Expert: Shan Yi Sheng - 1/18/2009

Question
QUESTION: my wife had periods on 06 dec 08. On 24 Dec there was a contraception failure and within 58 hours, she took I pill.Her periods didnot come on schedule and pregnancy test showed +ve. We went to the doctor who advised ultrasound. Ultrasound didnt detect pregnancy but intrauterine focal mass of 7x8x8 mm and products of early termination of pregnancy. Since the preg test was +ve, doctor advised 400mg misoprotol at 24 hr interval vaginally. My wife toof first dose of 400 mg 8AM 15 Jan and second on 8 AM 16 Jan. Today is 17 Jan there is no bleeding, Though there were cramps and stomach pain. Is it normal? Can anyone advise as to by what time first bleeding take place. Please advise earliest as cant trust doctor also.


ANSWER: Mr Singh,
1. A pregtest remains positive up to 3 weeks after an abortion.
2. What date did she do the pregtest ?
3. Your wife took 1 pill 58 hours after  the contraception    failure...question: what pill was that ?
4. 400 mcg perday is only for small midgets. Misoprostol is taken 3-4
tablets daily for 3 day, (best : let melt under the tongue.)

But I would have advised you to do nothing at all. Just wait, and if no period follows, do a pregtest ± february 15th.
in the mean time: have protected sex only.
take care,
dr Shan



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---------- FOLLOW-UP ----------

QUESTION: Dear Dr Shan
First of all thanks a lot for taking time out. Well my wife had taken IPill, the emergency pill from Cipla within 58 hrs.
Well on 17 Jan at night she passed some small clots, one red and about three white in colour. She is also passing white discharge continuosly but no bleeding.
Last dose of 400 mg Mesoprostol was taken on 16 Jan at 0800 hr vaginally. Total dose is 800 mg vaginally over 24 hrs.
There is some stomach pain, though not unbearable.
Please advise
Once again, Thanks a lot


Answer
Dear Sir,
the uterus us a self cleaning organ. That's clear from the menstrual periods, in which the old mucosal lining is removed.
This will also happen to (possible) rests of a very young pregnancy.
So the whole misoprostol treatment - in my humble view - was not needed. The tissue your wife passed with some clots was all there was.
As the ultrasound didn't detect pregnancy but "intrauterine focal mass" of 7x8x8 mm this means that the doc didnot know what he saw.
Now this doc cannot be blamed for that, as already 10 minutes after
an abortion there is some fluid and debris in the uterine cavity which
disappeares after 3-45 weeks.
By now the effect of the drugs taken must be gone.
Stomach pain cannot originate in miso taken 2 days ago.
I think your wife will be fine soon.
Hope this was helpful.
Bye for now,

dr Shan