Expert: Doctor Early Options - 1/21/2009

Question
Dear Doc
my wife had periods on 06 dec 08. On 24 Dec there was a contraception failure and within 58 hours, she took I pill(morning after 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 took first dose of 400 mg at 8AM on 15 Jan and second on 8 AM 16 Jan.On 18 Jan she passed three small clots, one red and two white. she also passed some fluid with cramps and stomach pain but no blood. Today is 21 Jan there is no bleeding, Is there a problem. Can bleeding be delayed for so long and what are our options now
Thanks a lot

Answer
Dear Lovely,
It sounds like this has been a difficult situation for your wife. It sounds like she has a pending miscarriage, but that the tissue hasn't fully passed. You have a few options.
1) Do nothing.  It will pass when it's ready.  This assumes that the doctor was definitely right and the pregnancy is not growing. The pregnancy tissue itself is very small.  However, passing it on your own can always be unpredictable.  
2) Repeat the misoprostol  If you were to do it again, I would do it in one dose - 800 mg at the same time.  Make sure she gets a stronger pain medicine, like vicoden.  Misoprostol can be repeated up to three times.  
3) Find an office that does the aspiration procedure.  This is a nonsurgical method that just takes a few minutes to complete.  However it can be very hard to find a doctor to do it.  If you are lucky to be near one of the sites listed on earlyabortion.com, they are very reliable.  
I hope this is helpful,
Doctor Joan
Earlyabortionoptions.com
New York City