Had D and C before a month. Should I continue Primolut?
Patient's Query
Hi doctor,
I had D and C before a month and I bled for five to six days after that. I was given Xamic for three days and Primolut N for 21 days. I had brownish discharge 18 days after my D and C and then had bleeding for seven days. I am still spotting. My hCG three days prior to periods came 21 and my ultrasound while in periods came normal. The reason of my D and C was hydropic villi in placental tissue. Should I continue the tablet?
Hi,
Welcome to icliniq.com.
I understand your concern.
As per me you should discontinue tablet Primolut (Norethisterone) as you have already taken for 21 days. After 7 to 10 days you will have normal periods. Now you do not need any hormonal tablets. If you have any abnormal bleeding in next period then do let me know.
Patient's Query
Hi doctor,
I still have two tablets. My concern is that is this not my periods? I have had light bleeding for a week this is precisely 18 days after D and C. I was scared of hydropic degeneration, so I am monitoring my hCG levels. Is there any other tests or issues I need to worry about?
Hi,
Welcome back to icliniq.com.
I understand your concern.
In your case the main reason for worry is hydropic degeneration and recurrence. You have to get serial hCG (human chorionic gonadotropin) level monitoring as well as repeated ultrasound estimation. As you said your hCG was 21 it appears to me as non-pregnant level. You have to get beta hCG again after six weeks post pregnancy. You should get ultrasound pelvis done at the same time. You can update me the report. You can take Primolut for two days as dosage is of total 21 days. You can get your complete blood count, liver function test, kidney function test and chest x-ray to rule out any rare chances of metastasis. In your case you have to use contraceptive for at least one year. It means that you do not have to get pregnant for the next one year.
Investigations to be done
Probable diagnosis
Preventive measures
Patient's Query
Hi doctor,
I was tested negative for gestational trophoblastic disease. My cardiolipin and liver kidney tests everything came out normal during D and C. The only two tests remaining are chest x-ray and hCG. If the hCG count goes to zero then do I still need to follow up for regular hCG test?
Hi,
Welcome back to icliniq.com.
Thanks for the update (attachments removed to protect patient identity). As you said you have been tested negative for gestational trophoblastic disease. But, hCG follow up is necessary just to detect recurrence. As, recurrence of this disease is very high. If hCG goes to zero you need to get it repeated after six months as this is the best test to detect recurrence. Chest x-ray should be done just to be on safer side.
Same symptoms don't mean you have the same problem. Consult a doctor now!
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