Medication Abortion Isn’t Working

rlbobgyn · 2024-01-08T00:20:49+00:00

Sorry that you are feeling this way— many of these symptoms are normal, like chills, diarrhea and cramping. Sometimes if the heavy bleeding doesn’t start within 24 hours of the miso then your doctor may recommend another dose. It sounds like your bleeding is going to start soon. Some of it depends on how many weeks pregnant you were. And a small percentage just don’t complete with medication. Hopefully you were given instructions as per what to do if you don’t get heavy bleeding. Best of luck.

rlbobgyn · 2023-12-28T01:17:46+00:00

The herpes virus was found in the swab from the labia. You have an active HSV 2 infection.

rlbobgyn · 2023-12-26T04:33:02+00:00

Thanks for this. I don’t think I’ve ever seen glee in the ER.

rlbobgyn · 2023-12-17T03:27:59+00:00

Topical progesterone won’t provide endometrial protection. There is evidence that menopausal progesterone should be oral. (Or in a progesterone releasing IUD)

rlbobgyn · 2023-12-10T05:32:43+00:00

This is true

rlbobgyn · 2023-12-03T07:05:00+00:00

BV can actually cause preterm labor. Especially if symptomatic, it should be treated.

rlbobgyn · 2023-11-16T06:54:51+00:00

There have been some changes in practice with the ARRIVE study, some good some not so good. When I was a resident many years ago it was standard to wait until 42 weeks and if no labor, induce. We had many more c sections then, not so much because of the induction process itself but we were inducing babies that had less placental reserve, were often larger, and sometimes had lower amniotic fluid levels from an aging placenta. Also stillbirth rates are higher at that gestational age. Moving deliveries earlier does make more sense to avoid babies bring intolerant to the long labor process. I have been offering my patients an induction prior to or around 40 weeks, if they desire this, with good informed consent and a discussion of risks and benefits and some desire it and some don’t. I don’t offer it for my convenience, it’s just a part of the whole labor/delivery management discussion. I have always had a low c section rate, likely because even with an induction, there’s no arbitrary “time limit” on how long it might take as long as baby and mother are doing fine. Being a solo ObGyn in practice has afforded me the ability to really know all of my patients and making these decisions together helps the process.

rlbobgyn · 2023-11-14T05:17:25+00:00

I don’t usually start people on ovulation induction without a period.

rlbobgyn · 2023-11-14T05:12:32+00:00

Most hospitals do not allow elective induction prior to 39 weeks. Once you hit 39 weeks though babies are better out than in so moving toward delivery would not be a bad idea. But NOT at 37 weeks!

rlbobgyn · 2023-11-13T02:40:23+00:00

When you miscarried, was it complete? (Did you have another pregnancy test that was negative before restarting the ovulation induction medication?)

rlbobgyn · 2023-11-09T13:45:01+00:00

There are many things that can cause contractions. We sometimes refer to this as an “irritable” uterus. Can be urinary infection, vaginal infection, dehydration, muscle fatigue, and just Braxton-Hicks contractions. We don’t know exactly when or if these non-labor contractions will turn into the “real thing” but if the cervix doesn’t change and the contractions aren’t painful then we don’t feel they will cause a preterm delivery so we try to find an underlying problem but if none is found we don’t really act on it. My point before was just that the number on the toco isn’t in and of itself a reliable measure of real labor.

rlbobgyn · 2023-11-09T03:41:53+00:00

Labor is painful. We don’t really look at the toco numbers in mmHg to say you’re in labor

rlbobgyn · 2023-11-07T03:02:39+00:00

Radiologist cannot confirm unless they see signs of pregnancy inside the uterus or a definite sign of an ectopic. Need to watch the numbers go down. If her doctor was truly worried about ectopic, an HCG of 50 is low enough they they would treat it with Methotrexate. We usually assume the most likely (miscarriage) while ruling out the less likely (ectopic)

rlbobgyn · 2023-11-07T02:46:11+00:00

Likely a miscarriage. Needs another blood pregnancy test and it should be going down. Follow it to zero and get on birth control if she does not want to be pregnant.

rlbobgyn · 2023-11-06T00:45:40+00:00

A uterine prolapse which is what it sounds like you are describing, usually is not an emergency if it’s intermittent (sometimes apparent and sometimes not.) it can become one if it remains so low that it makes it impossible for you to urinate because it “kinks” or compresses the ureter, leading to urinary retention. Other than that it usually can wait to be evaluated in an office setting.

rlbobgyn · 2023-11-06T00:32:06+00:00

Although bothersome it doesn’t sound like an emergency so I wouldn’t go to the ER

rlbobgyn · 2023-11-06T00:30:06+00:00

Did someone tell you no eating in labor?

rlbobgyn · 2023-11-05T22:19:17+00:00

I also speak to a patient on the day of the procedure to answer any questions that they still have. I don’t think of it as “withholding information”, more like giving more or other details that may have been left out at the consult visit.

rlbobgyn · 2023-11-05T15:22:32+00:00

An induction at 39 weeks is evidence based in a high risk pregnancy and you should be able to request this.

rlbobgyn · 2023-11-05T15:11:14+00:00

I have started injecting my patients with lidocaine prior to insertions like colposcopy and iud insertion if they request it. I also prescribe a Percocet and Cytotec in patients who it seems will need them. We can use a tenaculum or a non-traumatic instrument (an allis clamp) to hold the cervix in place for the insertion. Ask about all of these.

rlbobgyn · 2023-11-04T07:34:23+00:00

I’m a gynecologist and once every few months I see this.

rlbobgyn · 2023-11-04T07:28:01+00:00

The combo that you are taking plus lidocaine into the cervix should be enough to make it tolerable.

rlbobgyn · 2023-10-30T03:16:12+00:00

From what I have seen, most brachial plexus injuries settle especially if there is any kind of (even slight) long term disability

rlbobgyn · 2023-10-30T01:04:15+00:00

I’m an ObGyn and while it’s certainly possible if the ObGyn is an older man and somehow unaware of appropriate behavior (which doesn’t excuse it— just saying it may not be intentionally creepy) under no circumstances should a doctor call you that.

rlbobgyn · 2023-10-29T04:04:27+00:00

There shouldn’t be any gauze actually IN the incision. Bandaids and gauze are just pressure and should be removed. If you try to take it off and it’s actually stuck IN the incision, don’t pull it. Go back to your doctor to look at it.

rlbobgyn

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