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Had D&C for removal of blood clots. Ultrasound showed clots after a week. Having pelvic and rectal pain. Suggest

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I gave birth on4-1-13 then had a d&c for left over clots on 4-17-13 then 1 weeks later had a US and still showed clots then a week later my utures was clean! It's know 11 weeks since D&c and still no period! This past weekend I ended up in the ER with pelvic and rectal pain! Horrible! Hat a CR scan that showed no abnormalities, but this is what the DR wrote on the results!


There is some fluid within the endometrial cavity and correlate with respect to menstral cycle.


But I haven't had any period!!!! I'm worried that the d&c scarred me!! Would it had show on CT scan, also would endometriosis show? I'm worried bcuz of the rectal pain.
Posted Mon, 22 Jul 2013 in Women's Health
 
 
Answered by Dr. Timothy Raichle 58 minutes later
Hello, I would be happy to help you with your question.

So to summarize: you are a 26 year old who delivered on 4/1, but required a D&C for retained tissue on 4/17 with a subsequent ultrasound showing eventual resolution of anything in the uterus. Now, about 10 weeks later, you went to the ER with pelvic and rectal pain and a scan showing fluid in the uterus. Finally you have not gotten your period since the birth.

First, if you are still breast-feeding, then I would not expect that you would get your period. Second, if there had been a complication related to the D&C on 4/17 (related to poking through the wall of the uterus), I would not have expected it to take 10 weeks to present itself as a problem. Third, while D&C's can lead to scarring, it is actually unlikely AND it could not be picked up on the scan you had (but it is worth considering). Fourth, this is very unlikely to represent endometriosis unless it had been an issue before.

So hopefully that helps to some extent. Please tell me if you are breast-feeding or not? Also, when was the last time someone did an ultrasound? Is there any chance that you are pregnant? Have you done a pregnancy test?

Thank you.
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Follow-up: Had D&C for removal of blood clots. Ultrasound showed clots after a week. Having pelvic and rectal pain. Suggest 33 minutes later
I am not BF, how much long should I wait for a period? If inded they scarred my utures (ashminto) or something like that, would inhavento get surgery to fix the issue even if I don't want anymore kids. And no, I'm not pg.
 
 
Answered by Dr. Timothy Raichle 7 hours later
I am sorry about the delay. Thank you for this additional follow up information.

For whatever reason, you are not getting a period most likely because you have not ovulated. Usually this is caused by breast-feeding, but in your case this cannot be the cause. Even in the presence of a newborn, there can still be an effect on your cycle leading to non-ovulation. As I said before, it is very unlikely that any harm was done with regard to the uterus in terms of scarring. The name for uterine scarring is called 'Asherman's syndrome' by the way.

The best way to sort through the issue of not getting a cycle AND determining if any harm was done to the uterus would be as follows:
1. You doctor should give you a prescription for Provera 10mg for 10 days
2. After you complete the presecription you will almost certainly get a period
3. After you stop bleeding, in the week afterwards, a repeat ultrasound called a 'sonohysterogram' should be performed.

The sonohysterogram is an ultrasound where fluid is pushed into the uterine cavity. The image gives an excellent view of the contour of the uterine lining. From this one could tell if there was ANY retained placenta OR ANY scarring from the postpartum D&C. It is my strong opinion that they will find neither and you will eventually resume normal cycles.

I hope that this helps. Please ask if you have any followup questions.
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Follow-up: Had D&C for removal of blood clots. Ultrasound showed clots after a week. Having pelvic and rectal pain. Suggest 2 hours later
Wouldn't retain placenta show on CT and sono? The sonohysterogrm is it done with anestisia? What do they inject? The XXXXXXX the use for CT scans? I've also had clear sticky mucus.
 
 
Answered by Dr. Timothy Raichle 8 hours later
If there was a large amount of placental tissue in the uterus, it would show up on CT scan. If there was a small amount, it might not show up. In general, ultrasound is a much preferred way to look at the uterus - it gives a much clearer picture.

Sonohysterogram has the added advantage of assessing for any scar tissue within the uterus itself (which cannot be seen on CT scan). It is not necessary to use anesthetics with a sonohysterogram. The fluid injected is usually just sterile saline (salt water basically). It is totally different from the XXXXXXX used for CT scans.

As far as the discharge, this is not indicative of anything related to retained placenta or adhesions within the uterus. It is most easily diagnosed with an exam. The most common causes of an abnormal discharge is vaginal yeast infections and another common vaginal infection called BV (but this gets into a new question).

