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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Is Surgical Abortion Safe After Previous Blood Loss During Delivery?

Hello doc... My first baby is 1 year old (with normal vaginal delivery). During her delivery I suffered from retroplacental clot nd had heavy blood loss during delivery. My Hb reachd 5 at tht time. Now Hb is 11.5 and Im pregnant again at 8 weeks now. I cannot continue with pregnancy as my TSH Level is 108 nd first baby is also very small. I am going for a surgical MTP after 2 days. Can u plz advise if its safe or will I again have to face heavy blood loss or ny other complications due to MTP.
Tue, 23 Feb 2016
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OBGYN 's  Response
Hallow Dear,

You had excessive bleeding after previous delivery. That bleeding was due to retroplacental clot which is known to cause deficiency in clotting factors (DIC). I hope you have recovered from the anaemia as well as clotting factors. I would suggest you to undergo following investigations before you undergo termination of pregnancy:
1. Complete haemogramme with special reference to Haemoglobin percentage and red blood corpuscles count
2. Platelet count
3. Bleeding time
4. Clotting time
5. Prothrombin time
6. Fibrinogen levels

If these all blood factors have recovered, then you should not have any risk of excessive bleeding after or during abortion process. If you are still anaemic, then the risk of bleeding does increase during abortion. In that case treat the anaemia before you undergo surgical abortion.

However, you are just 8 weeks pregnant. So you can undergo termination of pregnancy by Medicines safely. Tab. Mifepristone followed after 24-48 hours by Tab. Misoprostol is a very effective and safe method of termination of pregnancy up to 9 weeks gestation. Moreover, these medicines being prostaglandins contract the uterus strongly and reduce the possibility of excessive bleeding.

These medicines are very effective abortifacient medicines no doubt; however, if at all these medicines fail, the decision of pregnancy termination should not be reverted to continuation of pregnancy since these medicines cause developmental abnormalities in baby. In such event, the pregnancy should be terminated by surgical evacuation of the uterus by MVA or such methods.

TSH levels need not be indication for termination of pregnancy. Hypothyroid condition can be monitored and treated effectively during pregnancy. However, since your first child is very young, your decision to terminate the pregnancy is justifiable.

I hope this helps you.

Dr. Nishikant Shrotri
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Is Surgical Abortion Safe After Previous Blood Loss During Delivery?

Hallow Dear, You had excessive bleeding after previous delivery. That bleeding was due to retroplacental clot which is known to cause deficiency in clotting factors (DIC). I hope you have recovered from the anaemia as well as clotting factors. I would suggest you to undergo following investigations before you undergo termination of pregnancy: 1. Complete haemogramme with special reference to Haemoglobin percentage and red blood corpuscles count 2. Platelet count 3. Bleeding time 4. Clotting time 5. Prothrombin time 6. Fibrinogen levels If these all blood factors have recovered, then you should not have any risk of excessive bleeding after or during abortion process. If you are still anaemic, then the risk of bleeding does increase during abortion. In that case treat the anaemia before you undergo surgical abortion. However, you are just 8 weeks pregnant. So you can undergo termination of pregnancy by Medicines safely. Tab. Mifepristone followed after 24-48 hours by Tab. Misoprostol is a very effective and safe method of termination of pregnancy up to 9 weeks gestation. Moreover, these medicines being prostaglandins contract the uterus strongly and reduce the possibility of excessive bleeding. These medicines are very effective abortifacient medicines no doubt; however, if at all these medicines fail, the decision of pregnancy termination should not be reverted to continuation of pregnancy since these medicines cause developmental abnormalities in baby. In such event, the pregnancy should be terminated by surgical evacuation of the uterus by MVA or such methods. TSH levels need not be indication for termination of pregnancy. Hypothyroid condition can be monitored and treated effectively during pregnancy. However, since your first child is very young, your decision to terminate the pregnancy is justifiable. I hope this helps you. Dr. Nishikant Shrotri