Expert: Doctor Early Options - 7/23/2011

Question
QUESTION: Hello i am from India. my wife had 1 medical abortion in 2003, then we had 2 children in 2004 & 2007. in 2008 or so there was a continuous period and D&C was done by the doc. In may 11 pregnancy was positive and Medical abortion was done in may 11 end, the bleeding lasted for around 15 days. doc confirmed the successful termination of pregnancey after sonogarphy in follow up visit. on 6th july 11 first period started, first 2 days only spotting then bleeding with small to medium clots, sometimes the blood was bright red too but mostly on darker side, the bleeding was continuous some times and sometimes intermittent. on 15th july doc gave some medicine (meftal spas/dysmen, dexorange and 1 more) for 5 days but the bleeding reduced and again started medium to high. yesterday the doc gave regulate medicine for 20 days but advised that if the bleeding does not stop in next 5 days they would do D&C and that should close the matter. we are worried. please advise

ANSWER: WE usually perform an Ultrasound to see if any tissue is remaining.  The bleeding can be due to that.  If you are bleeding that heavily, the tissue needs to be removed.  With the pill, you can bleed for 80 days.  

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

QUESTION: Thanks for the response.

Sir which pill have you referred in the answer - MT Pill or the regulate (since this is the first period after medical abortion).

after taking 3 tabs of regulate (1.5 days) the bleeding has reduced considerably and we hope that it may end. however as you told and we too doubted that there might be some tissue remaining in the uterus, please guide us on the following :-

In case the bleeding continues -

should we go for D&C after 5 days dosage of regulate as told by one doc (another doc told us that since we had used regulate the D&C can be done only after full dosage of regulate i.e. 20 days)

In case the bleeding stops -

should D&C still be done (since the tissue might still be there) or ultrasound should be done to see if the tissue is there and D&C be done only if the tissue is present?

What is the recovery time after D&C and is there any after effect of D&C?

Thanks in advance.

ANSWER: The ultrasound will reveal if there is a need to perform a D&C.  If there is no tissue, no intervention is needed.  If there is any left then the D&C is needed.  Recovery time is short.  

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

QUESTION: Thanks. Sir please answer to all queries raised in my followup question.

Answer
The pills I was referring to were Misoprostol.  That is what we use to stop bleeding.  Meftal spas does not work well to expel clots from the uterus. I can not answer your question.  I always perform my own ultrasounds so I always know whether there is any tissue left.  Also, the recovery from a D&C depends on whether general anesthesia is used.  If it is used then, the recovery is a few hours.  

The medicines you are discussing, are not used in the US.  I have no experience and can not address your concerns.