QuestionHi. I'm writing from Ontario, Canada. I want to know if/when a D&C is necessary. My history is: 5 early (7 - 12 weeks) miscarriages, one healthy baby born, then one more miscarriage and believe I have another non-viable pregnancy right now. I have had two D&Cs. One was at about 15 weeks when I had my first ultrasound and the pregnancy was found to be non-viable, but there was no bleeding. The other: after a long time with no period, I suddenly started bleeding A LOT. The heavy bleeding ended after a couple of days, but I continued spotting for about 2 months. At which point I got fed up and went to my doctor. Blood tests showed that I was pregnant, which I now understand to mean that the original bleeding was a miscarriage (even though I didn't know I was pregnant) but that it hadn't been complete since my body still thought it was pregnant.
But both times I went to Emerg (where my doctor told me to go), they asked if I wanted to have the D&C or not. Why would my doctor say to do it, but the hospital implies it's not necessary? What happens - long and short term - if I don't get the D&C? Might I stay in a "pregnant" state forever? Will that cause any problems?
Thanks very much!
Crystal
AnswerHello Crystal from Canada,
The problem is that you might have some retained products from the pregnancy, in which case the pregnancy test will still be positive. A D%26C would be recommended in that case. One way of knowing is that usually there will be continued bleeding after the "miscarriage" if there are retained products. This continued bleeding is a nuisance and most patients will want it taken care of, hence necessitating a D%26C. In addition, retained products can lead to a uterine infection, which can potentially cause scar tissue formation within the uterus and infertility problems.
If you decide not to have the D%26C, then your doctor should follow your pregnancy hormone test down to zero. That way he can assess if there is any retained products, that are actively producing the bHCG hormone. If that is the case, then a D%26C would have to be done. I think that you can see that I am leaning toward recommending a D%26C in your case, but each patient has to be evaluated individually. I certainly don't recommend D%26C in all my miscarriage patients and elect to follow them closely instead.
Good Luck,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf, and follow me on Facebook at http://bit.ly/9Iw9oV
