Suggest Treatment For Blocked Tubes After Missed Pregnancy And A Mymectomy

Posted on Sat, 28 Feb 2015

Question: I am 30 yrs old. with the help of IUI, but the fetalpole was not seen, no growth. Hence on 31st XXXXXXX doc asked me to get it aborted, as it was a missed pregnancy case. IUI was done on 25th Nov'14. my last day of periods was 14th Nov. In XXXXXXX 2013 I got operated for mymectomy. In aug'14 when we did hsg, they realised by left side of tube is blocked. We used the medicine for abortion. but when I did abdomen sonography, they found some part of the blood clots in uterine cavity. reports are attached. Please advice the next course of action.

Answered by Dr. Nidhi Setia (43 minutes later)

Brief Answer:
misoprostol; another attempt of IUI.

Detailed Answer:
Hello
Welcome to HCM.

You have had myomectomy in past. You also had missed pregnancy after IUI.

I can understand your concerns.

I have gone through your reports as well. Minimal retained products of conception/blood clots in uterine cavity are normal when medical termination of pregnancy is done. A further three-day course of misoprostol (only under your doctor's supervision) will help to clear these retained products.

Regarding future conception, I would suggest you to wait for a period of 3-4 months after the retained products are cleared. This time period would be needed for regrowth of healthy endometrium which required for a successful pregnancy.

You have left-sided tubal blockage. I would suggest another attempt of IUI. As you have had early pregnancy loss/missed pregnancy in previous attempt, a concomitant progesterone therapy is indicated when you try to conceive next. This would help in maintenance of pregnancy.

Keep a regular follow-up with your doctor. Any drugs are to be instituted only under doctor's supervision.

Hope this addresses your concerns satisfactorily.

Feel free to ask further.

Kindly close the discussion if you have no more queries and give you valuable feedback.

I wish you good health.

Thanks.

Dr. Nidhi Setia.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Nidhi Setia (19 minutes later)

Doctor. when will be appropriate time to take this second dose. today is 12th day. and any precautions I should take from health point of view.

Answered by Dr. Nidhi Setia (24 minutes later)

Brief Answer:
start the drug asap.

Detailed Answer:
Thanks for the follow-up query.

Ideally, the drug should be started as soon as the ultrasound detects retained products of conception. So you can start the drug from tomorrow itself under your doctor's supervision. There would be slight vaginal bleeding for the time you take the drug. Do not worry about that.
Get a repeat ultrasound scan of abdomen done once the bleeding stops to confirm that products are expelled completely.

Regarding the precautions, I have some suggestions for you:
1. Go for blood sugar and thyroid levels check-up as alteration in these can contribute to early pregnancy loss.
2. Since you have suffered blood loss, I would also suggest you to get your hemoglobin levels checked.
3. Increase green vegetables and fruits in your diet.
4. Get the blood groups of yourself and your husband checked to rule out Rh incompatibility.

Keep a regular follow-up with your doctor.

Hope this helps you.

Feel free to ask further. Kindly close the discussion if you are satisfied with the responses and give your valuable feedback.

I wish you good health.

Thanks.
Dr. Nidhi Setia.

Above answer was peer-reviewed by : Dr. Prasad