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Mifepristone-induced bleeding, abdominal pain, done urine and blood test, taken Oso, Uriliser. Complications of abortion?

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I would like to ask about complications of abortion. my gf's first date of last menstrual was 23 XXXXXXX 11, and we taken a very wrong decision, without consulting to any doc. without doing any ultra sound we have calculated the pregnancy weeks (8 weeks and 5 days) and decided to take first "Mifepristone" tablet on 24 august at 9 pm,she start with light bleeding after taking first tablet, and the second tablet "Misoprostol" is taken (4 tablets vaginally) after 48 hours on 26 august around 9 pm,wthin 3-4 hours she start to bleed very heavily continuous to bleed up to morning 5-6 am, after that bleeding becomes less and totally stops within 4-5 days, and the pain was also decreasing gradually. But ater 1-2 days she was complaining about abdominal pain on lower left side and is bearable when she is busy with some work day time, but become worst/unbearable at night hours while sleeping. thereafter we went to local gyn doctor for follow up visit after 2 weeks on last Saturday ( 10th sept) and the doctor did urine and blood test which came negative.but the doctor didn't do any ultrasound for confirmation of any tissue is left behind and simply gave some tablets(oso-200 etc.) and syrup (uriliser) for 5 days and said everything will be fine.doctor was saying somthing pinkish fluid in urine and said it may be infection.But even after 5 days the pain is same.please advise what it may be.
Posted Mon, 7 May 2012 in Abortion and Stillbirth
 
 
Answered by Dr. Minoo Bhagia 6 hours later
Hello,

Thanks for the query

The bleeding following medical termination usually continues upto 15 days of taking the pills.

In your case the pregnancy was of 8 weeks size, so the chances of bleeding and pain will be more.

I agree with you; if the pain is severe an ultrasound examination would be needed to rule out retained product or ectopic pregnancy. The chances of ectopic are very minimal as she had excessive bleeding but cannot be neglect.

Pelvic inflammatory disease and ovarian cyst are other causes of pain.

I suggest you to continue the medications prescribed to you and watch for progress of the condition. If the symptoms persists, then a thorough pelvic examination and ultrasound test are entailed.

In the mean while you may consider using analgesics such as mefenemic acid and dicyclomine.
Give her iron supplements and diet XXXXXXX in iron.

I hope this answers your query. Any further queries are welcome.

Take care
Above answer was peer-reviewed by
 
Follow-up: Mifepristone-induced bleeding, abdominal pain, done urine and blood test, taken Oso, Uriliser. Complications of abortion? 8 hours later
The pregnancy was about 9 weeks, when the abortion was induced.

1. Can medical abortion may cause PID.

2. Today we have done complete ultrasound screening but nothing is found, the doctor was only indicating chances of infection (may be serious), does uterus infection is lethal.

As the pregnancy was about 9 weeks, how long the pain may retain as it already been 20 days. whether we need to go for D&C procedure to avoid this pain.
 
 
Answered by Dr. Minoo Bhagia 1 hour later
Hello.

Thanks for writing again.

Since the pregnancy was of 9 weeks duration, the bleeding will be more.

Medical abortion may cause PID (Pelvic Inflammatory Disease) by putting misoprost vaginally. Any vaginal manipulation can cause infection.

Pain could be due to associated uterine infection which can be treated. It is not lethal.

It can be cured very easily by giving antibiotics like Doxycycline or Clindamycin under your doctor's guidance.

D&C (Dilatation and Curettage) will not cure the symptom.

It is done, only if there are retained products inside the cavity.

I hope she will recover soon.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Mifepristone-induced bleeding, abdominal pain, done urine and blood test, taken Oso, Uriliser. Complications of abortion? 26 hours later
We have been to local gyane for ultra sound screening, after that the gyane has advised uriliser (syrup thrice a day) and meftal forte (anti-inflammatory tablets twice a day), but all these are not showing any positive effects even the pain in breasts and back has also stared after taking these medicines, mam we are really confused what it is, we are not able to understand what should we do at this stage, please guide us with your expert advise. shall we wait for some more days as on 23rd her periods are due.
 
 
Answered by Dr. Minoo Bhagia 1 hour later
Hello,

Thanks for writing again.

She can take tablet Tramadol, as this is centrally acting drug and more effective in relieving the pain of medical abortions. It may cause nausea for which you can give antiemetic like Domperidone under doctor's guidance.

I am using this drug for my patients which gives tremendous response especially in in medical abortions.

