Expert: Pat G - 6/17/2010

Question
QUESTION: Hi Pat.
A little over a year ago I had an abortion. I was a mum of two, having just seperated from their father, and found I was pregant. I started a new relationship just before finding out, and chose to abort the pregnancy at 14 weeks. I couldnt take the risk that I would end up single again with three children.
After this, i went on the Depo injection as my chosen contraceptive method, but came off it after six months because of the amount of weight i gained. My preiods started again in January, and became regular from March. I can always tell when im due on because I get sharp cramps in my stomach the day before i bleed. After struggling to get down to the comfortable size 14 i am now, my parter and I have agreed to start trying for our own baby. We're not bothered about timing my ovulation schedule, etc. we're just going to have fun making love naturally. However, i was due on just over a week ago, but my partner and i had had unprotected sex a few days before, and my periods never came. I did an ovulation test yesterday- well, to be honest i did three!- and they were all positive results. If my body is ovulating, why has my period not come? Am i pregnant already? And will there be complications because of my previous abortion?
Thanks for reading this essay!!
Regards,

Kate

ANSWER: Hello, Kate,

When I read accounts like yours, it just reinforces the fact that I believe in "never say never"! I don't have any idea why you had a positive ovulation test after you should have had a period that didn't come. If your period had been completed a week ago, I'd fully believe that you are ovulating right now.

So I'm just as puzzled by this as you are.

You should go ahead and test for pregnancy. I know from personal experience it's possible to ovulate while pregnant, but this is not common. You could possibly conceive a second baby, and they would be a month apart in development. This may not be a problem, because sometimes both babies are born and do fine.

However, you asked me to tell you if there might be complications because of your previous abortion. Yes, that is a very real possibility. Here are the things you need to watch for.

Tubal pregnancy. Abortion at 14 weeks would have involved scraping the surface of your uterus. This causes scar tissue. If the scar tissue partly covers the opening to the Fallopian tube that ovulated this time, it could leave an opening big enough for sperm but too small for the zygote. If you start to feel pain, get it checked out right away. Tubal pregnancy requires emergency surgery.

Miscarriage or very early birth. This is caused because in a surgical abortion, the cervix is forced open with rods, and this causes many tiny tears in it. This weakens the cervix so it cannot hold the weight of a full term baby. Also, scar tissue can be a factor by providing inadequate support for the placenta. Prematurity can cause some fairly serious birth defects. Be sure and get good prenatal care, and tell the doctor you have had a surgical abortion. Ask him to tell you how to detect if you are experiencing early onset of labor. During the second trimester, he can fasten the cervix shut to prevent one of these things from happening.

Complications at the time of birth. There are two main ones. Placenta previa is when the placenta is too close to the opening to the cervix. Labor can tear it loose and the resulting hemorrhage threatens the life of both mother and baby. The remedy is to do a Caesarian section. They should be able to tell where the placenta is beforehand with ultrasound. The other one is prolonged labor. Again, this could be caused by damage to the cervix. If labor lasts too long, it is a threat to both mother and child. Again, the remedy is Caesarian.

I hope and pray everything goes well. Please take care of yourself and your baby (if you are pregnant). Let me know what happens!

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

QUESTION: Hi Pat.
After your help previously, I automatically thought of you now.
I had a positive pregnancy test yesterday, but the line is so faint, i thought i would wait a week before going to the doctors and hope for a more defined result. However, last night i experienced uncomfortable cramps, and i just started bleeding. However, the blood does not look like my usual period. Its, for lack of a better work, patchy and brown in colour. Is this a miscarriage?
Regards,

Kate

Answer
Hi, Kate,

It sounds like a miscarriage. It also sounds like it was awhile ago, and your body is just now taking care of the situation. As long as you don't put anything into your vagina, you should be fine; just let it take its course. People worry about infection, but infection has to be introduced from the outside. That means, keep everything out. Just keep an eye on things, and test again in a few days.

Doctors are a little too quick to intervene and scrape out the uterus. Not only is this another source of infection, but it can cause the same damage an abortion does, and this can cause significant problems in the future. So as long as you are doing OK, it's best to wait to let a doctor do anything.

Obviously, I can't determine for sure you are having a miscarriage, but sooner or later it will become obvious what has happened.

Please take care. And thank you for thinking of me.