Post-Medication Abortion: Pregnancy Tests and Bleeding Concerns

Three weeks after a medical abortion, there are still signs of pregnancy and bleeding?

Hello, I took RU486 on October 28 and three pills of the second dose on October 30, and received a three-day supply of uterine contraction medication.
That night, I expelled a piece of tissue that was flesh-colored (about 1 cm).
For the next 3 to 4 days, the bleeding was similar to a menstrual period for 2-3 days; then the bleeding decreased, resembling days 4-5 of a menstrual cycle.
Seven days later (November 4), I returned for an ultrasound, and the doctor indicated that half of the tissue had not been expelled, so I received another three-day supply of uterine contraction medication.
This week, the bleeding has decreased to a small amount of brown discharge.
Seven days later (November 11), I returned for another ultrasound, and the doctor stated that half of the tissue was still retained, but the gestational sac had been expelled, and I received another three-day supply of uterine contraction medication.
A pregnancy test still showed a positive result, and I continued to have bright red bleeding, similar to days 4-5 of a menstrual cycle.
Today (November 18), I returned for a check-up, and the pregnancy test still showed a positive result, with ongoing bright red bleeding, again similar to days 4-5 of a menstrual cycle.
The doctor indicated that an ultrasound was no longer necessary, as the positive pregnancy test means that the tissue has not been completely expelled, and I received another three-day supply of uterine contraction medication.
The doctor also mentioned that if I still have a positive pregnancy test next week, I will need to undergo surgical intervention.

Questions:
1.
I have read that it is normal to still have a positive pregnancy test within a month after a medical abortion, but my doctor is certain that a positive pregnancy test indicates that the tissue has not been completely expelled.
Is this normal?
2.
This week, I am still experiencing bright red bleeding, and the amount is not as the doctor described (a few drops), but rather similar to days 4-5 of a menstrual cycle.
Is this a normal situation?

Niming, 20~29 year old female. Ask Date: 2020/11/18

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, theoretically, a miscarriage after 3 weeks should result in a negative test result.
It is recommended to follow up with the hospital for further management as per your original clinic's advice.
Wishing you good health.

Reply Date: 2020/11/18

More Info

Understanding post-medication abortion, particularly with the use of RU486 (mifepristone) and misoprostol, involves recognizing the expected physiological responses and potential complications that may arise during the process. Your experience, as described, raises several important points regarding the continuation of pregnancy tests showing positive results, the nature of bleeding, and the implications of retained products of conception.

1. Pregnancy Test Results After Medication Abortion: It is indeed common for pregnancy tests to remain positive for some time after a medical abortion. This is primarily due to the presence of residual human chorionic gonadotropin (hCG) in the bloodstream. After taking RU486, it can take several weeks for hCG levels to drop to undetectable levels, especially if there are retained products of conception. The timeline for this varies among individuals, but it is generally expected that hCG levels should decrease significantly within a few weeks post-abortion. If your healthcare provider is indicating that the continued positive test results suggest retained tissue, they may be concerned about the potential for complications such as infection or excessive bleeding.

2. Bleeding Patterns Post-Abortion: The bleeding you are experiencing, described as similar to a menstrual flow on days 4-5, can be considered within the normal range for post-abortion bleeding. After a medical abortion, it is typical to experience bleeding that can vary in amount and duration. Initially, you may have heavier bleeding, which can taper off to lighter spotting. However, if you are experiencing bright red bleeding that is consistent and resembles a menstrual period, it is essential to monitor this closely. While some bleeding is expected, significant or prolonged bleeding could indicate complications such as retained products of conception or an incomplete abortion.

3. Follow-Up Care: Given that your ultrasound indicated retained tissue and you are still experiencing significant bleeding, it is crucial to follow your healthcare provider's recommendations. The use of additional uterotonics (like misoprostol) is often employed to help expel any remaining tissue. If, after this treatment, you continue to have positive pregnancy tests or significant bleeding, further evaluation may be necessary, which could include a surgical procedure such as dilation and curettage (D&C) to ensure that the uterus is clear of any remaining products.

4. Potential Risks: Retained products of conception can lead to complications such as infection, heavy bleeding, or even sepsis in severe cases. Therefore, it is vital to maintain open communication with your healthcare provider and report any concerning symptoms, such as increasing pain, fever, or foul-smelling discharge.

5. Emotional and Psychological Considerations: The experience of a medical abortion can be emotionally taxing. It is important to seek support from healthcare professionals, counselors, or support groups if you find yourself struggling with the emotional aftermath of the procedure.

In summary, while it is common for pregnancy tests to remain positive for a period after a medical abortion, the persistence of these results alongside significant bleeding warrants careful monitoring and possibly further intervention. Always consult with your healthcare provider regarding any concerns you have during this process to ensure your health and well-being are prioritized.

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