Post-Abortion Symptoms: When to Seek Medical Advice

Symptoms and Concerns After Surgical Abortion

Hello Doctor, I would like to ask about my condition.
After my surgery on December 6th at 3 PM, everything was very normal for the next 1-4 days; there was no bleeding or abdominal pain.
However, starting on the afternoon of the fifth day, I noticed dark red blood spots and small clots after urinating before my follow-up appointment at 3:30 PM.
The doctor performed a transvaginal ultrasound and informed me that everything was normal, then prescribed uterine contraction medication and antibiotics, but no pain relievers! After my appointment, I took one dose of the medication, and about 30 minutes later, I began to experience severe abdominal pain, similar to menstrual cramps, but even more intense.
The doctor explained that this was due to uterine contractions.
Each time I experienced severe pain, I would pass a blood clot, and once the clot was expelled, I would feel some relief.
The bleeding was intermittent, with the most clots occurring on the fifth night, and by the sixth day, the clots and bleeding had decreased.
However, the pain persists, coming in waves.
The doctor advised me to return for a follow-up on Thursday.
I should also mention that each time I experience pain, it is located on the left side of the uterus, and sometimes the pain is more generalized, but the right side does not hurt at all.
Additionally, I have significant lower back pain.
I would like to know if this is normal or if I should consider changing my primary physician.

ninikoko, 20~29 year old female. Ask Date: 2018/12/11

Dr. Huang Jianzhong reply Obstetrics and Gynecology

On December 6th, I underwent surgery at 3 PM.
The first 1-4 days post-surgery were very normal, with no bleeding or abdominal pain.
However, on the afternoon of the fifth day, I returned for a follow-up appointment at 3:30 PM.
Before the consultation, I went to urinate and noticed dark red blood and small clots.
After the physician performed a transvaginal ultrasound, I was informed that everything was normal.
I was prescribed uterine contraction medication and antibiotics, but no painkillers! After my appointment, I had a meal and immediately took the medication.
About 30 minutes later, I began to experience severe abdominal pain, similar to menstrual cramps, but even more intense.
The physician explained that this was due to uterine contractions.
Each time I experienced severe pain, I would pass a blood clot, and after each clot was expelled, I would feel some relief.
This continued intermittently, with the most clots occurring on the night of the fifth day.
On the sixth day, the number of clots decreased, and the bleeding also reduced, but the pain persisted, coming in waves.
The physician advised me to return for a follow-up on Thursday.
I would like to add that each time I experience pain, it is located on the left side of the uterus, and sometimes the entire area hurts, but the right side does not hurt at all.
Additionally, I am experiencing significant lower back pain.
I would like to know if this is normal or if I should consider changing my attending physician.

Answer: This is generally normal, and there is no need to change your attending physician.

Reply Date: 2018/12/11

More Info

After an abortion, it is common to experience a variety of symptoms as your body adjusts and heals. The symptoms you described, including dark red blood, small blood clots, and significant abdominal pain, can be concerning and warrant careful monitoring. Here’s a breakdown of what you might expect and when to seek further medical advice.

Understanding Post-Abortion Symptoms
1. Bleeding: After an abortion, some bleeding is expected. This can range from light spotting to heavier bleeding, especially in the first few days post-procedure. The presence of dark red blood and small clots can be normal, particularly if they are not excessive. However, if you experience soaking through a pad in an hour or less, or if the bleeding lasts longer than two weeks, you should contact your healthcare provider.

2. Pain: Abdominal pain is also common after an abortion. This pain can be similar to menstrual cramps and may vary in intensity. The fact that you are experiencing severe pain, especially if it feels more intense than typical menstrual cramps, is something to monitor closely. Pain that is localized to one side (like the left side in your case) could indicate other issues, such as an ovarian cyst or other complications, and should be evaluated by a physician.

3. Blood Clots: Passing small blood clots can be normal, especially in the days following the procedure. However, if you are passing large clots (larger than a quarter) or if the clots are accompanied by severe pain, this could indicate retained tissue or other complications, and you should seek medical attention.

4. Follow-Up Care: It’s essential to follow up with your healthcare provider as recommended. If you feel that your concerns are not being adequately addressed, or if your symptoms worsen, it is within your rights to seek a second opinion or request a different healthcare provider. Your health and comfort should always be a priority.

When to Seek Medical Advice
You should seek medical advice if you experience any of the following:
- Heavy Bleeding: Soaking through one or more pads in an hour for two consecutive hours.

- Severe Pain: Pain that is not relieved by over-the-counter pain medications or that is significantly worse than what you were told to expect.

- Fever: A temperature above 100.4°F (38°C) could indicate an infection.

- Foul Smelling Discharge: This could also indicate an infection and should be evaluated.

- Prolonged Symptoms: If your symptoms do not improve or worsen after a few days, it’s important to consult your healthcare provider.

Conclusion
In summary, while some bleeding and pain are normal after an abortion, it is crucial to monitor your symptoms closely. If you have any concerns about the severity or nature of your symptoms, do not hesitate to reach out to your healthcare provider. Your health and well-being are paramount, and you deserve to feel comfortable and informed about your care. If you feel that your concerns are not being taken seriously, seeking a second opinion is a reasonable and often necessary step.

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