What is the appropriate management for a reproductive‑age woman 3½ weeks after miscarriage who now has increased bleeding, an 8 mm endometrial thickness with a small vascular area on color Doppler ultrasound, an empty uterine cavity, and a serum beta‑human chorionic gonadotropin level of 6.2 IU/mL?

Management of Increased Bleeding 3.5 Weeks Post-Miscarriage

Your clinical picture—an 8 mm endometrial stripe with small vascular spots on Doppler, an hCG of 6.2 IU/mL, and increased bleeding at 3.5 weeks—most likely represents normal uterine healing rather than retained products of conception (RPOC), and you should continue expectant management with close monitoring rather than proceeding to surgical intervention. 1

Why This Is Likely Normal Healing

• Endometrial thickness of 8 mm is well within normal limits after miscarriage; the American College of Radiology considers endometrial thickness up to 20–25 mm nonspecific in the early post-miscarriage period, so your 8 mm measurement does not suggest RPOC. 1

• The small vascular area (blue and red spots) on Doppler does not automatically indicate RPOC; normal uterine healing involves remodeling of the placental implantation site, which produces vascularity as the endometrium regenerates. 1

• Your hCG of 6.2 IU/mL indicates near-complete resolution of trophoblastic tissue; this low level is consistent with normal post-miscarriage involution rather than persistent pregnancy tissue. 1

• Intermittent spotting and light bleeding for 3.5 weeks is expected as the endometrium sheds and the uterus involutes; bleeding can persist for several weeks during normal healing. 1

What Would Actually Suggest RPOC

The American College of Radiology defines concerning ultrasound features as: 12

• An echogenic endometrial mass (not just diffuse thickening) with internal Doppler flow
• Focal endometrial thickening with vascularity (not uniform 8 mm lining)
• A discrete, identifiable mass rather than the diffuse appearance you have

Your scan shows none of these high-risk features.

When to Seek Immediate Care

You need urgent evaluation if you develop any of these warning signs: 12

• Heavy bleeding: soaking through more than one pad per hour for 2 consecutive hours
• Fever ≥38°C (100.4°F) or foul-smelling discharge (suggests infection)
• Severe abdominal pain beyond typical cramping
• Dizziness, lightheadedness, or feeling faint (suggests significant blood loss)

Recommended Follow-Up Plan

Serial hCG monitoring is essential to confirm complete resolution: 12

• Repeat quantitative hCG in one week; it should continue declining toward undetectable levels (<5 IU/mL)
• If hCG plateaus (stays the same over 3–4 weekly measurements) or rises >10%, this raises concern for gestational trophoblastic disease and requires immediate gynecologic referral 1
• If hCG remains detectable for ≥6 months, this also warrants specialist evaluation 1

Clinical monitoring: 12

• If bleeding remains light to moderate and you have no warning signs, expectant management is appropriate
• Most women with your presentation resolve spontaneously within 4–7 weeks total 3
• Consider checking a complete blood count if bleeding persists, to assess for anemia 2

When Intervention Would Be Indicated

Dilation and curettage should be reserved for: 1

• Heavy bleeding requiring transfusion
• Confirmed vascular RPOC on Doppler (which you do not have)
• Persistent or rising hCG levels
• Patient preference after prolonged expectant management

A common pitfall is performing unnecessary D&C based solely on endometrial thickness <20 mm—this leads to overtreatment of normal healing. 1

Bottom Line

Your increased bleeding at 3.5 weeks with an 8 mm lining, minimal vascularity, and hCG of 6.2 represents the expected tail end of post-miscarriage healing. 1 Continue expectant management, repeat hCG in one week to confirm ongoing decline, and seek care only if you develop heavy bleeding, fever, severe pain, or hemodynamic symptoms. 12