I hope this helps.
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Follow-up: Had D&C for removal of blood clots. Ultrasound showed clots after a week. Having pelvic and rectal pain. Suggest 0 minute later
If I do have small pices of placenta in my utures would my HCG or Pg test be positive?
 
 
Answered by Dr. Timothy Raichle 5 minutes later
This far out from delivery, your pregnancy test should be negative. If it was positive, it is incredibly unlikely that it is related to the placenta (it would only occur in vary rare problems called gestational trophoblastic disease). But this would really be rare.

Since you are raising the question, I would recommend that you do a pregnancy test just to be sure something unusual like this is not going on.
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Follow-up: Had D&C for removal of blood clots. Ultrasound showed clots after a week. Having pelvic and rectal pain. Suggest 4 minutes later
I had a negative pg test and my HCg levels were good.
 
 
Answered by Dr. Timothy Raichle 5 minutes later
That is good to hear. So I think you will be on the right path - look at my recommended plan above - this is exactly how I would approach someone with your history.

Good luck!
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Follow-up: Had D&C for removal of blood clots. Ultrasound showed clots after a week. Having pelvic and rectal pain. Suggest 6 hours later
What if the Provera doesn't work?
If it does give me a period then I'm not at risk for Areahmans?
Also the CT scan showed that my uterus was deviated to the right, could that cause and issue?

I've also had pelvic pain for about 3 weeks
 
 
Answered by Dr. Timothy Raichle 29 hours later
In some women, the provera does not work, but you do not know until you try! Usually you take it for 10 days, and when you stop, you get your period within 1-2 weeks.

If you get a period, it does not indicate whether or not you have Asherman's. This can only be determined with a sonohysterogram or with a camera placed inside of the uterus.

The deviation of the uterus to the right is likely of no significance whatsoever. This question could be re-addressed at the time of your followup ultrasound.

Good luck and remember to leave feedback!
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Follow-up: Had D&C for removal of blood clots. Ultrasound showed clots after a week. Having pelvic and rectal pain. Suggest 19 hours later
If I do have Asherman's does it have to be fixed even if I do t want kids anymore?

And does the sonohysterogram require me to be out under anesthisia?

My last HCG test is as follow:

U HCG QL NEGATIVE

Does that mean my levels are low?
 
 
Answered by Dr. Timothy Raichle 21 hours later
If you actually have Asherman's syndrome (which is unlikely and yet to be determined) then it should be fixed as it may predispose to miscarriage and problems with future pregnancy. If you were not planning on kids, then it would not need to be fixed unless it was causing problems related your cycle.

The sonohysterogram is an office procedure done at the time of ultrasound that does not require any anesthesia.

If the qualitative HCG is negative, then you are NOT pregnant! Yes it means that your levels are absent.

I hope that this helps.
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Follow-up: Had D&C for removal of blood clots. Ultrasound showed clots after a week. Having pelvic and rectal pain. Suggest 4 hours later
Well lets say i "do" have it and its obviously its affecting my cycle bcuz I haven't had a period. What can happen if I leave it untreated, if I don't want it fix?!?!
 
 
Answered by Dr. Timothy Raichle 3 hours later
When women do not bleed with their cycle, one of the causes is an 'outlfow obstruction'. This means that the blood cannot get out of the uterus. Blood can accumulate in the uterus (called hematametra). This can lead to pelvic pain and cyclic cramping.

If it were an issue, then it would eventually be associated with symptoms like I described. It would be obvious on ultrasound as there would be accumulated fluid in the uterus.

Review my answers above. I have outlined a plan that would be reasonable. Talk with your OB/GYN. It is worth sorting out what is going on because it is not normal to NOT get your period. If, for example, the cause of your absent cycles was related to non-ovulation (i.e. the lining grows but does not shed) then you could be at risk long-term of uterine cancer.

Thank you - I hope that this helps!
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Follow-up: Had D&C for removal of blood clots. Ultrasound showed clots after a week. Having pelvic and rectal pain. Suggest 5 hours later
I had a ct scan 2 weeks ago, which showed fluid in my endomitral cavity and it said that it might be related to my menstral but I never got my period.
 
 
Answered by Dr. Timothy Raichle 40 hours later
As I said before, here is what I would recommend:

The best way to sort through the issue of not getting a cycle AND determining if any harm was done to the uterus would be as follows:

1. You doctor should give you a prescription for Provera 10mg for 10 days
2. After you complete the presecription you will almost certainly get a period
3. After you stop bleeding, in the week afterwards, a repeat ultrasound called a 'sonohysterogram' should be performed.

The fluid in the uterus is likely related to blood that has not made its way out. It would help significantly to be on medication that would shed the lining and the ultrasound, as above, repeated to see if anything is still there.

Good luck!
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