A 26-year-old woman, G4P2, with one previous surgical abortion, requests an abortion at 44 days' gestation. After learning about her options, she selects medical abortion with mifepristone and misoprostol. Her initial hematocrit is 40%. Six hours after taking misoprostol orally, she calls her nurse practitioner's office and states that she is "hemorrhaging." Upon further questioning, her practitioner determines that she has passed blood clots and has been saturating 1 maxipad per hour for the past 2 hours. She denies feeling faint, dizzy, or lightheaded.
Resolution of Case 2
The rate of bleeding in this case is below the threshold of 2 or more maxipads per hour for 2 consecutive hours. In addition, the patient's initial hematocrit was in the normal range, and she denies any symptoms indicative of hypovolemia. Her description of "hemorrhaging" may have reflected her anxiety related to passing blood clots. The nurse practitioner reassured her that this type of bleeding is normal and that the bleeding generally subsides after the abortion is complete. As in the first case, close follow-up by phone is an appropriate measure.
Return to Expected Side Effects of Medical Abortion.
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