How to Manage Complications After Medical Abortion: A Patient's Guide

How should I handle this situation now?

On May 11, I underwent a medical abortion at a small clinic and have been in severe pain for the past few days, experiencing heavy bleeding.
On the evening of May 27, I returned to the clinic for a follow-up, where a urine test indicated that I still showed signs of pregnancy.
They advised me to return for another check-up next week.
Currently, I am experiencing some bleeding, but it is not heavy.

On the morning of May 28, I felt abdominal discomfort and passed a large blood clot, which was very uncomfortable.
I thought the small clinic was not very reliable, so I went to find a female doctor in the Zhongli city area (at a larger clinic).
She said everything was normal, mentioned the presence of blood clots, and told me to return for a follow-up next week.
I did not have a urine test done and was given medication to help with uterine contractions before going home.
After taking the medication, I felt slightly better.
On June 17, I experienced heavy bleeding again and consulted the female doctor, who mentioned the presence of a cyst and advised me to return for a follow-up next week with medication for uterine contractions.
No urine test was performed.

On June 24, during my follow-up appointment, the female doctor had just finished her consultations, and a male doctor took over.
He said there was no cyst, just a small amount of blood clots, and instructed me to take a urine test, which indicated that I was still pregnant.
When I asked him what to do next, he advised me to continue taking the medication for uterine contractions and to return next week to see the female doctor.

The main issue is that I have been continuously bleeding and feeling very uncomfortable.
What should I do?

Xiao Tao, 40~49 year old female. Ask Date: 2021/06/28

Dr. Wu Xianghui reply Obstetrics and Gynecology

1.
After a medical abortion, if pregnancy is still detected, ectopic pregnancy must be ruled out (which can lead to significant internal bleeding in severe cases).

2.
After a medical abortion, if there is still heavy bleeding, it is necessary to rule out incomplete placental detachment or endometritis.

3.
It is recommended to visit a major hospital for outpatient or emergency evaluation and assessment.

Reply Date: 2021/06/28

More Info

Managing complications after a medical abortion can be a challenging experience, especially when symptoms such as heavy bleeding, severe pain, and the presence of blood clots occur. It is essential to understand the normal expectations following a medical abortion, as well as when to seek further medical attention.

Understanding Medical Abortion
A medical abortion typically involves taking medication to terminate a pregnancy. This process can lead to various side effects, including cramping, bleeding, and the passage of tissue. It is normal to experience bleeding that can last for several days to weeks, but the amount and duration can vary significantly among individuals.

Common Symptoms and Their Management
1. Bleeding: After a medical abortion, it is common to experience bleeding that can be similar to a heavy menstrual period. However, if you are soaking through two or more pads in an hour for two consecutive hours, this is considered heavy bleeding and warrants immediate medical attention.

2. Cramping and Pain: Cramping is a normal part of the process as the uterus contracts to expel its contents. Over-the-counter pain relief medications, such as ibuprofen or acetaminophen, can help manage discomfort. If the pain is severe and not relieved by medication, it is crucial to consult a healthcare provider.

3. Passing Clots: It is also normal to pass blood clots, especially in the first few days following the abortion. However, if you are passing large clots (larger than a golf ball) or experiencing significant pain, you should seek medical evaluation.

When to Seek Help
Given your situation, where you have experienced ongoing bleeding and discomfort, it is essential to communicate these symptoms clearly to your healthcare provider. Here are some guidelines on when to seek further medical attention:
- Heavy Bleeding: If you are experiencing heavy bleeding that does not subside, or if you have soaked through two pads in an hour for two consecutive hours.

- Severe Pain: If the pain is severe and not manageable with over-the-counter medications.

- Signs of Infection: Symptoms such as fever, chills, or foul-smelling discharge could indicate an infection and require immediate medical attention.

- Persistent Pregnancy Symptoms: If urine tests continue to show positive results for pregnancy after a medical abortion, this may indicate that the abortion was incomplete, and further evaluation is necessary.

Follow-Up Care
It is crucial to attend all follow-up appointments as recommended by your healthcare provider. These appointments are essential for monitoring your recovery and ensuring that the abortion was complete. If you feel that your concerns are not being adequately addressed during these visits, do not hesitate to seek a second opinion or consult a different healthcare provider.

Conclusion
Your experience of ongoing bleeding and discomfort after a medical abortion is concerning and should be addressed promptly. It is essential to advocate for your health and ensure that you receive appropriate care. Keep a record of your symptoms, including the amount of bleeding, the presence of clots, and any pain levels, to provide your healthcare provider with the necessary information to assist you effectively. Remember, your health and well-being are the top priority, and you deserve to have your concerns taken seriously.

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