Expert: Pat G - 3/9/2010

Question
QUESTION: hi. i went to a clinic three saturdays ago to have a medical abortion. i had gone to the er the wednesday before taking the medication and that is where i learned i was pregnant. i was told that they didnt know really what was going on. they couldnt determine a yolk sak and said that the rate the what could be the fetus was slow to date. they did see something in the uterus. so i decided to have the abortion bc i considered a lot of things and decided it was the best thing for me to do. if the baby was going to have disabilities or not. (my hcg was also low for how far along i was.) i should have been 5 weeks. when i took the pills that disolved in my mouth it took 24 hours for me to feel any different or to start to bleed. i only bled a small amount. i threw up one day. had some back pain and slept a lot. it seems like the bleeding stopped after 5 days. i only used two pads a day. yesterday i started feeling bad back pain and have felt like im going to throw up real serious like. when i get that sick feeling in my stomach i start to bleed. i am bleeding bright red blood and jelly like clots the size of a quarter. is this normal? if this my period? i also started taking birthcontrol the day i took the pills that disolved in my mouth. should i be concerned? please help

ANSWER: Hello, megan,

You didn't say how far along you were. This is important. Please let me know that.

A woman should always be concerned when taking these powerful and dangerous medications! From the sound of things, you got some bad advice. The first principle of medicine is "first do no harm". That means unless there is a clear medical indication, they should do nothing. The people in the emergency room should have told you to wait and see what happens. They should have suggested you test again for your hCG levels in a few days. And the waiting and doing nothing should also have included the person who gave you the pills. I sometimes tell women to have their hormones tested to see if there is even a possibility that the pregnancy isn't strong and will go away by itself. If a woman takes medication as soon as she becomes pregnant, it is also pretty much a make or break situation. Birth defects are less likely than outright miscarriage.

Given that your hCG was low, I would suspect you really didn't need to do anything. If the pregnancy wasn't viable, you wouldn't have to do anything at all, and it would resolve itself, without risk to you. But of course if they had done that, they wouldn't have gotten money for the pills from you.

There is nothing normal about what happens after a woman attempts an abortion. Abortion is dangerous, and everything that happens afterward is also abnormal and possibly dangerous. One of the pills they give is being given against the express instructions of the manufacturer, which instructs that a pregnant woman should never take it. Whoever gave you these pills committed malpractice, in my opinion.

The birth control also complicates the picture, because sometimes it will cause excessive bleeding, and sometimes it stops the bleeding altogether. Your situation seems complicated enough that there is no telling what is really happening.

If you tell me how far along you were, I'll offer some additional thoughts. In the meantime, I recommend you find a decent doctor and ask him about all these issues. Don't go back to the person who did this to you. Please let me know what you find out, and take care of yourself. Don't take any more chances. If you are still pregnant, make sure your doctor thinks of you both as his patients, and follow his guidance.

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

QUESTION: I was six weeks pregnant from the first day of my last period. The er dr also came to this conclusion. I got my er reports from the hospital just recently. Which I know I should have done a long time ago because something just didn't seem right of why no one could tell me what was going on after four hours in the er and a ton of tests. I failed to mention that iras having some back pain and a feeling of a uti or a bladder infection that I did let them know about. When the er dr came to tell me all my results he said I didn't have an infection but I had clue cells that could be causing me to feel this way. I continued to feel like I had a bladder infection for a total of three weeks. It strted a week before I went to the er. I left that out in my last message. Sorry. I thought that may help something too. But according to my us report it said there are two hypoechoic areas in the endometrium that are too small to characterize. Very early gestational sac is a consideration versus other etiology. The right ovary has a 17 mm cyst. What is probably the gestational sac at the uterine fundus measures 3 mm in diameter which is below range for gestatioanal age. Neither fetal pole or yolk sac can be confirmed. Probable interuterine pregnant below range for dating.
I don't know I'd that helps anything or not. After the er doctor was no help besides scaring me and telling me e didn't know what was going on but he didn't think it was good was when I did some research and decided for the medical abortion and went to plan parenthood. I guess it was kinda confusing in my last question bc I didn't tell you where I went I think I just said a clinic.
So I dis make a decision based on the er doctor. But I take full responsibility for what I did too. There was no way I could take care of a baby the way it needs to be. My work schedule is very stressful. I had been drinking. And takins prescription medication for stress. I had been taking phenteremine. I am a smoker. I was scared to dealth that these things would have could disabilities or abnormalties or even miscarriage. So in a way I had to do what I thought was best and I know some people wouldn't agree with me but I did it. And I will beat peace with my decision. I'm just wondering what I need to do now.
I don't know if feeling sick to my stomach at night is normal. Or the back pain or the bright red blood and the jelly like clots are something to be concerned about. I so have back pain with my periods but I don't usually feel sick to my stomach unless I have a migrane. Nut again the abortion happened three weeks ago it seems to be too soon for my period. But I have had problems with birth control knocking me off track even though I know they try to give it to you sometimes to he'll regulate. And I am coming to you for advice because iso t have insurance and I racked up a bill of 2500 I'm the er an paid planned parenthood 600.
Thank you for your help and your patience with my questions

Answer
Hello, megan,

This was very helpful. Thank you. And you're welcome.

