Incomplete Abortion: Questions and Concerns for Patients

Incomplete medical abortion with medication?

Hello Doctor, on November 8th, we started the medical abortion process.
Afterward, the doctor informed us that the abortion was successful.
However, since the original hospital was too far away, we had to switch to another obstetrics and gynecology clinic for follow-up.
I have been taking Ergometrine and Mefenamic Acid for almost three weeks now, but the ultrasound still indicates "incomplete evacuation." I would like to confirm a few questions:
1.
Does "incomplete evacuation" mean that there are still some tissues that have not been expelled from the body?
2.
Does the use of Ergometrine really help with tissue expulsion? Is taking 0.2 mg four times a day too much? I am experiencing significant pain.
3.
What potential risks or complications can arise from incomplete tissue expulsion?
4.
Generally, how long does it take to completely expel the tissue? Are there situations where medication will not be effective in achieving complete evacuation?
5.
The second hospital suggested that we return to the original hospital for surgery, but when we went back for an examination, they said it was unnecessary.
They also mentioned that the second hospital misinterpreted inflammation as fetal tissue during the ultrasound.
The first hospital, in addition to the ultrasound, conducted a pregnancy test that showed no pregnancy response, so they only prescribed anti-inflammatory medication.
I am confused—will just taking anti-inflammatory medication really resolve the issue? The assessments from both hospitals are completely different (even somewhat contradictory).
Who should I trust?

YY, 20~29 year old female. Ask Date: 2015/12/04

Dr. Lin Wenbin reply Obstetrics and Gynecology

1.
Incomplete expulsion may be due to retained products of conception or blood clots.
An ultrasound examination shows that there are still remnants in the uterus, leading to a preliminary diagnosis of incomplete evacuation.

2.
This is a uterine contraction medication, and uterine contractions can cause pain.
Therefore, the physician has also prescribed pain relief medication for you.
Contractions are necessary to facilitate expulsion.

3.
There is a possibility of persistent bleeding, uterine inflammation, adhesions, and other complications, which may increase the risk of infertility in the future.

4.
A physician should evaluate the situation before making a determination.
If medication fails to achieve complete evacuation, surgical intervention may be required.
The following are the most important points:
5.
The reason for this is that physicians are not omniscient and cannot predict treatment outcomes with 100% certainty.
Therefore, the second physician essentially warns you that there may be incomplete evacuation.
This is beneficial for you.
If the first physician has already determined that the issue is not incomplete evacuation but rather inflammation, then you should follow the treatment plan provided by the first physician.
The original physician (who performed the procedure) will ensure that you receive comprehensive care, and if they cannot manage your case, they will refer you to another specialist.
In medical treatment, there is a fundamental truth: subsequent physicians often have a clearer understanding than the initial ones.
It’s like watching a movie; without seeing the ending, no one can fully grasp the plot development.
The second physician is merely offering advice without seeing the final outcome, so you can confidently return to the first physician.
Wishing you a speedy recovery!

Reply Date: 2015/12/04

More Info

Understanding incomplete abortion can be a complex and emotionally challenging experience for patients. It is essential to address your concerns with clarity and empathy, as well as to provide you with the necessary medical information.

1. What does "排不乾淨" mean?
When your doctor mentions that the abortion is "not complete" or "排不乾淨," it typically indicates that there are still remnants of pregnancy tissue remaining in the uterus. This can occur after a medical abortion, where the body may not expel all the tissue effectively. It is crucial to monitor this situation, as retained tissue can lead to complications.

2. Does ergoMETRINE help with tissue expulsion?
ErgoMETRINE (ergometrine) is a medication that can help stimulate uterine contractions, which may assist in expelling retained tissue. However, the effectiveness of this medication can vary from person to person. The dosage you mentioned, 0.2 mg taken four times a day, is within the typical range, but if you are experiencing significant pain, it is essential to communicate this with your healthcare provider. Pain can be a sign that the body is responding to the medication, but it can also indicate other issues that need to be addressed.

3. What are the risks of retained tissue?
Retained products of conception can lead to several complications, including:
- Infection: The presence of tissue can create an environment conducive to infection, leading to conditions such as endometritis.

- Heavy Bleeding: If the tissue does not pass, it can cause prolonged bleeding or heavy menstrual-like bleeding.

- Hormonal Imbalance: Retained tissue can affect hormone levels, potentially leading to further complications.

- Future Fertility Issues: In rare cases, complications from retained tissue can affect future pregnancies.

4. How long does it typically take to expel retained tissue?
The timeframe for expelling retained tissue can vary widely among individuals. Some may pass the tissue within a few days, while others may take weeks. If the tissue does not pass on its own, medical intervention may be necessary. In some cases, surgical procedures such as dilation and curettage (D&C) may be required to remove the retained tissue.

5. Conflicting advice from different hospitals:
It is not uncommon for different healthcare providers to have varying opinions based on their assessments. The first hospital's conclusion that no further intervention is necessary, combined with the second hospital's recommendation for surgery, can understandably cause confusion. It is crucial to consider the following:
- Seek a second opinion: If you feel uncertain, consider consulting another healthcare provider for a third opinion.

- Discuss your concerns: Bring up the conflicting advice with your current healthcare provider. They may be able to clarify the reasoning behind their recommendations and help you understand the best course of action.

- Trust your instincts: If you feel that something is not right, advocate for yourself. It is your body, and you deserve to feel confident in the care you receive.

In conclusion, navigating the aftermath of an incomplete abortion can be distressing. It is essential to maintain open communication with your healthcare providers, seek clarification on any conflicting information, and ensure that you are receiving the appropriate care for your situation. If you continue to experience pain or have concerns about your health, do not hesitate to reach out for further evaluation and support. Your well-being is the priority, and you deserve comprehensive care during this challenging time.

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