Regarding her periods, it might get delayed. Breast pain will go away with time. Repeat urine pregnancy test after 15 days.

I hope, this helps. I wish her speedy recovery.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Mifepristone-induced bleeding, abdominal pain, done urine and blood test, taken Oso, Uriliser. Complications of abortion? 2 days later
Mam at present she was taking following medicines:-

1. Uriliser (2 bottels 30 ml 3 times a day)
2. Ofloxacin-OZ (for 5 days 2 tablets everyday)
3. Meftal forte ( for 3 days 2 tablets a day)

she is taking the medicines regularly , but now on 4th day of medicines she is complaining that she is getting yellow color fluid(pus) in urine and continuous pain in lower left abdomen, breast, and back, please advise mam i am very tense, can we XXXXXXX you personally, please give me your contact details or guide.
 
 
Answered by Dr. Minoo Bhagia 8 hours later
Hello,
Welcome XXXXXXX

Why don't you give her urine sample in the lab so as to confirm whether it is pus or something else.
If she is having pain while passing urine you can give her tablet flavoxate.

Uriliser and Oflox-oz are fine.

If very severe pain give her injection diclofenac sodium 75 mgm IM stat under doctor's supervision.
I told you to give tablet tramadol instead of meftal forte.

I am sure she will get relief in the pain within two to three days.
For backache she can use hot water bottle and some analgesic anti inflammatory ointment locally.

Regarding personal contact number you may ask XXXXXXX authorities.
Best wishes
God bless you
Above answer was peer-reviewed by
 
Follow-up: Mifepristone-induced bleeding, abdominal pain, done urine and blood test, taken Oso, Uriliser. Complications of abortion? 2 days later
Hi, Doctor

Toady we have a complete ultrasound of uterus, everything was clear there (no retained tissues).

Blood test as under:-
HB GM - 10.6%
TLC - 6200
NEUTROHILS - 65%
LYMPHOCYTES - 30%
MONOCYTES - 7%
EOSINOPHILS - 4%

Urine Test as under :-
PUS CELLS - 4-5
RBC - NIL
RBC CASTS - NIL
EPITHELIAL CELLS - 1-2
OXALATES - NIL
ALBUMIN - NIL
SUGAR - NIL

Whether these reports are normal.

after five days antibiotic course, gyane again recommended for another 5 days antibiotics course, the gyane have not done any tests for PID or STD.

Mam she is having continuous pain in lower left abdomen, back and in breasts with little pus after urination.

Please suggest any tests so that we can confirm the cause of this pain.

And tramadol+PCM tablets are available here, can she take it for pain.
 
 
Answered by Dr. Minoo Bhagia 13 hours later
Hello,
Thanks for the follow up.

The reports are fine.She is not having any pus in the urine according to this report.

Yes , she can take another course of antibiotics for further 5 days.Pain can be of intestinal origin also.

I don't think she requires more tests.Yes , you can give tramadol and paracetamol combinations.

Do not worry , this pain will go with time.

For backache you can visit a physiotherapist for hot steam packs , TENS (Transcutaneous electrical nerve stimulation )and ultrasonics.

Give her calcium supplements.

Wishing you good health.
Take care
Best wishes
Above answer was peer-reviewed by
 
Follow-up: Mifepristone-induced bleeding, abdominal pain, done urine and blood test, taken Oso, Uriliser. Complications of abortion? 36 hours later
Hi Doc,

As per the reports she is not having any pus urine, but now she is saying she is having little blood in pus.

I doubt whether she is really having all these symptoms or she is creating all these situations to get my attention. As the local gyane is saying that she is only having psychological pain nothing real.

Is there any test available to know whether she really gone through the medical abortion process, according me she is making fool of me.

Or if she is true than can she have an abscess inside the abdomen or PID or what is this doc i am not able to understand.

Please suggest me what should i do at this stage.

Mam please don't get angry as my questions are irrelevant to medical queries.

Thanks
 
 
Answered by Dr. Minoo Bhagia 7 hours later
Hello XXXXXXX

After going through the history again and again, I have come to a conclusion that she must be having pain , may be not severe but it is her first time that she took these medicines so she might feel it more.

Both of you are taking it very seriously. The chance of intraabdominal abscess is very, very unlikely. I do not feel this a concerning problem.

Reassurance and understanding is required.

Concentrate on other things like your work and make her move as soon as possible.

Thanks again for following up with me. Wish you good health

Take care
Best wishes
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