Is Surgical Intervention Necessary After Incomplete Medical Abortion?

If a medical abortion is not completely successful, will the body absorb the remaining tissue without the need for surgery?

I would like to ask whether a medical abortion that is not completely clean requires a curettage procedure.
My last menstrual period was on October 13.
On December 4, I discovered I was pregnant, and after a hospital examination, the doctor said I was 5 weeks along (based on my knowledge, it should be 7 weeks from October 13).
On December 11, I went to the hospital, and the doctor diagnosed me as being 6-7 weeks along and prescribed RU-486.
I took the first dose that day to terminate the pregnancy, and on December 13, I took the second dose, which resulted in the expulsion of a large amount of blood and clots.
On December 16, during a follow-up visit, the doctor examined me and said the embryo had been expelled and that everything inside was very clean.
I was advised to avoid alcohol and sesame oil, but I could eat normally, and the doctor mentioned that a little bleeding was normal.
No medication was prescribed, and I was sent home (I had some doubts at the time because the ultrasound was very brief and felt rushed, but I trusted the professional opinion and went home to rest).
For a few days, my condition was normal, and the bleeding gradually decreased until...
on December 21, day 8 of the medical abortion, the bleeding suddenly increased, and there were blood clots.
On December 22, day 9, the situation worsened, with more and more blood clots.
Since I happened to be in Taichung, I sought medical attention at a clinic there, and the result was that the embryonic tissue was not completely expelled.
The doctor immediately prescribed uterotonics for me.
Why were the examination results from the two hospitals so different? Which doctor's advice should I follow, and should I take the medication? I then called back to the original hospital in Kaohsiung, and the staff transferred me to the education department to speak with a nurse about the situation...
I asked, "Why did the doctor say everything was clean when it clearly wasn't?" The nurse replied, "Because you couldn't return to Kaohsiung immediately for treatment.
From the medical records, Dr.
Lin only noted that everything was clean.
Usually, medication would be prescribed to help the patient expel everything." I responded, "Dr.
Lin didn't prescribe any medication for me." The nurse was surprised and admitted she didn't know that either (her reaction was also quite perplexing)...
I was truly speechless.
On December 23, early morning, day 10 of the medical abortion, the situation had not improved; whenever I coughed, sneezed, or exerted myself slightly, large blood clots would flow out.
I had to change a large sanitary pad every half hour to an hour, and within two hours, my bed was soaked.
By the evening, I had to go to a large hospital, where the doctor gave me an injection and said if the blood clot situation did not improve the next day, I would need to go to the emergency room for surgery.
I was really worried and afraid of the curettage procedure.
Fortunately, the next morning, my condition improved, and the bleeding decreased, but unexpectedly, in the evening, I started having blood clots and bleeding again, but it was already late at night.
On December 24, day 11 of the medical abortion, my condition stabilized significantly, and the amount of blood and clots gradually decreased (however, after several days of this, I was pale, had a rapid heartbeat, and felt dizzy and had headaches, likely due to excessive blood loss causing anemia).
On December 29, day 16 of the medical abortion, I returned to Kaohsiung and consulted my original attending physician.
After a transvaginal ultrasound, it was found that it was still not clean, and I needed a curettage.
After blood tests, it was confirmed that my blood cell count was low, indicating significant anemia, and I was at risk of fainting and needed a blood transfusion before surgery! That night, I lost faith in my original doctor and had to transfer to Chang Gung Memorial Hospital in Kaohsiung.
The doctor, knowing I was young and reluctant to undergo a curettage, prescribed medication instead, saying that the remaining tissue was minimal and could be absorbed by my body.
On December 29 and January 4, I had blood tests, and a week later, on January 5, during a follow-up visit, the doctor said my pregnancy hormone levels had dropped from over 7,000 to just over 1,700 and prescribed more medication for continued observation.

I would like to ask:
Q1: Is it really okay not to have surgery in my case? Could there be any long-term effects? What should I do now?
Q2: Was the initial doctor's assessment of being clean, which led to the subsequent heavy bleeding, a misdiagnosis? Can I file a complaint? Since I do not have children yet, I am really afraid of potential long-term effects on my body.
I have been worried and helpless for days and hope to receive some advice and assistance.
Thank you very much.

