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Abortion/clot, bleeding, cramping, foul odor, abortion pill, medical abortion

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Expert: - 10/18/2009


Question

Tissue mass
My husband and I choose to have a medical abortion on July 17th of this year do to my age (39). The procedure went as expected and I did a follow up appt a week later. There I took a pregnancy test and had a vaginal ultrasound down. I was told I was not longer pregnant and that everything looked fine. I bleed for about 2 weeks after again as expected that tapered of and stopped. I didn't not use tampons even after they cleared me to use them. about 42 days later (Aug 28) I had very light spotting lasting about 4 days. I only used a panty liner.  I was told my periods would come back a bit irregular and assumed that was the case. On Sept 17 I had light cramping and spotting after sex with my husband that only lasted 1 day. Panty liner protection. I had been having some discomfort during sex if my cervix was bummed. Also I inserted my finger to feel my cervix to see if it was hard or soft. It felt soft but moving it did cause some slight discomfort. Never a buckled over shooting pain discomfort but more resembling the light cramping you would feel when your period is about to start.  On Sept. 28th ,31 days after what I thought was my first period after the procedure. I started spotting with mild cramps. I assumed this was my 2nd period after the procedure. The flow was so light really only on the tissue when I wipe and a couple of times light spotting would appear on my panty liner. Today is Oct 18th and since the 28th of Sept. I have been spotting like this. the flow is very mucusey clear with red stringy blood in it. Sometime it would be a dark brownish red. Some days I would feel light cramping and had a heavier discharge. Always the discharge seemed mucusey. I called the clinic to try and set up a follow up exam as I am concerned and wanted to make sure the procedure did in fact go as expected. they told me the Dr. is not taking new patients that my hormones are probably out of balance and that they referred me to a recommended obgyn for a pap. I was very surprised and upset by this as I would think that aftercare shouldn't have ended with the 1 week follow up exam. This was on Friday and it is now Sunday morning. Saturday I started having some mild cramping again and a heavier discharge but still not enough to wear more then a pantyliner. This morning I just passed a firm dark reddish black mass of tissue the size of a large cashew. The mass had a fatty fleshy looking coating and when press on it, it leaks bright red blood. I have no cramping and there was no blood that came out with it. Overall I feel and have felt fine. Other then the constant spotting this past 3 weeks, No fever, No weakness, Plenty of energy. Is this left over pregnancy tissue?  I wrapped it in plastic wrap and put it in an envelope in my fridge. Should I take it to the clinic or just call a obgyn? I don't have a regular doctor here yet. I was waiting to be "back to normal" before I went to find a regular doctor.  I know this is a rather long question but I wanted to be as detailed as I can to give you a clear picture of what is going on and what I have been experiencing. Thank you.

Answer
Dear Debbie,
I am so glad that you asked this question.  Believe it or not, there is very little written about passing this type of tissue after a medical abortion.  I only know about it because my office has been at the forefront of providing medical abortions since 2000, when the abortion pill was first approved by the FDA.  This happens in only about 1/1000 or less medical abortions.  So, unless you have seen many patients, you would not know about it. The first time I saw this with a patient, I was as concerned as you are.

The tissue that you passed is called DECIDUA.  Decidua is a thin but strong layer of connective tissue that forms within weeks of becoming pregnant.  It lines the inner cavity of the uterus, and it attaches to the uterine wall, to hold the developing pregnancy in place. In early pregnancy, under 9 weeks, there is no visible embryo, only cells.  There is only decidua, and a tiny fluid filled "sac" - about the size of a grape - that later becomes the amniotic sac.  

In this situation, you passed the pregnancy (sac) during the medical abortion (that is why the doctor said it was successful).  However, the decidual tissue got "caught" in your cervix, on the way out.  It has been sitting in the opening of your cervix for 3 months forming a sort of "plug."  The longer it sits there, the more dense it becomes.  IT IS HARMLESS, and does not cause problems for future pregnancies, and does not typically cause a serious infection.  It can start to develop a very foul odor. This is an overgrowth of normal bacteria, and can be treated with antibiotics.

The reason I am so happy you asked this question, is that many women encounter this problem, but they don't know what it is, and the doctors don't know what to check for.  FOR WOMEN WHO HAVE SIGNIFICANT CRAMPING AFTER 24 HOURS OF TAKING THE ABORTION PILL, or intermittent heavy bleeding, THE DOCTOR SHOULD RULE OUT A CLOT THAT MAY BE STUCK IN THE CERVIX.  THE DOCTOR SHOULD DO A SPECULUM EXAM, AND THEY SHOULD LOOK AT THE CERVIX ON ULTRASOUND.  Many doctors and sonographers only look at the uterus, to make sure it is empty, but don't look at the cervix.

You intuitively did exactly the right thing, by feeling your cervix.  Because you did this, it dislodged the plug, and it came out naturally. The good thing is that once it is passed, you should be completely fine.  There is no need to get another check up, unless you keep having symptoms of cramping, a foul odor, or unusual bleeding.  That might indicate that part of the clot is still in the cervix or that you have an overgrowth of bacteria.  Looking at the picture you sent, it looks like the entire clot passed intact.

I hope this clears up all your concerns and questions.  
Doctor Joan
http:www.earlyabortionoptions.com
New York City

Doctor Early Options

Expertise

We are a group of family doctors who provide abortion care for over a decade. We can answer any health or medical related questions about early abortion, including the aspiration procedure, the abortion pill (RU486), or surgical abortion. We run a practice called Early Options, located in New York City: http://www.EarlyAbortionOptions.com. The practice is dedicated to making early abortion part of mainstream medical care. There are other family doctors around the United States who practice a similar approach to early abortion care: see http://www.EarlyAbortion.com. Please do not ask "private" questions so that other women can learn from your experience. Please tell me what country you are from so that we can better help you.

Experience

Experience in the area: We are all board certified family doctors who have special training in early abortion and reproductive health. Dr. Joan Fleischman is the founder of Early Options (earlyabortionoptions.com) dedicated to making early abortion part of mainstream medical care. Organizations: National Abortion Federation American Association of Family Physicians

Education/Credentials
Dr. Joan Fleischman, Founder M.D., Harvard Medical School M.P.A., John F. Kennedy School of Government

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