Persistent Bleeding After Miscarriage: When to Seek Medical Advice

Persistent bleeding after a miscarriage?

Hello Doctor, I experienced a natural miscarriage on March 5th, and I have been bleeding for over two weeks since then.
A few days after the miscarriage, I had a follow-up appointment where a transvaginal ultrasound was performed.
The doctor said that the tissue had been cleared out, and only some blood clots remained, which would be expelled naturally.
No additional medication was prescribed, and I was advised that a follow-up visit was not necessary.
Last week, the bleeding had turned a deep brownish-red, even coffee-colored, and the amount gradually decreased.
However, two days ago, the bleeding suddenly increased again, and the color became more bright red.
During this time, I have experienced intermittent mild cramping in my lower abdomen.
Yesterday, when I got up and before bed, I suddenly passed 2-3 streams of blood and expelled a blood clot about the size of a five-dollar coin.
Aside from these two instances of noticeably increased bleeding, the amount during the rest of the day has been minimal, sufficient to use a panty liner.
Should I schedule another follow-up appointment, or should I continue to patiently wait for the bleeding to stop? Thank you.

Xiao Bo, 30~39 year old female. Ask Date: 2021/03/22

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, it is recommended to return to the obstetrics and gynecology department for an examination to confirm whether the miscarriage has been completed properly.
Wishing you good health.

Reply Date: 2021/03/22

More Info

After a miscarriage, it is not uncommon for women to experience bleeding for a period of time as the body expels remaining tissue. However, persistent or changing bleeding patterns can be concerning and warrant further medical evaluation. In your case, since you have been bleeding for over two weeks and have experienced a sudden increase in bleeding volume and the passage of blood clots, it is advisable to seek medical advice promptly.

Bleeding that changes from a brownish color to bright red, especially if accompanied by clots, can indicate that there may still be retained tissue in the uterus. This retained tissue can lead to complications such as infection or prolonged bleeding. The intermittent abdominal pain you are experiencing could also be a sign that something is not quite right. While some amount of bleeding and cramping can be expected after a miscarriage, significant changes in the bleeding pattern, especially if it becomes heavier or is associated with pain, should be evaluated by a healthcare professional.

In your situation, I recommend scheduling a follow-up appointment with your healthcare provider. They may perform a pelvic exam and possibly another ultrasound to assess the status of your uterus and ensure that all tissue has been expelled. If there is retained tissue, your doctor may discuss options for management, which could include medication to help expel the tissue or, in some cases, a minor surgical procedure.

It is important to monitor for any additional symptoms that could indicate complications, such as fever, foul-smelling discharge, or severe pain. If you experience any of these symptoms, you should seek medical attention immediately.

In summary, while some bleeding is normal after a miscarriage, the changes you have described suggest that it would be prudent to consult with your healthcare provider again. They can provide the necessary evaluation and support to ensure your recovery is progressing as it should. Your health and well-being are paramount, and it is always better to err on the side of caution when it comes to your body.

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