Patient: I had a miscarriage in March and have had 2 d&c procedures since then to remove retained products of conception. I had an ultrasound done 2 days ago after continued bleeding 3 weeks after my last d&c procedure. It showed that there is a small piece of tissue attached to my c-section scar. It is approximately 1 inch in diameter. The radiologist said that the tissue may resort and expel on its own. How long does it take for resorption to occur?
Symptoms: Vaginal bleeding post incomplete miscarriage in March
Doctor: Hello,Thanks for the query to ATD for an opinion,As you have had a caesarean section earlier and then this miscarr iage in March was followed by 2 D&C procedures already and still there is a 1 inch of gestational tissue stuck to the caesarean scar left inside, a repeat D& C procedure is not indicated as it can be dangerous and can lead to excessive bleeding again. So , the idea that it would reabsorb on its own would take around 2-3 months in general if not accompanied with medication to help resorption.Ideally now the course of management should be to check for serum beta hcg levels weekly which should show a declining trend each time. If the levels don’t reduce in next three weeks then you may have to be placed on methotrexate therapy protocol which shall help resolute the cytotrophoblastic tissue faster and then that would have to be followed again with weekly serum beta hcg levels till the levels drop below 1ng/dl. Till then pregnancy has to be avoided and contraception has to be practiced. You may discuss the option of methotrexate therapy with your physician and take an informed decision.You may have irregular bleeding off and on till the complete tissue resolves, so please don’t be alarmed.I hope i have answered your query in detail,Wishing you good health,Regards
Comments / Follow Ups
Patient: Thank you so much for your thorough response. Do I need to worry about infection occurring while waiting for resorption to occur? Should I take antibiotics even though I currently don’t have any signs of infection…no fever, tenderness, or bad smelling discharge? If so, would it be possible to take Levofloxacin as monotherapy rather than metronidazole and doxycycline?
Antibiotics are not indicated for products of conception unless there is an infection. The concern with retained products is inadequate involution of uterus which can sometimes predispose to infection. In case of infection levoflox alone may not be sufficient as it would be covering anaerobes which is covered with mertronidazole or ornidazole.
So single therapy may not be sufficient. Please follow as advised earlier regarding methotrexate therapy, it would be helpful.