Prolonged Bleeding After Abortion: What You Need to Know

The bleeding from the abortion has not yet stopped?

Dear Doctor, my baby had a miscarriage at eight weeks, and I underwent a dilation and curettage (D&C) on January 11.
After returning home, the bleeding was minimal, just a few drops, and there was no blood when I wiped after urination.
On January 14, during a follow-up visit, the doctor indicated that there were still blood clots remaining in the uterus and prescribed three days' worth of uterotonics and anti-inflammatory medication.
Starting January 16, I began to notice bright red blood (not much on the pad, but the toilet paper was fully stained bright red).
Concerned, I returned for another check-up after finishing the medication, and the doctor was surprised to see that the bleeding had not stopped.
He prescribed another three days' worth of medication (this time including estrogen) but did not inform me whether I needed to return for another follow-up after completing the medication.
The bleeding continued until January 27, when it turned brown with some clear discharge, but on January 29, I noticed bright red blood again, along with some blood clots and streaks when wiping after urination.
I would like to ask the doctor if the persistent bright red blood without transitioning to brown indicates that the uterus was not completely cleared at that time? Given the early gestational age, is this prolonged bleeding unusual? I am very worried about the condition of my uterus but feel powerless...

Lili, 20~29 year old female. Ask Date: 2022/01/29

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, you had surgery on January 11, and there is still bleeding on January 29.
It is possible that there may still be retained products of conception.
It is recommended to return to your original obstetrics and gynecology clinic for an examination.
Wishing you good health.

Reply Date: 2022/01/29

More Info

Prolonged bleeding after an abortion can be a concerning issue for many women, and it is essential to understand the potential causes, management strategies, and when to seek further medical attention. In your case, it appears that you have experienced a series of complications following a surgical abortion (dilation and curettage, or D&C) performed at eight weeks of gestation.
Firstly, it is important to recognize that some bleeding after an abortion is normal. The body needs time to heal, and the uterus must expel any remaining tissue. However, the persistence of bright red bleeding, especially if it is accompanied by blood clots, can indicate that there may still be retained products of conception or other complications.

In your situation, you initially had minimal bleeding, which is a good sign, but the subsequent discovery of blood clots and the return of bright red bleeding after taking medications raises concerns. The medications prescribed, including uterotonics (to help the uterus contract) and anti-inflammatory drugs, are standard treatments aimed at facilitating the expulsion of any remaining tissue and managing pain or discomfort.

The fact that you experienced a change from bright red blood to brownish discharge and then back to bright red bleeding suggests that your body is still in the process of clearing out the uterine lining and any remaining tissue. Brown blood typically indicates older blood that has taken longer to exit the uterus, while bright red blood is fresh and may indicate ongoing bleeding.
It's crucial to monitor the amount and nature of the bleeding. If the bleeding is heavy (soaking through a pad in an hour), accompanied by severe pain, fever, or foul-smelling discharge, you should seek immediate medical attention. These symptoms could indicate an infection or significant retained tissue that may require further intervention.

Regarding your concern about whether the prolonged bright red bleeding indicates that the uterus was not cleared properly, it is possible. Retained products of conception can lead to continued bleeding and may require additional treatment, such as another D&C or medication to help expel the remaining tissue.
In terms of follow-up care, it is essential to maintain open communication with your healthcare provider. If you have not been advised on when to return for a follow-up appointment, it is advisable to schedule one, especially given your ongoing symptoms. Your doctor may want to perform an ultrasound to assess the status of your uterus and determine if any further action is necessary.

In addition to medical management, self-care is also vital during this recovery period. Ensure you are resting adequately, staying hydrated, and eating a balanced diet to support your body’s healing process. Avoid strenuous activities and sexual intercourse until you have been cleared by your healthcare provider.

In summary, while some bleeding after an abortion is normal, prolonged bright red bleeding, especially with clots, warrants further evaluation. Stay in close contact with your healthcare provider, and do not hesitate to seek help if your symptoms worsen or if you have any concerns about your recovery. Your health and well-being are paramount, and timely intervention can help prevent complications.

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