symptoms. Chronic headaches, including migraines; dementia and seizures are possible when a blood
clot blocks blood flow to parts of your brain.

Cardiovascular disease. Antiphospholipid syndrome can damage heart valves.

Bleeding. Some people have a decrease in blood cells needed for clotting. This can cause episodes of bleeding,
particularly from your nose and gums. You can also bleed into your skin, which will appear as patches of small red
spots.

When to see a doctor

Contact your doctor if you have unexplained bleeding from your nose or gums; an unusually heavy menstrual period;
vomit that is bright red or looks like coffee grounds; black, tarry stool or bright red stool; or unexplained abdominal
pain.

Seek emergency care if you have signs and symptoms of:

Stroke. A clot in your brain can cause sudden numbness, weakness or paralysis of your face, arm or leg. You may have
difficulty speaking or understanding speech, visual disturbances and a severe headache.

Pulmonary embolism. If a clot lodges in your lung, you may experience sudden shortness of breath, chest pain and
coughing up blood-streaked mucus.

Deep vein thrombosis (DVT). Signs and symptoms of DVTs include swelling, redness or pain in a leg or arm.

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Causes

Antiphospholipid syndrome occurs when your immune system mistakenly produces antibodies that make your blood
much more likely to clot. Antibodies normally protect the body against invaders, such as viruses and bacteria.

Antiphospholipid syndrome can be caused by an underlying condition, such as an autoimmune disorder, infection or
certain medications. You also can develop the syndrome without an underlying cause.

Risk factors

Risk factors for antiphospholipid syndrome include:

Your sex. This condition is much more common in women than in men.

Immune system disorders. Having another autoimmune condition, such as lupus or Sjogren's syndrome, increases
your risk of antiphospholipid syndrome.

Infections. This condition is more common in people who have certain infections, such as syphilis, HIV/AIDS, hepatitis
C or Lyme disease.

Medications. Certain medications have been linked to antiphospholipid syndrome. They include hydralazine for high
blood pressure, the heart rhythm-regulating medication quinidine, the anti-seizure medication phenytoin (Dilantin)
and the antibiotic amoxicillin.

Family history. This condition sometimes runs in families.

It's possible to have the antibodies associated with antiphospholipid syndrome without developing signs or symptoms.
However, having these antibodies increases your risk of developing blood clots, particularly if you:

Become pregnant

Are immobile for a time, such as being on bed rest or sitting during a long flight

Have surgery

Smoke cigarettes

Take oral contraceptives or estrogen therapy for menopause

Have high cholesterol and triglycerides levels

Complications

Depending on which organ is affected by a blood clot and how severe the obstruction of blood flow to that organ is,
untreated antiphospholipid syndrome can lead to permanent organ damage or death. Complications include:

Kidney failure. This can result from decreased blood flow to your kidneys.

Stroke. Decreased blood flow to a part of your brain can cause a stroke, which can result in permanent neurological
damage, such as partial paralysis and loss of speech.

Cardiovascular problems. A blood clot in your leg can damage the valves in the veins, which keep blood flowing to
your heart. This can result in chronic swelling and discoloration in your lower legs. Another possible complication is
heart damage.

Lung problems. These can include high blood pressure in your lungs and pulmonary embolism.

Pregnancy complications. These can include miscarriages, stillbirths, premature delivery, slow fetal growth and
dangerously high blood pressure during pregnancy (preeclampsia).

Rarely, a person can have repeated clotting events in a short time, leading to progressive damage in multiple organs.

Diagnosis

If you've had episodes of blood clots or pregnancy loss that aren't explained by known health conditions, your doctor
can schedule blood tests to check for abnormal clotting and for the presence of antibodies to phospholipids.

To confirm a diagnosis of antiphospholipid syndrome, the antibodies must appear in your blood at least twice, in tests
conducted 12 or more weeks apart.

You can have antiphospholipid antibodies and never develop any signs or symptoms. A diagnosis of antiphospholipid
syndrome is made only when these antibodies cause health problems.

Treatment

If you have blood clots, standard initial treatment involves a combination of blood-thinning medications. The most
common are heparin and warfarin (Coumadin, Jantoven). Heparin is fast-acting and delivered via injections. Warfarin
comes in pill form and takes several days to take effect. Aspirin is also a blood thinner.

When you're taking blood thinners, you have an increased risk of bleeding episodes. Your doctor will monitor your
dosage with blood tests to be sure your blood is capable of clotting enough to stop the bleeding of a cut or the
bleeding under the skin from a bruise.

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Lifestyle and home remedies

Depending on your treatment plan for antiphospholipid syndrome, there are additional steps you can take to protect
your health. If you take blood-thinning medications, take extra care to keep from injuring yourself and to avoid
bleeding.

Avoid contact sports or other activities that could cause bruising or injury or cause you to fall.

Use a soft toothbrush and waxed floss.

Shave with an electric razor.

Take extra care when using knives, scissors and other sharp tools.

Food and dietary supplements

Certain foods and medications may affect how well your blood thinners work. Ask your doctor for guidance about:

Safe dietary choices. Vitamin K can lessen the effectiveness of warfarin, but not other blood-thinners. You may need to
avoid eating large amounts of vitamin K-rich foods such as avocado, broccoli, Brussels sprouts, cabbage, leafy greens
and garbanzo beans. Cranberry juice and alcohol can increase warfarin's blood-thinning effect. Ask your doctor if you
need to limit or avoid these drinks.

Safe medications and dietary supplements. Certain medications, vitamins and herbal products can interact
dangerously with warfarin. These include some over-the-counter pain relievers, cold medicines, stomach remedies or
multivitamins, as well as garlic, ginkgo and green tea products.