Expectant management of retained products of conception

Expectant management of retained products of conception involves ongoing review to monitor bleeding, symptoms of infection and general health.

A minority of individuals with retained products after medical abortion have an elevated serum hCG concentration (above 20% of the baseline value) 7 days after taking mifepristone. If an ultrasound scan has excluded a continuing intrauterine pregnancy but shown retained products, serial serum hCG measurements are useful to confirm that the elevated concentration is falling. If it is not falling, consider other diagnoses (eg ectopic pregnancy, trophoblastic disease) and refer for specialist management.

Ensure that the individual has written instructions on symptoms requiring medical attention; see Advice after a medical abortion: patient information.

If moderate bleeding persists at 3 to 4 weeks, consider a repeat ultrasound scan and specialist advice.

If bleeding is becoming lighter and only spotting persists at 4 to 5 weeks after medical abortion, no further intervention is needed.