Expert: Doctor Early Options - 2/19/2009

Question
Dear Dr. Joan,

I had the aspiration procedure on Jan. 29th.  I had severe bleeding and huge clotting with minor cramps so I came back for a follow-up and given methergine to help stop the bleeding. The ultrasound just showed some blood but nothing serious.  I took all the methergine (about 10 total over a few days) and the bleeding subsided somewhat.  Tonight I am clotting again, and some gushing of fluid, and I am wondering what could be causing all the bleeding and clots?  I am getting afraid I have a uterine perforation, although it seems so unlikely.  Are there any other complications that could happen?  Thank you so much for your kind expertise.

Answer
Dear April,
It sounds like you have something called "retained tissue."  Sometimes even a tiny bit of tissue in the uterus can cause continued bleeding that forms clots before it comes out.  This is common, and does not have long term consequences.  Retained tissue happens most commonly with a uterus that is retroverted, or tipped back.  This is a completely normal shape, but it just makes it hard to pass tissue naturally.

As far as treatment, methergine usually does not help with this situation.  The treatment is to either wait it out, and see if it will pass on its own, or to repeat a procedure.  If you are having a significant amount of bleeding and clots today, then I would give it 24 hours and see if it resolves on its own.  If it doesn't you may need to get a very quick and simple repeat procedure.  It only take a minute or so to re-aspirate the remaining blood and tissue.  

I am curious where you got the aspiration procedure.  It is the most safe and simple way to end early pregnancy, but very few women have heard of it.  It is difficult to find a doctor who performs it.  

I hope this is helpful,
Doctor Joan