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SRH clinical consult
Troublesome bleeding following early medical abortion
  1. John Joseph Reynolds-Wright1,2,
  2. Joanne Fletcher3
  1. 1 MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
  2. 2 NHS Lothian, Chalmers Centre, Edinburgh, UK
  3. 3 Gynaecology, Room G25, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  1. Correspondence to Dr John Joseph Reynolds-Wright, MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK; jjrw{at}doctors.org.uk

https://doi.org/10.1136/bmjsrh-2020-200672

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    Key messages

    • Retained products of conception (RPOC) are diagnosed clinically – in the absence of symptoms, post-abortion ultrasound is not necessary.

    • Infection may be responsible for troublesome bleeding following abortion.

    • Ensure post-abortion contraception needs are met – including an acceptable bleeding profile.

    Introduction

    Early medical abortion (EMA) (ie, using combination mifepristone and misoprostol to terminate pregnancies of less than 10 weeks’ gestation) is the the most common method of induced abortion in the UK.1

    The majority of EMAs in the UK are completed by patients in their own homes. Success of abortion can be confirmed with self-performed low-sensitivity urinary pregnancy tests (LSUPTs). LSUPTs are used 2–3 weeks after misoprostol administration, depending on local protocol. LSUPTs turn positive at concentrations over 1000 iU human chorionic gonadotrophin (hCG).2

    In response to the 2020 novel coronavirus (COVID-19) outbreak, UK guidance was issued to encourage telemedicine where possible (figure 1), and minimise the use of ultrasound3 scanning, in keeping with existing Royal College of Obstetricians and Gynaecologists (RCOG) guidance.4 Telemedicine for abortion care is also encouraged by National Institute for Health and Care Excellence (NICE) guidance and is likely to remain the standard of care beyond COVID-19.5

    Figure 1

    Patient journey through telemedicine early medical abortion (CCBY4.0 John Reynolds-Wright available from https://flic.kr/p/2j8HtKK).

    Clinical case

    Ms X calls her general practitioner for advice – she has been experiencing light continual bleeding without pain for the last 4 weeks.

    Four weeks ago she had an EMA at home …

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    Footnotes

    • Editor's note The details of this case are fictitious. Any resemblance to actual persons, living or dead, or actual events is coincidental.

    • Twitter @doctorjjrw

    • Contributors JJR-W and JF contributed equally to the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Commissioned; externally peer reviewed.