I had a missed miscarriage at around 3 months that


Q: I had a missed miscarriage at around 3 months that was found 3 weeks ago. I was given two rounds of misoprostol to clear the remaining tissue and fluid. I went in for a follow up appointment because I was having a lot of pain and bleeding still so my doctor gave me pain medication and told me to wait for it to clear. Over the last two weeks I ended up in the ER twice due to continued bleeding and such severe pelvic cramping and stabbing sensations I was vomiting. They performed a D&C to clear any remaining tissue and found a mucus plug as well. It's been a week since and my pain has gotten worse and I am now having spasms that radiate through my back, I'm still bleeding heavily and the pain in my pelvis and uterus is so intense I am bedridden. My gynocologist cannot find a reason why this is happening and seems to think I'm now just faking the symptoms for pain medication. I'm miserable and in more pain than I've ever experienced, had to take the semester off school, and am desperate for any sort of answer. Please help


A:   Hello,
Thanks for the query to ATD for an opinion,

It is surprising that the bleeding and pain continues after D&C has been performed for continued bleeding post misoprostol for retained products of conception. The fact that you still have cramps and heavy bleed indicates that possibly D&C was inadequately performed and the products are still remaining or there may be an element of placenta ingrate where the placental tissue grows in the myometrium and disallows myometrial vessels to contract and cause continuous bleeding and cramps with an aim to remove that piece of placental tissue naturally.

You need to get a transvaginal ultrasound done to check for any remnants and any evidence of placenta-increta because if present then you have to undergo a D&C again but after a hysteroscopic removal of the products under vision.

You may discuss the possibility with your gynecologist and take an informed decision.

I hope i have answered your query in detail,
Wishing you good health,

Comments / Follow Ups

Patient: I've had several trans-vaginal ultrasounds already and since the procedure and the D&C was hysteropic (they used a camera). Are there any other potential causes of this pain?
Doctor: You should be placed on antifibrinolytics to control the bleeding and NSAIDS should help. Other causes could be sub mucous fibroid, adenomyosis, uterine polyp, but as usg and hysteroscopy has been done no other causes seem to fit in .
Patient: Is it possible the placenta-increta could have been missed during the D&C? Is it normal to have a full mucus plug after only three months of pregnancy and could that potentially be a clue to whatever is going on?
Doctor: Mucous plug is present cervically whites normal. Also increta is usually not missed if hysteroscopic examination is being done.
Doctor: Mucous plug in cervix during pregnancy is normal.

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