Early Options: Case Presentation 5

Early Options - A Provider's Guide to Medical Abortion

(Persistent Gestational Sac/Persistent Bleeding Requiring Surgical Intervention)

A 34-year-old woman, G₄P₂, at 49 days' gestation received mifepristone followed 2 days later by vaginal misoprostol. Six days after insertion of the misoprostol, she developed heavy bleeding and was changing 1 maxipad per hour for 2 consecutive hours. She arrived at the medical clinic, where an ultrasound was performed. A persistent gestational sac without visible cardiac activity was present within the uterus. Click here to view her ultrasound scan.

Resolution of Case 5

This clinical presentation requires the provider to distinguish among a medical abortion in progress, an incomplete abortion, and a continuing pregnancy. The ultrasound shows a gestational sac without signs of continued growth or embryonic cardiac activity. If these findings were detected after a follow-up period of 14 days, the patient would be diagnosed as having a persistent gestational sac. However, only 6 days have elapsed since she took misoprostol. Therefore, her symptoms probably indicate that she is in the process of aborting. Because the patient is not bleeding excessively, she can be managed expectantly. Appropriate treatment options include continued observation, repeat administration of misoprostol, or surgical aspiration if the patient prefers.

Her provider outlined these treatment alternatives. The patient elected to take an additional dose of misoprostol, 800 µg, intravaginally. She remained at the medical clinic for monitoring and passed the gestational sac 2½ hours later.

Return to Complications of Medical Abortion.