Subject: Miscarriage
Date Asked: 2009-10-15
Date Answered: 2009-10-15 on allexperts.com
QUESTION: Dear Doctor Joan,
I am 28 year old who have been for 2 years. I got pregnant for the 1st time in August and my pregnancy lasted for 9 weeks because I found out on the 8th week that the fetus had no heartbeat so the doctor suggested to either wait for miscarriage to happen or I do D&C and I chose to do D&C. After 2 weeks of the procedure, I kept on spotting and then I went to the Gyno and he said that there is still some more left but he didn’t want to remove it all because he says it might cause rupture so he believes the body should expel it on its own as well. So last week, he gave me Cytotec for 2 days to swallow and then after 5 days of taking Cytotec, I went for a vaginal ultrasound and it still showed that I had a bit left. So again, he prescribed 16 pills for 24 hour period, as in 4 pills every six hours to be inserted vaginally. It’s been 28 hours and I still have no bleeding and slight cramping. Though when I started taking them, I slept and got chills. My question is, is it normal that after I do D&C to have pieces left inside my uterus? Also, is it ok to be taking Cytotec so much over a short period? Lastly, the doctor suggested that if the Cytotec doesn’t work then I should do another D&C but im scared, should I do it?Is it ok to do D&C twice in 1 1/2 months??
Doctor, what do you think I should do!?I’m very worried and emotionally drained and where I’m residing currently, I don’t trust doctors as much as Canada or the States.
Thank you,
Tia
ANSWER: Dear Tia,
This sounds like a very difficult situation. My suggestion would be to do nothing. In the United States, the most common way to treat an early miscarriage (under 9 weeks) is to let it pass on its own. In an early pregnancy (less than 8 weeks), there is very little tissue. What the doctor is seeing on ultrasound is very small. The body will expel whatever tissue that is remaining naturally in the next few months. There is no risk to waiting. There is no additional risk of infection. There is no problem with spotting, or having some cramping. However, there are risks of D&C’s – given what you describe to me, it is not worth the risk at this point. There is no restriction on your activity – you can go ahead and have sex again, and it is good for you to exercise. These activities will naturally stimulate your uterus to contract.
Emotionally, it would be most helpful for you to be reassured that there is anything wrong with you. It is common and normal to have a little tissue remain for weeks after a miscarriage. There is no reason you won’t be able to get pregnant in the future. From what you describe, the only thing wrong is that your doctor is being too aggressive for something that your body is able to do naturally.
I hope this is helpful,
Doctor Joan
———- FOLLOW-UP ———-
QUESTION: Dear Doctor Joan,
Thank you so much for your very detailed and comforting response, muchly appreciated.
So you’re suggesting the next time my doctor suggests to do D&C, I should tell him to wait and also if he prescribes Cytotec again, I should ask him to wait. As I did the D&C on Sept.14th.2009 so it has only been a month.
My only concern is because my cousin had some tissue left after having a miscarriage and she couldn’t get pregnant then but when she did D&C 2nd time, she was able to get pregnant afterwards. I really want to hope for the best.
In the US, with persons like myself, you don’t recommend another D&C? And how long should one wait to see when the body expels the remaining tissue? When should I expect my next period?
I’m glad you mentioned, that extra tissue does not cause an infection. It’s very comforting.
You know what bothers me about residing here in the Middle East is that doctors are so quick on giving strong medications and following invasive procedures. They don’t beleive in the body healing itself which makes me worry so much. What’s worse is when they tell you things like “no sex for another 3 months, no exercise for another 2 months as well and no lifting heavy things”. Now, for me it makes sense not to do the mentioned above for 2 weeks or up to a month but not 2 months. When my husband heard that, he was like “no sex for 3 months, why?” and he freaked out about because he was worried about me.
I’m really drained from people here. It’s tiring to always doubt what doctors are doing, yet you have no other option. I’m glad I found this site and found you.
Thank you,
Answer:
Dear Tia,
Yes, it my recommendation to just watch and wait, and to go about your usual activities. It is completely fine to have sex and to exercise, and can help resolve this issue naturally. You might just wait and schedule your next visit with the doctor several months from now. There is no way to tell when you will get your period.
Write me back if you have any problems or continue to feel concerned. If this situation does not resolve on its own in the next few months – the best option would have been the Aspiration Procedure, but I am sure it is not available in Jordan. The second best option is to try cytotec again.
It is not only in the Middle East where doctors are overly invasive…in the United States most abortions are completed by D&C, even though the World Health Organization recommends the Aspiration Procedure and the Abortion Pill as the most safe early abortion methods. Unfortunately, it is extremely difficult to find a doctor who will do the Aspiration Procedure – even here in the U.S.
I hope this is helpful,
Doctor Joan
http://www.earlyabortionoptions.com
New York City
Tags: Early Pregnancy, infection, Miscarriage, ultrasound