Soreness, swollen breasts, discharge of milky fluid, itching, whitish vagina, spotting, urine test showed pus cells. Had abortion
This is a follow up query with regards to my wife's condition, who was pregnant and ultimately due to leaking of amniotic fluid, the pregnancy had to be aborted. She was 14 weeks +3 days pregnant, when amniotic fluid leakage caused the fetus to die; and wife had to undergo an abortion followed by D&C procedure. She was discharged from hospital a week ago. Antibiotic coverage was extended for upto 3 days post discharge - Tazact + Metrogyl + Amicacin.
Currently since last 3-4 days, she has been complaining of soreness, swelling and tightening of her breasts, with discharge of milky fluids. Additionally, there has been increased itching and whitish fungus like appearance on her vagina. Bleeding has not yet stopped and she is still spotting - but very less. The gyneac had alerted us that bleeding would take minimum of 2 weeks to stop permanently. The abortion happened on 2nd May. So she is still within the 2 weeks period. But this itching and vaginal fungus like appearance is a new symptom. 2 days ago we had her blood and urine tests. While blood test has revealed normal TLC and other counts post antibiotics; Urine RE has shown some pus cells (2-4 units). Other parameters are within normal ranges.
We are concerned about her symptoms relating to swelling and milk discharge from breasts and any potential fungal infection in the vagina.
Request your advice in terms of whether this is normal post abortion; if not, what is the recommended treatment for the same. Additionally, what post abortion care should be taken for her well-being and by when she can be recommended to be ready to concieve again.
Thanks for the query.
For swollen breasts and milky discharge from the breasts, your treating doctors prescribe bromocryptine or cabergoline medicine for suppression of milk. She should wear exact size of bra. She should not touch the breasts, and there is no need to remove the milk manually or pump. She may be advised to take analgesic and anti-inflammatory pills for the pain. This is quite a common symptoms after the abortion of mid trimester pregnancy.
For the white itchy discharge, most probably it is fungal discharge. After the course of Antibiotics, there are chances of fungal discharge. She must be given Anti-fungal medication either orally or for vaginal use.
She should be given some normal flora tablets also.
Scanty bleeding may happen for 1- 2 weeks.
She may conceive after 3 normal periods. Was this her first pregnancy?
She needs to do some investigations and pre-natal counseling before she plans her next pregnancy. The most common causes for these types of abortion could be some maternal infections, especially Chlamydia, which can cause amniotic fluid infection, and thus the premature preterm leaking. There is also a possibility of Incompetent cervix, or excess amniotic fluid, Diabetes, Syphilis etc. There are number of abortions for which we may not find any cause, but we should try our best to know the underlying cause. It would help in planning for the next successful pregnancy.
I hope, I have answered your question. In case of further query, you are most welcome.
My wife has been advised to apply candid ointment to get relief from fungal itching. She is using the same , however she is complaining of the itching and peeling of skin spreading a little bit. We consulted the gynaec and she has only advices the ointment. She examined the vaginal opening and advised that there is no XXXXXXX infection, only external fungal. Please suggest if you think otherwise. This was my wife,s first pregnancy, and hence all symptoms are new. Thanks again for your advice. Regards, XXXXXXX
Candid ointment is fine for Vaginal Fungal infection. if she is not feeling relief, she may need to take oral antifungal tablets like Fluconazole. Her peeling of skin and itching could also be because of irritation due to use of pads. There may be need for some soothing ointment or mild steroid ointment also. Make sure that she wears only cotton underwear, and changes her pad and underwear frequently. Every time she passes urine, she must wash her external parts with water, and then dab with dry toilet paper.
I asked for the history of any other pregnancy to determine the risk for the next pregnancy. Hopefully with good management for next pregnancy, you will be blessed with a healthy baby soon.
If you have any further query, you are most welcome.
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