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Pregnant. Ultra sound showed blighted ovum and abnormal endometrium. Suggested to do hysterectomy. Need second opinion

Mar 2016
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Hi, I had US done on March 26 that showed "blighted ovum" at 7 weeks, with mass in it size 1 mm and my guess is that I was 8-9 weeks pregnent. Started miscaring on April 5th (not including spoting for about week prior), bleedind lasted for 4 days and after that gradualy slowing to brown color spotting. When I assumed around 16 of April that I'm not bleeding anymore and on 21-st of April counted one more week to go, before geting my life to "normal" On Tuesday 23-rd late evening I had large amount of fluids coming out of my uterus with small mass about 2 mm after the fluids. Then I started bleeding and cramping. Bleeding was much hevier then the first time. Next day I spend in bed, but folowing day I got up and I was better. I decided to go out but did that couse stress on my body as that night I was feverish and when I got up I got shivers and temp went up to 101 with pulse up to 105. For 2 hours I was debating if to go to emergency or wait till morning, but then temp whent down to normal and puls as well went back to normal. I decided I call doc. in the morning on friday but then I feltperfectly ok. This week I called him on monday just to get piece of mind, got ultrasound and blodwork done and the US result said that size of the uterus is normal and so the ovaries are normal too. But XXXXXXX endometrium is ubnormal in appearence measuring approximately 25mm. Is hypervascular and heterogenous in appearance. This my represent retained products of conception. The 5x4x5cm fibroid is identified in the lower uterine segment (...) No adnexal masses or free fluid are identified XXXXXXX My doc said that I need D&C next week and to monitor fibroid every 6 months if it growe then he sugests hysterectomy.
Does D&C is my only option at this time? Can I wait longer? Blood results showed 1/3 hormon levels but I don't know what that means. The Ultrasound does not specified what kind of fibroid it is or at least not to my understanding as to the position in the uterine wall or else. The reading I mean. I'm going to get the US pictures from lab on Monday along with blood test results to have for second opinion. I'm 38 years old and I don't want D&C and removal of the uterus if there are other options for me. Please Help.
Posted Tue, 21 May 2013 in Pregnancy
Answered by Dr. S Patra 1 hour later

Thanks for writing to us. My suggestions are as follows:

1) Following medical or natural abortion, it is mandatory to undergo ultrasound (USG) scan to check retained bits of placenta or aborted products. In your case, USG reveals endometrial thickness is 25 mm which is above normal range (3-14 mm) in comparison to any phase of normal menstrual cycle. It is also hyper vascular and heterogeneous in appearance.

In this context, doing D & C is quite helpful to evacuate uterus from retained bits or incomplete products. Otherwise it may cause irregular spotting/ bleeding and may lead to infection. Please consult with your doctor to proceed D & C. Following this, endometrial tissue may be needed to send for histopathological examination to rule out pathology if any.

2) Fibroid is most common tumor among women in reproductive age group and accounts for near about 50%. Fibroid is located in the lower portion of the uterus where inferior portion of isthmus & cervical canal joins. Size of the fibroid is not big enough and it can be treated medically at this stage.

I also do not understand blood test with 1/3 hormone level. You can upload blood report image in the follow up query to assist you better.

MEDICAL THERAPY includes 1) GnRH Agonist (like Goserelin) 2) Anti Progesterone (like Mifepristone) 3) Aromatase Inhibitors which are very much effective in reducing size of the fibroid along with symptoms. These group of drugs should be continued for 3-6 months duration for effective results. Tranexamic acid is quite useful to control bleeding in combination with any above group of drugs. There may be some tolerable side effects.

In case of failed or resistant medical treatment, surgical treatment is the last option. These include myomectomy (removal of the fibroid only), uterine artery embolization, radio frequency ablation etc. Hysterectomy (complete removal of the uterus) is the definite treatment in your age group. It gives high patient satisfaction.

Hope, this information is quite helpful to you. If you have any further questions I will be happy to help.

For any future query, you can directly ask me by viewing this page WWW.WWWW.WW
Wish your good health. Take iron and vitamin supplement with healthy diet, drink plenty of fluid/ water and maintain personal hygiene properly.

Dr Soumen
Above answer was peer-reviewed by
Follow-up: Pregnant. Ultra sound showed blighted ovum and abnormal endometrium. Suggested to do hysterectomy. Need second opinion 24 hours later
My HCG levels are at 130, not 1/3 as I wrote before.
I just got copy of the lab tests, before I misunderstood my OBGYN

Thank you for your very informative answer, It did help me to have better understanding of my situation and this morning I was feeling more like in charge of my health than the day before.

I'm to have D&C scheduled this week and I hope that pathology will be good.
As to fibroid I will see if I can help with remedies and tonics to stop it from growing. My Dr. is going to monitor it every 6 mo. but since he didn't mention any form of treatment I will try to help myself. In case the fibroid is growing I will ask for options then.

Is it safe or wise to have Mirena IUD placed in after D&C and when I get better with that fibroid inside the uterus??
Having the Paragard for 10 years could have any role play in growth of the fibroid? Is using tampons safe?

I just wrote that all and it seems that it didn't upload so I'm writing it again so you may get two similar follow-ups.

Thank you!

Answered by Dr. S Patra 1 hour later

Thanks for your follow up queries.

Following medical abortion, beta-HCG hormone is cleared out from blood within 1-4 weeks and comes down to normal range (less than 5 mIU/ ml).

Here, you should undergo D & C at the earliest and send endometrial tissue for histopathological examination.

In your case, Levonorgestrel IUD (Mirena) is quite effective treatment option to reduce blood loss & uterine size including fibroid. So you can easily put on inside the uterine cavity and proceed follow up examination or monitoring according to your doctor's recommendation.

Paragard is a Copper-IUD and it has no role in growth of the fibroid. It acts as contraceptive device only. It is better not to use tampon or douche your vagina to avoid pelvic or vaginal infection.

Hope, this helps. If you do not have any clarifications, you can close the discussion and rate the answer.

Good luck. Take care yourself.

Dr Soumen
Above answer was peer-reviewed by
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