What is going on?

My dear Doctor Brown,

After the natural miscarriage in the week 5 and after finishing flagyl and docycycline ( for the infection and severe pains 3 weeks after the miscarriage), now ecactly one month after the miscarriage i got the period.
  One month after i got the period, with very bad pains. Today im in the 5th day of the period, it is not normal, i passed some tissue today, like skin and brown in color and have horrible pains in the lower back and lower tummy. does this mean that i am passing out the dead baby? But why after 5 weeks, is this the reason why it is 5 weeks i am in severe lower back and abdominal pains? Is this the case of the infection? Does it mean that i will not be able to have children? When they prescribed the medication said that i had infection but from the ultrasound said the ovaries and uterus look normal. I dont understand why i am passing these tissues after a month an not when i had the miscarriage? How am i sure that everything is out and wont continue to have infection? The pain since the day that i got the period is horrible and yeasterday and today thaat passed a big clot of around 1 or 1,5 cm the pain in the lower abdomen and back makes me cry. I dont know what is going on. If the dead baby was inside me ( as one month ago i had simply pure clean red blood when had the miscarriage, i didnt pass any clot) is it impossible for the doctor to find out from the ultrasound? Does this mean that they have to do a d and c? How can they be sure that everything is expelled? will this episode give me continues infections, horrible pains like the ones i am having and maybe making me infertile? I am making too many questions but i am feeling very bad emotionally and physically. What do you suggest me to do? What check ups if i was your patient?
Your time and suggestions are very much appreciated.
Thank you.

[Elaine Brown, MD]

Hi!
If you completed all of the medication that they gave you (Flagyl and Doxy) it is pretty unlikely that you still have an infection.  If you had an ultrasound that was reported as normal, it is pretty unlikely that you have any retained tissue--the ultrasound can see even a small amount of tissue.  It is also unlikely that you will suffer permanent harm or reduced fertility.  It is common for the first few periods after a miscarriage to be "different".  I always warn my patients that they may experience something they are not used to--like heavy bleeding or clots.  When clots pass, they look like tissue (liver) and they cause severe cramping ( like labor pains).  I suspect that is what is going on with you.  If you were my patient, I would probably give you some anti-inflammatory pain medication like Ibuprofen or Aleve, and we would watch to see what happens.  If the heavy bleeding and clotting stops, just wait.  If the heavy bleeding continues, then another ultrasound.
I hope this is helpful!
Dr B