Did you experience any kind of foul odor due to the clue cells? Why did you say it felt like a UTI? Did you test for pregnancy? When was this relative to the time you went to the emergency room? I also don't understand why the ER doctor would tell you that you didn't have an infection, when he said he saw clue cells. These would be in the endometrium of your cervix or uterus. Did he do any kind of examination of the cells? Clue cells are caused by Gardnerella vaginalis. If the substances you were taking had altered the normal vaginal flora of Lactobacillus, then G. vaginalis could take over. Maybe he thinks that's not an infection, but I wouldn't agree with him.

You didn't say what prescription medication you were taking for stress. But your taking Phentermine concerns me. For one thing, it lends itself easily to substance abuse. For another, it could be creating the very stress that you are trying to combat with the other medication. If you have been taking Phentermine for obesity, there are safer answers. There are things to look into that I would want to ask you about. For example, do you drink or eat anything with artificial sweeteners? If so, please be aware that artificial sweeteners can cause a person to put on fat. Aspartame, for instance, is a neurotoxin, and is definitely harmful. You don't even want to know about the manufacturing processes for sucrilose. It is NOT simply a different form of sugar. (If you want to talk more about all of this, let me know.) Add on top of that, the smoking, and it sounds to me like a recipe for medical disaster. Here are articles that tell you more about reasons not to take Phentermine:

http://www.drugs.com/phentermine.html
http://en.wikipedia.org/wiki/Phentermine

And then there is the birth control on top of that. Oy vey! This alone will alter the pH of your vagina, and leave you wide open for infection.

Regarding your pregnancy, several possibilities come to mind. If you were 6 weeks LMP when you went to the emergency room, your baby would have been about the size of the joint of your thumb. 3mm is nowhere close to that size. So if you were actually pregnant, I think the doctor would have been correct to say that all he found was a gestational sac, without a fetal pole or a yolk sac. However, if you had been pregnant for a shorter time, it could make more sense that it would be that size and that's all they found. I assume they did an ultrasound, and that's what they found. I'm not that gung ho about the accuracy of ultrasound, frankly. There have been too many times I know about where the conclusions reached from it were wrong, because it doesn't give a very clear picture of anything, just a very gross picture. In other words, it's like taking a picture of someone or something with your lens out of focus. That's OK if you're trying to look at a baby who is at least an inch long. But something only 3mm? I would be full of doubts about that.

What I'm questioning here isn't so much your actions, as those of Planned Parenthood. They gave you these powerful and dangerous medications, and from the sound of things, all they were interested in doing was collecting your $600, and that's money you could have used to get to the bottom of your problem. If indeed, you had just a sac and nothing more, then taking pills to produce abortion would be the wrong remedy. For one thing, you said you were afraid of miscarriage. These pills mimic a miscarriage to some extent, so I don't offhand see the difference. The only difference I can see is that you are less likely to experience guilt feelings from a miscarriage. From the sound of things, you didn't even have a baby to begin with, so I'm not sure that taking the pills should even be CALLED an abortion. Either your situation would have resolved itself, or it might require a D&C, not a medication used for stomach ulcers that the manufacturer says should NEVER be taken by a pregnant woman. Also, I don't think you'd have to worry about birth defects if there wasn't a baby to begin with. Did you show Planned Parenthood the information from your ER visit? Were they even interested? Did they take a medical history? Did they bother to determine whether you were really pregnant? Yes, there are abortionists who will provide an abortion on a woman who isn't even pregnant! I don't have a very high opinion of Planned Parenthood at all, for a large number of reasons.

As for your being in a poor position to take care of a baby, I can understand that. However, if you didn't have a baby to begin with, it wasn't something you needed to worry about. What you should worry about is continuing to take risks that might result in pregnancy with a live baby. What I mean to say here is that you should stop having sex, not that you should use "protection". Condoms are very unreliable. Unless you are married, the sexual activity just increases your risks, both medical and otherwise.

Since you don't have the money for additional medical care, here's what I recommend. Find an organization in your area that offers services to pregnant women and women who have experienced abortion. They do have doctors who volunteer to help women. You can get a recommendation from them. To find one near you, go here:

http://www.pregnancycenters.org/

You clearly have ongoing medical problems, and you need help. The kind of disaster you're courting could be far more serious than simply being pregnant when you are not in a position to take care of a baby.

That's all I have time to write right now. Please let me know how you do, and feel free to continue to discuss this with me, and provide the information I asked about.