To remove retained products from the uterus (RPOC), doctors use medical management with drugs like misoprostol to help the uterus contract and expel tissue, or surgical procedures like Dilation and Curettage (D&C) or hysteroscopy, often done under anesthesia, to physically remove the tissue to prevent infection, heavy bleeding, and complications like infertility. The choice depends on the amount of tissue, patient stability, and physician preference, with expectant (waiting) management also an option for small amounts.
Whether the RPOC remains in the uterus for 48 hours or 10 years, there is no significant difference in terms of future pregnancy outcomes once they have been removed [18,19]. While the timing of removal does not affect pregnancy in the future, having RPOC will be a cause of infertility in a woman.
Suction evacuation is a surgical procedure to clean the uterus. The doctor will access the uterus via the cervix, use a suction or vacuum pump, and evacuate the contents of the uterus. It is a simple and pain-free procedure that may cause cramping or spotting soon after the procedure.
Dilation and curettage (D&C): D&C is a surgical procedure to remove the contents of the uterus. Your healthcare provider dilates (opens) your cervix and uses a curette (usually a small, plastic suction tube) to remove tissue.
Presentation and signs of RPOC
The characteristic clinical manifestations of RPOC may include heavy or prolonged uterine bleeding and pelvic pain. Signs of infected RPOC can commonly include pyrexia, offensive discharge or uterine tenderness.
After an abortion, the main risk is infection in the uterus (womb). This is caused by leftover pregnancy tissue that hasn't been removed or passed. An infection after abortion may cause you to: bleed heavily.
Your body may pass these remains naturally, however, sometimes this does not happen. If retained products of conception are left untreated this can make you unwell, sometimes with prolonged and heavy vaginal bleeding, pain and infection.
An incomplete abortion (sometimes called incomplete miscarriage) means that the uterus has not fully emptied after a pregnancy ends. Some tissue or blood clots remain inside. This can cause heavy bleeding, cramping, and infection if not treated.
Current evidence suggests that uterotonic agents (such as misoprostol and sulprostone) may result in little to no difference in the rates of manual removal of the placenta, and probably result in little to no difference in postpartum haemorrhage and the need for blood transfusions, compared to placebo or no treatment ...
Up to 50% of people who miscarry don't need a D&C procedure. If the miscarriage occurs before 10 weeks of pregnancy, it'll most likely happen on its own (natural miscarriage). After the 10th week of pregnancy, there's a higher risk of having an incomplete miscarriage.
Risks
The first sign of a problem with the uterus may be abnormal bleeding. Bleeding could occur between periods, be very heavy, or last much longer than usual. Other symptoms may include bleeding after sex or pelvic pain.
A glass of lemon water is a simple addition to a uterus cleansing diet plan. Whole grains are a good source of fibre and B vitamins. They help balance hormones by removing excess estrogen through digestion. Eating whole grains daily supports a healthy menstrual cycle and lowers the risk of uterine fibroids.
Women who retain the dead embryo/fetus can experience severe blood loss or develop an infection of the womb. These are rare complications. Gastro‐intestinal side effects such as nausea and diarrhoea, cramping or abdominal pain and fever have been reported with misoprostol.
Fertility hormones after miscarriage
As pregnancy hormone (HCG) levels decrease, the menstrual cycle can resume normally. However, this process can take a few weeks. Levels of other hormones, such as progesterone and estrogen, will stabilize, allowing ovulation and the fertile window to return to normal.
Most women experience painful cramping and bleeding. As the pregnancy passes, the blood loss can be heavy and cramps stronger. Most women pass clots into the toilet; the pregnancy tissue may be in one of the clots. After the pregnancy tissue has passed, the bleeding slows and pains decrease.
A medical abortion feels most like strong period cramps. The intensity of the cramping and pain are different from person to person. You can use a heating pad and take most over-the-counter (OTC) pain relievers to help. Most people use NSAIDS, such as ibuprofen.
Incomplete abortion is defined by clinical presence of an open cervical os and bleeding, whereby all products of conception have not been expelled from the uterus, or the expelled products are not consistent with the estimated duration of pregnancy. Common symptoms include vaginal bleeding and abdominal pain.
The obstetrician will place their fingers inside the uterus, through your cervix to detach the placenta and remove it. Their other hand is placed firmly on your tummy to steady the top of the uterus. If you had any tears or had an episiotomy, these can be stitched at the same time.
Vaginal bleeding: Moderate to severe vaginal bleeding is a common symptom of incomplete abortion that should not be ignored. Pain and discomfort: Women can experience frequent lower abdomen or pelvic discomfort that spreads to the lower back, buttocks, genitalia, and perineum.
Do not have sex for 1 week. For surgical/in-clinic abortions, do not use tampons for 1 week. (After a medical abortion/abortion pill, it is OK to use tampons immediately.) Do not douche for 1 week.
Symptoms of RPOC include heavy or irregular bleeding, passing clots, vaginal discharge, enlarged or tender uterus, fever, pain, infection, or a missed period.
You may also be able to get an ultrasound or blood test to make sure that the abortion worked. If you had an in-clinic abortion, they'll check to make sure your abortion was complete. If they see something that makes them think it wasn't, they may have you do follow-up tests to make sure.
Often, some of the pregnancy tissue remains in the uterus after a miscarriage. If it is not removed by scraping the uterus with a curette (a spoon-shaped instrument), you may bleed for a long time or develop an infection.
Common incomplete abortion symptoms include: Pain in the abdominal/pelvic regions or back pain that does not get better with pain medication. Cramping. Heavy vaginal bleeding (soaking more than two pads an hour for two hours)