Tong An'an, 20~29 year old female. Ask Date: 2016/01/06

Dr. Lin Wenbin reply Obstetrics and Gynecology

Q1.
In medicine, there are no absolute procedures that remain unchanged.
If you choose to trust your original physician, you should proceed with a blood transfusion followed by a thorough surgical intervention.
If you opt for the physician at Chang Gung Memorial Hospital, you should cooperate with their observation until the pregnancy hormone levels decrease.
(If the levels do not decrease, the physician at Chang Gung may also consider another surgical intervention, which could be more complicated at that time.)
Q2.
No physician is a deity; they are just as human as you and I.
Medical conditions can vary greatly, and it is not something that physicians can fully control.
I have not reviewed your medical history or your case, so I cannot determine which physician is right or wrong.
Filing a complaint can be time-consuming and labor-intensive; you should focus on getting your condition treated promptly.
You are not considered recovered until your pregnancy hormone levels drop to zero.
Focus on recovery first! When you choose a physician, you must fully cooperate with them to effectively treat your condition.
In my view, it is more practical to have an early and thorough surgical intervention.
The first physician also recommended a thorough surgery, which you declined.
Even if you decide to file a complaint later, the first physician may not have committed a significant error (post-surgery, even if deemed successful, complications can still arise).
The original physician is more familiar with your condition than the subsequent physician, so the decision to observe was not without reason.
However, this does not guarantee that observation will lead to improvement.
Since you have already chosen the second physician, you should follow their advice closely.
Take the prescribed medications and proceed with surgery if it is indicated.

Reply Date: 2016/01/06

More Info

The situation you are describing involves a complex medical issue following a medical abortion, and it raises important questions about the necessity of surgical intervention, the potential for complications, and the quality of care received. Let's address your questions in detail.

Q1: Is it safe to avoid surgery after an incomplete medical abortion? What are the potential consequences?
In cases of incomplete abortion, where some fetal tissue remains in the uterus, the decision to proceed with surgical intervention (such as dilation and curettage, or D&C) depends on several factors, including the amount of retained tissue, the patient's symptoms, and overall health. If you are experiencing heavy bleeding, passing large blood clots, or showing signs of infection (such as fever or foul-smelling discharge), surgical intervention may be necessary to prevent complications like severe blood loss or infection.

In your case, it seems that you experienced significant bleeding and were diagnosed with retained tissue after the initial assessment indicated that everything was "clean." This discrepancy in diagnosis can lead to serious complications, including anemia from blood loss, which you have already experienced. If the retained tissue is not expelled naturally, it can lead to prolonged bleeding, infection, or even more severe complications requiring emergency care.

While some healthcare providers may choose to monitor the situation and allow the body to expel the remaining tissue naturally, this approach carries risks, especially if the bleeding is heavy or if there are signs of infection. It is crucial to have close follow-up with a healthcare provider who can monitor your condition and determine the best course of action.

Q2: Was the initial doctor's assessment of "clean" a misdiagnosis? Can I file a complaint?
The initial assessment that indicated the abortion was complete, followed by a significant change in your condition, raises valid concerns about the quality of care you received. Misdiagnosis can occur for various reasons, including limitations in the ultrasound examination or misinterpretation of the findings. If the doctor did not adequately assess the situation or failed to provide appropriate follow-up care, this could be considered a lapse in medical judgment.

If you believe that the initial misdiagnosis directly contributed to your complications, you may have grounds for a complaint. Many hospitals and clinics have procedures for filing grievances regarding patient care. It may also be beneficial to seek a second opinion from another healthcare provider to discuss your experience and any ongoing concerns you have about your health.

Recommendations for Your Situation
1. Follow-Up Care: Continue to seek medical attention, especially if you experience any worsening symptoms. Regular follow-up appointments are essential to monitor your recovery and ensure that any retained tissue is addressed appropriately.

2. Discuss Concerns with Your Provider: Be open with your healthcare provider about your fears and concerns regarding future pregnancies and potential long-term effects. They can provide you with information and reassurance based on your specific medical history.

3. Consider Counseling: The emotional toll of experiencing complications after an abortion can be significant. Speaking with a counselor or therapist who specializes in reproductive health may help you process your feelings and fears.

4. Educate Yourself: Understanding the medical procedures and potential complications can empower you to make informed decisions about your health. Resources from reputable medical organizations can provide valuable information.

5. Document Everything: Keep a detailed record of your symptoms, treatments, and communications with healthcare providers. This documentation can be helpful if you decide to pursue a complaint or seek legal advice.

In conclusion, while some cases of incomplete abortion may resolve without surgical intervention, your situation indicates a need for careful monitoring and possibly surgical intervention to prevent further complications. It is essential to advocate for your health and seek the care you need to ensure a safe recovery.

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