A medication abortion involves the body expelling the uterine lining and pregnancy tissue, resulting in bleeding and the passing of blood clots. Understanding what is typical is important for monitoring recovery at home. Heavy bleeding and clots are expected signs that the medication is working and the process is progressing. This experience is often described as feeling similar to a very heavy menstrual period, but with more intense cramping and noticeably larger clots.
Appearance of Typical Blood Clots
The passage of blood clots is a normal part of the process, particularly during the heaviest phase of bleeding. These clots form when blood coagulates within the uterus or vagina before being expelled. The appearance of these masses can vary significantly, so monitoring them is important.
Typical blood clots are generally dark red, maroon, or purple, resembling thick, jelly-like masses. They often have a gelatinous or solid texture, distinguishing them from liquid blood flow. Clot size can range from small, grape-sized clumps to masses as large as a golf ball or even a lemon, especially during peak bleeding.
The heaviest bleeding and largest clots usually occur within the first few hours after taking misoprostol and can last for several hours. Passing these large clots is a sign that the uterus is contracting effectively to empty its contents. Once the pregnancy tissue has passed, the intensity of the bleeding and the size of the clots should noticeably decrease.
It is common to continue passing smaller clots and experiencing heavy flow for a day or two, followed by lighter bleeding or spotting for a few weeks. The presence of clots indicates that the blood flow was heavy enough for coagulation to occur. The process gradually slows down as the uterine lining is fully shed and the uterus begins to return to its pre-pregnancy size.
Identifying Passed Pregnancy Tissue
While most of what is passed will be blood clots, you may also notice tissue distinct from coagulated blood. This is the pregnancy tissue, which can sometimes be mixed in with the clots. Its appearance is usually different from the dark, uniform look of a typical blood clot.
Pregnancy tissue may appear as grayish, whitish, or stringy material, often described as membranous. This material formed the gestational sac and the lining that supported the pregnancy. In early abortions, the tissue may be extremely small, possibly encased within a large blood clot, making it difficult to distinguish.
For those under eight weeks gestation, the tissue passed may be primarily the small gestational sac, which can be difficult to identify clearly. As the pregnancy advances, the tissue may be more noticeable, though it can still be fragmented and mixed with heavy blood loss. The presence of this tissue confirms that the uterus is emptying.
Because the expulsion process is dynamic, the tissue may be passed in one piece or in several smaller fragments. Seeing specific identifiable tissue is not necessary to confirm the abortion is complete. The subsequent reduction in bleeding and resolution of pregnancy symptoms are the reliable indicators.
When Bleeding Requires Medical Attention
While heavy bleeding and large clots are normal, monitoring the volume and duration of blood loss is important for safety. Specific thresholds indicate when bleeding is excessive and requires immediate medical attention. Monitoring your bleeding using maxi-sized sanitary pads is the recommended way to track volume.
Seek immediate medical care if you are soaking through two or more maxi pads in one hour for two consecutive hours or more. This rate of blood loss is considered excessive and may indicate a complication such as hemorrhage. Passing clots consistently larger than a lemon is another sign that requires urgent contact with a healthcare provider.
Other warning signs accompanying bleeding also necessitate medical attention. These include feeling faint, dizzy, or lightheaded, which are signs of significant blood loss. Unrelieved severe abdominal pain, a fever of 100.4°F (38°C) or higher, or chills may suggest an infection.
A foul-smelling vaginal discharge is a sign of potential infection requiring medical evaluation. While some cramping is expected, pain not managed by over-the-counter medication or pain that worsens should be reported. Promptly seeking care for these symptoms ensures that potential complications are addressed quickly.