Expert: Doctor Early Options - 1/12/2010

Question
I had a mva done on january 6th with barely any bleeding, this morning january 11th I am having heavy bleeding and severe cramping. I go through about a pad every hour and a half. is this normal? And how long can i expect this to last?

Answer
Dear Suzanne,
Heavy cramping and bleeding following an MVA (Manual Vacuum Aspiration), surgical abortion, or even a medical abortion usually indicates "retained products of conception."  This simply means that all of the tissue of the pregnancy was not removed, and your uterus is now expelling it naturally. "Retained products" is not really considered a problem or a complication unless your uterus is not able to complete the process on its own, in which case you need to have a quick repeat procedure.  

An early pregnancy consists of a small "gestational sac" (a fluid filled membrane about the size of a grape) and decidua - a thick membrane that lines the uterus to support the pregnancy.  There is no visible embryo at this stage.  It is common (and normal) during an abortion to remove the sac, but sometimes there can be a little decidua that remains in the uterus. Usually the uterus expels this without difficulty and you don't notice it, but sometimes women have heavier bleeding or clots as you describe.

The process of naturally expelling the tissue usually takes about 24 hours.  You can take ibuprofen(800mg), massage your lower belly, or even have sex (probably not appealing - but it does help to stimulate your uterus to contract and expel the tissue).  If it takes more than 24 hours of if you bleeding more than 2 pads/hour for 2 hours, you should call your doctor.  Also, if you have any signs of infection (fever, persistent pain that does not come and go, pain on touching your belly, or pain on walking or jumping) you should call your doctor right away.

There is more information on retained products of conception on my website: http:/www.earlyabortionoptions.com (after your abortion).  

I hope this is helpful,
Doctor Joan
Early Options
New York City