Question: Hi XXXXXXX

Hope you remember my case history. As advices by you I had scheduled an appointment for repeat ultrasonography on Saturday (10 days after taking repeat Misoprostol ) however I got my periods on Friday night (26th day after abortion). Today on the 3rd day of my periods I expelled something which seemed like remains of the pregnancy tissue (elastic jelly like substance which was an inch long). Can this be the remnant that showed in the ultrasonography ? Do u still recommend repeat scan ? Also there is some irritation & burning around the vagina/vulva but never had intermittent abdominal pain. Is this a sign of infection?

Hi,
I have copied the entire thread of my conversation with Dr. XXXXXXX Can you please review & advice.

Q: I had a medical abortion on 21st April. I had bleeding for first 7 days and spotting from 8th day onwards. After 2 weeks (5th May) I went for a follow-up visit and ultrasound. Ultrasound showed some remnants of pregnancy with no other abnormalities. So I was administered with misoportol (2 tablets with an interval of 2 hours orally on 5th May & 2 on 6th May). Both days I had only spotting and today 7th May spotting continues. There is no abdominal pain or signs of infection. Should I be worried? How do I confirm that the remnants are expelled and the uterus is completely cleared. How do I assess if this is just debris and will clear during the next menstruation? Thanks for your advice.

Wed, 7 May 2014     
Dr. XXXXXXX XXXXXXX
Wed, 7 May 2014
Brief Answer:
repeat ultrasound check scan after a week

Detailed Answer:
Hello XXXXXXX

This process of abortion though very simple but at times takes some time and effort to clear off completely.

You are following the correct protocol which all gynecologists follow worldwide.

After administration of misoprostol products are usually expelled within 48 hours and slight spotting may follow after expulsion for about a week thereafter.

This time as you just had some retained products of conception you may not feel them coming out and they will just look like small blood clots or even just as spotting only.

Complete clearing is subjectively perceived as stoppage of any amount of spotting and abdominal pain if any.

And for objective documentation you can get a repeat ultrasound a week after last dose of misoprostol.

But in most cases if spotting has stopped it clearly indicates that abortion process is complete.

i hope i have answered your questions and in case you have any other query i will be happy to help.


Q: Thanks for the help, it is reassuring. I was 6 weeks & 4 days MLP when I underwent medical abortion. On the day of pills I expelled a jelly like translucent product about a size of a golf ball covered with blood. After 2 weeks I went for repeat scan & the report was as follows: "uterus is anteverted & normal in size. Endometrium is thickened & heterogenous with no evidence of gestational sac/fetal pole. Minimal trophoblastic activity noted on colour dropper. Myometrial texture is normal. Both ovaries are normal in size, position & texture. No mass is seen in the uterus & adnexa. Pouch of XXXXXXX free.
Impression: incomplete abortion/retained products of conception. No other significant abnormality detected in pelvis."
Post this report & being administered with Misoprostol, it may clear. As you suggested I could go for a repeat scan after 1 week. I now have slight pain on my left side starting from pelvic bone upto my feet. Is this a concern?
Also I read online that it is important to distinguish debris from remains of the product as debris will clear during next menstruation. How can I be sure that what is remaining is debris or not? & that any further procedure or pills may not be required?
If during the next scan, it still shows some remains what is the suggested prognosis? Pills, MVA, D&C etc?
What are the adverse signs/symptoms I need to watch out for?
Will the remains affect my next menstruation cycle?
What are the possible complications if the remains are still there in Uterus that are not cleared?
Also, I have not been prescribed any antibiotics. Should I be taking them after consulting the doctor ?
Also do you recommend any specific post abortion care/diet?
When can I start gymming/yoga/swimming?

Wed, 7 May 2014     
Dr. XXXXXXX XXXXXXX
Thu, 8 May 2014
Brief Answer:
REPEAT SCAN AFTER ONE WEEK

Detailed Answer:
Hello XXXXXXX firstly i must say you have a very good insight of your medical status and you are very well informed which is not commonly seen.
The slight pain on your left side if tolerable and mild will subside soon, placenta might have been on left side so that side of uterus is responding more to misoprostol or many patients at times just rest in same position all the time which can also cause this discomfort.
It is most probably a debris because remains of products of conception are seen as bright echogenic localised mass on ultrasound which is not the case in your report.
If remains are still there they will definately manifest as either intermittent abdominal pain or bleeding so if bleeding stops in coming week then it will be an indirect evidence of complete abortion.
But if spotting persists or there are remains on ultrasonography then you should opt for D&C which will be 100% treatment of remains of products of conception.
it can affect your next cycle which can be a little heavy and early or late in onset but will resume its normal rhythm in a couple of months.
Remains if stay in uterus can cause secondary infection, excessive blood flow and even infertility in future but after reading your ultrasound report the chances of these complications are nil.
Antibiotics are given if there is a suspicion of infection but that is not the case so no need to ask for them.
As far as care is concerned
-take a lot of water
- incluse nuts and fresh fruits in your diet
- dont miss meals in case you dont feel like eating them then also try to eat something at least to fill you with energy and calories.
Once your repeat ultrasonography is normal you resume your light exercise schedule and escalate it gradually.
Take care and wish you all the best

Q: Thank you so much. You have been really helpful and elaborate in your response. This is valuable information.
Fri, 9 May 2014     
Dr. XXXXXXX XXXXXXX
Fri, 9 May 2014
Brief Answer:
Welcome

Detailed Answer:
Hello, you are most welcome. In case you have any other concern you can always contact me at Health Care Magic.


Q: One more question. I have iron deficiency and was adviced by doctor to take Globac Z for 1 month. I had taken it for only 20 days & learnt I was pregnant & opted for the abortion. I had stopped taking the supplements at that time (almost 1 month ago). Can I resume the iron supplements now? Or is it recommended to wait until the spotting stops?
Sat, 10 May 2014     
Dr. XXXXXXX XXXXXXX
Sat, 10 May 2014
Brief Answer:
iron supplements are good for you

Detailed Answer:
Hi dear, globac xt is an iron supplement and totally non controversial.
It can be resumed like before and will be rather helpful in regaining the original vitality of body.
Now just relax and let the nature takes its own course.
Wish you the best of evrything.

Thank you. Since I have my periods now, I may go for the scan this Saturday. By then I think this thread will close. How do I reach you?