QuestionI had an missed miscarriage and used misoprostol abortion. On day 14 ultrasound identifid a 2.1x1.4cm mass in the uterus. I was suggested by my doctor to wait for the period to come instead of doing D%26C. On day 33, I got my period. On day 35, I did ultrasound it showed inhomogeneous endometrium and a 1.1x0.8cm hyperechoic area within the uterus and my HCG is 9 IU/L. On my day 45, I still have a light bleeding. The bleeding stop on day 47 now. Should I do D%26C to get rid off the mass? If not, what happen later?
AnswerDear Lisa,
Thank you for your question about residual tissue after miscarriage and misoprostol. Generally, I have a natural approach to this issue. I prefer to do nothing, or to treat with a procedure called Manual Vacuum Aspiration. There is no problem with just waiting for the tissue to pass on its own. The uterus is generally capable of expelling tissue and clots, and should do so on its own time. Some things that can help stimulate the uterus to contract include sex, and lower abdominal massage. Many women are concerned that having residual tissue can be a cause of infection. There is no evidence to support this.
The other natural approach to treating retained tissue (after miscarriage, misoprostol, the Abortion Pill, or incomplete abortion) is the Aspiration Procedure. I hesistate to tell you about it, because it is unlikely that your doctor performs this procedure, and it can be hard to find someone who does it correctly. The Aspiration procedure is a gentle method, that only takes a few minutes to complete. The doctor inserts a thin "straw" through the natural opening of the cervix, attaches a small handheld device, and applies gentle pressure. In minutes, the tissue is drawn into the device and the issue is resolved. There is minimal discomfort because there is no electric suction or scraping. This procedure is optimally done in a regular medical examination room, and the experience can be similar to getting a simple pap smear.
There is more information on treatment of miscarriage and the Aspiration procedure on my website: http://www.earlyabortionoptions.com and at www.ipaswomancare.com. You can find doctors who perform Aspiration at http://www.earlyabortion.com
If you cannot get the Aspiration Procedure, I would do nothing. If the bleeding continues and it is not tolerable to you, my second choice would be to get a surgical procedure, but make sure is not a D&C and does not utilize scraping. A surgical abortion without scraping is sometimes called "suction curettage." Uterine scraping is completely unnecessary in this situation, and can cause scar tissue that can interfere with future pregnancies.
I hope this is helpful,
Doctor Joan
Early Abortion Specialist
New York City
