Expert: Doctor Early Options - 3/26/2011

Question
Hello,

I took the first pill on Thursday at 3pm. My nurse-practitioner said i should start bleeding after i took the 2nd pill on Saturday at 3pm. However,  I started to bleed and mildly cramp Friday around 11am. I called my doctor and she said this was a good sign. A small purplish brown piece of "blood"?? came out at first. i wasn't worried it was about 2 inches long and 2/4 on an inch think. But about 5 hrs later a huge  clump about the size of my fist came out while urinating. The inside of the "sac"?? had was pinkish with a thick white substance that appeared like a line. Before the  "sac"?? came out i was changing pads every hour. But the bleeding slowed down right afterward. I called the doctor on call and she said its normal. and i should take the 2nd pills.  This advice conflicts with my my original doctor said. Can you tell if  the doctor's on call advice was sound and what was that large thing that came out? Also, can you explain the real terms for the words i put in quotes? And tell me  what questions i should ask my obgyn during the follow up visit?
-thank you

Answer
We always have our patients take the second set of pills to make sure that all the tissue is passed from the uterus. The second doctor was correct.  The "sac" is the gestational sac where the fetus develops and is nourished.  In early abortion, the fetus is so small it is not visible. Only the sac can be seen.
You need a follow up ultrasound. You should ask about contraception and how long you will bleed.  Most patients fail to start a reliable form of birth control.