Medical Abortion: Managing Complications and Next Steps

Medication abortion

Hello, I received my first dose on November 19 and the second dose on November 21 (about four hours later, an ultrasound confirmed that the embryo had been expelled).
The doctor prescribed medication to induce uterine contractions (I experienced bleeding for about a week).
After two weeks, during a follow-up visit, there was still some tissue remaining, so I took the contraction medication for another three days (during this time, I expelled more tissue for about five days).
A week later, during another follow-up, the doctor mentioned that there was still 1 cm of retained tissue.
He prescribed another three days of contraction medication, but this time there was no further bleeding or expulsion of tissue.
However, the hospital tests still showed faint positive results.
Despite taking the contraction medication, why is there no expulsion? The doctor suggested that I could drink herbal soup.
If I do this, can I wait for my next menstrual period to expel the remaining tissue, or is surgery necessary (which I am not very keen on)?

Niming, 20~29 year old female. Ask Date: 2015/12/15

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, the patient must return for follow-up within one to two weeks after taking the abortion medication.
Clinical examination, β-HCG measurement, and ultrasound scanning are necessary to confirm whether the embryo has been completely expelled.
The medical abortion has a failure rate of about 4-5%.
If the expulsion is incomplete, medication will be used for treatment, but it may not guarantee complete clearance.
It is advisable to discuss with the treating physician how long to observe and whether surgical intervention is necessary.
Thank you! Wishing you safety and health.
Dr.
Zhang

Reply Date: 2015/12/15

More Info

Medical abortion is a process that involves the use of medications to terminate a pregnancy. It is generally considered safe and effective, but like any medical procedure, it can come with complications. In your case, it seems that you have undergone a medical abortion and are experiencing some ongoing issues with retained products of conception (RPOC), which is not uncommon.

After taking the medications for a medical abortion, it is typical for patients to experience bleeding and cramping as the body expels the pregnancy tissue. However, in some cases, not all tissue is expelled, which can lead to complications such as infection or prolonged bleeding. The fact that you had an ultrasound confirming that the embryo was expelled is a positive sign, but the subsequent findings of retained tissue indicate that further management is necessary.

The use of uterotonics (medications that stimulate uterine contractions) is a common approach to help expel any remaining tissue. It is concerning that after taking the uterotonics, you did not experience any further bleeding or expulsion of tissue. This could suggest that the retained tissue is either adherent to the uterine wall or that there are other factors at play, such as hormonal influences or the nature of the retained tissue itself.

Regarding your question about drinking "生化湯" (a traditional Chinese herbal remedy), while some women may find comfort in using herbal remedies, it is essential to approach this with caution. There is limited scientific evidence supporting the efficacy of herbal treatments for expelling retained products of conception. Additionally, relying solely on herbal remedies without medical supervision could lead to complications, including infection or further retention of tissue.

If the retained tissue is not expelled naturally or through medication, surgical intervention may be necessary. This procedure, known as dilation and curettage (D&C), involves the gentle scraping of the uterine lining to remove any remaining tissue. While surgery can be daunting, it is often the most effective way to ensure that all products of conception are removed, thereby reducing the risk of complications.

It is crucial to maintain open communication with your healthcare provider. If you are hesitant about undergoing surgery, discuss your concerns with your doctor. They can provide you with information about the risks and benefits of both surgical and non-surgical options, as well as monitor your condition closely. If you choose to wait for your next menstrual cycle, be sure to have follow-up appointments to ensure that you are not developing any complications.

In summary, while medical abortion is generally safe, complications such as retained products of conception can occur. It is essential to follow your healthcare provider's recommendations and to consider surgical intervention if the retained tissue does not resolve with medication. Always prioritize your health and well-being, and do not hesitate to seek a second opinion if you feel uncertain about the recommended course of action.

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