Incomplete abortion overview
Incomplete abortion occurs when there is an inadequate effort to expel product of conception by uterus. This may occur spontaneously or during induction of abortion by an ineffective method or partial use of methods e.g. taking less dose of MISOPROSTOL. Patients with incomplete abortion can be managed with evacuation of content or medical managements.
Incomplete abortion definition
When entire products of conception are not expelled in an abortion but a part of the product of conception is left inside uterine cavity, it is termed as incomplete abortion. This is the commonest type of abortion found in hospitalized women.
Incomplete abortion code in ICD 9
ICD-9-CM code for abortion is 634.91. This code can be used to specify a diagnosis on a reimbursement claim. ICD-9-CM code for incomplete abortion, 634.91 will be replaced by an equivalent ICD-10-CM. This switch to ICD-10-CM code will happen when the United States transitions from ICD-9-CM to ICD-10-CM on October 1, 2015.
Incomplete abortion clinical feature
- Amenorrhoea for variable period
- History of expulsion of fleshy mass per vagina
- Continuation of pain in lower abdomen
- Persistence of vaginal bleeding
- Height of uterus is smaller than the period of amenorrhoea
- On examination of the expelled mass found to be incomplete
Incomplete abortion cervix condition
Cervical os is usually open and admits tip of the finger. There is varying amount of bleeding. The product of conception may be found to hang from the os on speculum examination.
Incomplete abortion versus missed abortion
- Incomplete abortion is commoner than missed abortion.
- In incomplete abortion a part of product of conception comes out. But in missed abortion no product of conception comes out.
- Incomplete abortion is evident by vaginal bleeding, where missed abortion shows brownish discharge.
- Incomplete abortion shows an open cervix but missed abortion shows a closed cervical os.
- Incomplete abortion gets quick attention due to its manifestation by bleeding. But missed abortion may be an incidental diagnosis with no knowledge of the patient.
- Incomplete abortion can be managed by evacuation. But missed abortion mostly managed by medical measures.
Incomplete abortion Investigation
As patient is usually in shock and diagnosis is obvious by clinical features, no investigation is required.
But these investigations may be done:
- Complete blood count
- Blood grouping Rh typing
- Blood coagulation profile
- Ultra sonogram of whole abdomen
- Urine analysis
- Biopsy of evacuated material
Complications of incomplete abortion
- Profuse bleeding
- Coagulation error leading to DIC
- Sepsis leading to septic abortion
- Placental polyp
Management of incomplete abortion
At first we seek for patient condition if the patient is in shock we treat to recover her from shock. Then we decide what to do for the expulsion of product of conception.
Evacuation is the primary procedure for expulsion of product of conception.
For early abortion: Dilatation and evacuation under general anesthesia is to be done.
For late abortion: The uterus is evacuated under general anesthesia and products removed by ovum forceps or by blunt curette. In late cases, dilatation and curettage operation is to be done to remove the bits of tissues left behind.
All the removed materials are to be sent for histological examination.
- Medical management
Tablet misoprostol may be tried to evacuate the product. Medical treatment is safer and having less complications than surgical ones.