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Why do I feel nauseous after a medical abortion? #325/12

I received a positive pregnancy test on February 14, 2012.  I made an appointment with my doctor a scan and blood test came back as early pregnancy (likely 1 or 2 weeks pregnant).  The doctor gave me the tablet for a medical abortion (this was on the 20th of February 2012).  I waited for two weeks for the bleeding to stop,but I had only 4 or 5 days bleeding. After that, I went for a scan and it showed the abortion was complete.  I went to doctor for the scan report on March the 3rd  and she told everything was okay. 


I just want to know why I still feel nauseous? We had sex (once protected and other 2 times on pills). I just checked the pregnancy test kit and it was positive  2 times. So I was worried and I went to the doctor and ask if the scan report could be wrong or something else was wrong and the doctor suggested checking beta hCG levels.Today the report has come with hCG level of 122.  I just want to know whether I am pregnant or not?  It continues to worry me. I am not able to concentrate on anything.


Please help me. I have a doctor’s appointment in 2 days. Please help.....

Please study the information below.  As you can see the fall in hCG levels is quite variable.


You will know more very soon.


hCG Levels After Pregnancy


After a pregnancy is terminated by delivery or abortion, blood and urine hCG levels gradually decrease. Figure 23-3 below represents the hCG disappearance curve following uterine aspiration at 7 to 13 weeks (upper curve), miscarriage at 6 to 15 weeks (middle curve), and surgical treatment of ectopic pregnancy (bottom curve).


 Disappearance curves of serum βhCG in three groups of women.                                                            Semilogarithmic scale. Upper curve represents women (n=36) who had elective vacuum aspiration abortion at 7-13 weeks LMP. Middle curve represents women (n=35) with spontaneous abortion at 6-15 weeks LMP treated with uterine aspiration. Lower curve represents women (n=35) with ectopic pregnancies diagnosed 2.5-11.0 weeks after LMP and removed surgically.

                        Source: Steier et al. (1984)  with permission.


The initial decrease in beta hCG (βhCG) after full-term delivery is quite rapid, so that an hCG level following the delivery will have dropped to less than 50 mIU within 2 weeks, and hCG will be undetectable after 3 to 4 weeks. In the case of first-trimester abortion, if hCG is clearing normally from the bloodstream as expected, the hCG level should decline steadily, halving at least every 48 hours. However, initial hCG levels are at the peak at 8 to 10 weeks LMP, as high as 150,000 mIU; therefore even 2 weeks after first-trimester abortion, the hCG levels may still be 1,500 mIU, high enough that all pregnancy tests will still be positive. hCG is likely to be detectable by sensitive tests, including commonly-used office urine test kits, for as long as 60 days after first-trimester abortion.

When patients have medication abortion, beta hCG continues to increase following mifepristone but then declines precipitously after administration of misoprostol.  By the first follow-up visit 5-17 days after taking mifepristone, beta hCG levels drop to 20% of the initial value (measured on the day of mifepristone) in 98.5% of successful medication abortions. In contrast to the usual pattern of sharp drop in hCG after medication abortion, it is possible for hCG levels to have a lengthy plateau even though the patient has a clinically normal course without need for surgical intervention. Patients who require surgical intervention less than 15 days after medical abortion due to prolonged bleeding or pain generally have higher absolute and relative beta hCG values than women with normal courses whose beta hCG values drop sharply. However, there is an overlap in absolute and relative beta hCG values between patients with lengthy plateau who in the end have successful medication abortion and those who will require uterine aspiration. Beta hCG measurement is merely a supplement to the general clinical evaluation in determining whether intervention is indicated

If intrauterine pregnancy continues to evolve after medication or surgical abortion, an upward trend (mean 124% rise, minimum 53% rise in 2 days) will be seen in serial quantitative beta hCG values. If an ectopic pregnancy continues to evolve after medication or surgical abortion, beta hCG values can behave erratically; these patterns are discussed in more detail in the section, Managing Problems in Early Pregnancy. 


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Key Words:  pregnancy, scan, blood test, abortion, bleeding, nauseous, sex, protected, unprotected, beta hCG levels, decrease, uterine aspiration, disappearance curve

Posted 3-21-2012, Updated 3-25-2012

Robert A. Hatcher MD, MPH
Emeritus Professor of Gynecology and Obstetrics
Emory University School of Medicine
Atlanta, GA

The directors and owners of this website and any publications and information concerning health matters offered here advise a person with a particular problem to consult a primary-care clinician or a specialist in obstetrics, gynecology, or urology (depending on the problem or the contraceptive) as well as the product package insert and other references before diagnosing, managing, or treating the problem.
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