Medical abortion with little bleeding and no gestational sac

Pregnant women who use medical abortion must pay attention to whether the gestational sac is discharged. Because if the gestational sac is not discharged, it means that the medical abortion is not clean. There are also residual substances in the uterus, which makes the uterus prone to inflammation. Some pregnant women often bleed due to their physical conditions, but the actual gestational sac is not expelled. At this time, it is necessary to adopt appropriate methods according to the situation and continue to use drugs to expel the gestational sac. Or stop medical abortion and use other methods. But what can I do if the bleeding is less and no gestational sac is seen after medical abortion?

1. What should I do if I don’t see the gestational sac discharged after medical abortion?

As required, after taking abortion pills and starting vaginal bleeding, you should use a basin to catch the bleeding when going to the bathroom, and observe whether the gestational sac has been discharged. However, some patients are sometimes negligent and do not use a basin to catch the bleeding, resulting in not knowing whether the gestational sac has been discharged after bleeding. At this time, you can make a judgment based on the following situations.

(1) If you have heavy bleeding within a few hours after taking misoprostol, but the bleeding is gradually decreasing now, it means that the gestational sac has been discharged, but you did not see it at the time. It is white, about the size of your own fingernail or pigeon egg, and sometimes it is wrapped in a blood clot. You cannot see the blood clot without washing it with water. If the gestational sac has not come out, the bleeding will not decrease, but will continue to increase. Generally, the embryonic tissue is expelled within 4-6 hours. Generally, after the blood clot is discharged, the abdominal pain gradually stops and the amount of bleeding is greatly reduced. However, whether it is completely discharged needs to be identified. Abortion is successful only when the complete embryonic tissue is eliminated. Identification of the blood clot is a very important step. The method is to put the menstrual blood in a container, add water and gently rinse it. After the blood clot disappears, if you see a small water bag, sometimes you can see something that looks a bit like a shrimp, which is the embryo. Then you need to find the villi, which are attached to the surface of the embryo sac. After being rinsed in water, they appear white and fluffy. If this mass of fluff is seen, it can be further confirmed that it is an embryo, indicating that the embryo has been expelled and the abortion is complete.

If only blood clots or some flat tissues are discharged, and no embryo or villi are found after identification using the above method, and the abdominal pain is still severe and the bleeding is still heavy, then the gestational sac tissue has not been discharged. At this time, you can take 3 more misoprostol pills or inject another oxytocin at the same time, which will help cervical dilation and uterine contraction, thereby expelling the gestational sac. You can also take Gongxuening at the same time, two pills at a time, once every 6 hours, for 7 consecutive days. This medicine can reduce inflammation, stop bleeding, help the uterus contract, and expel residual tissue, with a relatively good effect. You can also take motherwort paste or motherwort powder. Check again after 15-20 days. If it is negative, it is clean. If it is positive, it is not clean and you can have another uterine cleaning. After such treatment, most of the abortions will be successful.

(2) If there is little or no bleeding a few hours after taking misoprostol, it means that the gestational sac has not been expelled. You can take 3 more misoprostol tablets or inject another oxytocin at the same time. If the gestational sac is still not seen after 6 hours, observe for a few more days, because 10% of people can expel it within a week. If the gestational sac is still not expelled after a week, you should go to the hospital to see a doctor and take the next step, such as taking abortion pills again or having a uterine cleaning.

2. Is medical abortion clean?

Incomplete abortion is very rare. Some people say that the medical abortion was not complete, so they did a uterine curettage. A very small number of people should have a uterine curettage, but the vast majority should not do it. The main reason is that the doctors' level is limited, or they have no experience. For example, in medical abortion, 98% of the fetal sac is expelled within 6 hours after taking misoprostol, 1% is expelled within a week, and 1% is ineffective. In actual work, some doctors consider medical abortion failure if the fetus is not discharged within 6 hours, and they will easily perform uterine curettage. They don't know that there is still 1% chance of discharge within a week. Furthermore, even if the abortion is complete, a small amount of bleeding may continue for 14-18 days. What you see under B-ultrasound are also residues. These residues are composed of blood stasis and decidual fragments, which are gradually discharged after the abortion. Some doctors mistakenly believe that the residues or bleeding that are gradually discharged within a normal period of time are not complete, and perform a uterine curettage prematurely, which causes unnecessary pain to the patients. This shows that when choosing to have a medical abortion, you must go to a regular large hospital!

Furthermore, if the abortion is medically successful (calculated from the time the gestational sac is expelled after taking miso), check again 15-20 days later. If the pregnancy test is negative and there is no more bleeding, the abortion is considered complete. If the pregnancy test is positive or bleeding is still ongoing, it may not be a complete abortion. In this case, another B-ultrasound examination is required. If it does show that the abortion is not complete and conservative treatment has been unsuccessful, then a uterine curettage should be performed.