Could Misuse of Medication Lead to Miscarriage? A Gynecological Inquiry

Could taking the wrong medication cause a miscarriage?

I would like to ask the following questions: My last menstrual period started on August 12, with a cycle of about 27 days.
On August 16 (D5), towards the end of my period, I took traditional Chinese medicine to help with conception, but I noticed blood-streaked discharge.
I had intercourse with my husband on August 24 and 25, and there was still blood-streaked discharge, so I thought it was due to hormonal imbalance and went to see a doctor.
The doctor prescribed me with progesterone.
After finishing the medication, on August 28, I experienced dark red bleeding, so I went for a check-up (not knowing I had successfully conceived at that time).
After taking hemostatic and pain-relieving medications, the bleeding decreased to a brownish color, and I thought the bleeding had finally stopped (from August 28 to September 2).
However, on September 4 (D24), I noticed bright red bleeding in the morning, which did not seem like a menstrual period but rather abnormal bleeding, so I rushed to see a doctor.
The doctor did not perform a pregnancy test, and during the pelvic examination, no abnormalities were found, but there was evidence of endometrial shedding.
I was prescribed progesterone and hemostatic medications.
After taking the medications for four days, the bleeding stopped, but a few days later, I noticed brown discharge and quickly took a pregnancy test, which turned out positive (on September 15)! A urine test at the hospital also showed positive results (about five weeks pregnant), but a transvaginal ultrasound could not detect the embryo, so they decided to check my HCG levels through blood tests.
I had the first blood draw, and the next day I went on a business trip for two days.
When I returned to the hospital for the second blood draw, I woke up with lower back pain, and in the afternoon, I experienced some abdominal discomfort.
Later, I had bleeding accompanied by the passage of a membrane-like tissue, approximately the length of my middle finger, with a funnel-shaped mass in the middle.
After this tissue passed, the abdominal discomfort decreased, and the next day there was only a small amount of bleeding.

My questions are:
1.
Is this a miscarriage?
2.
Did the doctor mistakenly prescribe me progesterone and hemostatic medications during my fifth week of pregnancy without realizing I was pregnant, potentially causing issues with the embryo that led to the miscarriage?
3.
Was the progesterone medication prescribed by the doctor the cause of the heavy bleeding I experienced on August 28?
4.
How could I have successfully conceived despite the unstable endometrial condition last month?

Hua Yu, 30~39 year old female. Ask Date: 2010/09/20

Dr. Lü Lizheng reply Obstetrics and Gynecology

Dear Huayu,
Hello.

1.
It is likely that a miscarriage has occurred.
You should wait a week and then purchase a home pregnancy test, which should show a negative result.
However, if you test immediately after the miscarriage, the pregnancy test may still show a positive result.
Normally, the bleeding should decrease, and abdominal pain should lessen.
If bleeding or abdominal pain persists, or if the pregnancy test is still positive after a week, you must see a doctor.
Additionally, the HCG levels from the two blood tests should be decreasing; please confirm this.
If the HCG levels do not decrease, further monitoring is necessary.
2.
The two medications mentioned do not cause miscarriages.
The issue is likely related to the embryo itself.
3.
According to the literature, there is no adverse effect of the medication on the embryo.
The bleeding may be due to the rupture of the endometrium during implantation.
4.
Pregnancy involves the function of the endometrium and the health of the embryo.
Vaginal bleeding does not necessarily indicate instability of the endometrium.
5.
I recommend that you take a break for three months, relax, and engage in more physical activity to improve your physical and mental state.
After that, I encourage you to continue trying, as the chances of success next time are quite high.
Wishing you peace and health.
Sincerely,
Dr.
Lǚ Lìzhèng
Department of Obstetrics and Gynecology, Taoyuan General Hospital, Ministry of Health and Welfare

Reply Date: 2010/09/20

More Info

Misuse of medication can indeed lead to complications during pregnancy, including miscarriage. In your case, it appears that a series of medications were taken without the knowledge of an existing pregnancy, which raises several important considerations.

1. Understanding Miscarriage: A miscarriage, or spontaneous abortion, is defined as the loss of a pregnancy before the 20th week. It is often caused by chromosomal abnormalities in the fetus, but other factors such as hormonal imbalances, uterine abnormalities, and environmental factors can also contribute. In your situation, the presence of dark red blood and the subsequent passage of tissue could indicate a miscarriage, especially if accompanied by cramping and pain.

2. Impact of Medications: The medications you mentioned, including 伊始蒙 (likely a form of hormonal treatment), 普維拉 (which may be a form of progesterone), and止血藥 (hemostatic agents), can have various effects on the body. Hormonal medications can influence the uterine lining and may lead to changes in bleeding patterns. If these medications were prescribed without confirming pregnancy, there is a risk that they could have contributed to complications. However, it is essential to note that the primary cause of miscarriage is often not related to medication but rather to genetic issues with the embryo.

3. Timing of Medication Use: The timing of when you took these medications is crucial. If you were already pregnant when you started taking 伊始蒙, it could have affected the pregnancy. However, if the embryo had already been compromised due to other factors, the medications might not have been the direct cause of the miscarriage. It is also important to consider that some medications can lead to uterine contractions or changes in the endometrial lining, which could potentially lead to miscarriage.

4. Hormonal Imbalances and Pregnancy: Regarding your question about how you could conceive despite having an unstable uterine lining, it is possible for women with hormonal imbalances or irregular cycles to become pregnant. The body can sometimes compensate for these imbalances, allowing for ovulation and fertilization to occur. However, if the hormonal environment is not conducive to maintaining a pregnancy, it can lead to complications such as miscarriage.

5. Consulting Healthcare Providers: It is crucial to communicate openly with your healthcare provider about any medications you are taking, especially when trying to conceive or if you suspect you might be pregnant. If you experience any unusual bleeding or pain during early pregnancy, seeking immediate medical attention is essential. Your healthcare provider can perform appropriate tests, including blood tests for hCG levels and ultrasounds, to assess the status of the pregnancy and provide guidance on the next steps.

In summary, while misuse of medication can lead to complications such as miscarriage, it is often a multifactorial issue. The best course of action is to consult with your healthcare provider for a thorough evaluation and to discuss any concerns regarding medications and their potential effects on pregnancy. They can provide personalized advice based on your medical history and current situation.

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