# Cytotec before a D&C?



## AmyG

I found out about 2-1/2 weeks ago that I have a blighted ovum. I really wanted to wait and miscarry naturally, but I reached my 14th week today, and my doctor is strongly recommending a D&C. She asked what my greatest fear was, and I mentioned that, among other things, if I ever had problems with my cervix in later pregnancies, I would feel like it was my fault.

Anyway, she's recommending that I take Cytotec 6 hours before the D&C. (Actually, she calls it a D&E. I don't know if there's a difference.) She said it would make me dialate some so that they don't have to do it quite as much. But she didn't tell me it was Cytotec. I left the office to make my decision, and when I called the nurse, she said she'd call in the prescription for Cytotec.

Does anyone know if the risks associated with Cytotec apply when it's not a full-term baby? I just want to make the decision that's going to have the smallest possibility of affecting my future fertility and ability to birth naturally. The D&C is scheduled for next Thursday, one week from now, and I'm really hoping and praying that I'll just miscarry before then. The doctor was very concerned that since I'm so far along that I would have problems with bleeding too much if that happened, but I'm willing to take the chance. Does anyone have any experience with this?


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## Darci

I'm sorry, I don't have any experience with this, but I wanted to tell you how very sorry I am for you. I hope that it works out the way that is best for you.


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## Ms. Mom

AmyG, my heart aches for you. You have some very difficult decisions before you.

The only information I have on Cytotec is from a recent article in Mothering. I can't seem to find my copy, so I don't want to give you any hard facts.

What I do remember from the article, is that the drug has not been approved for use in pregnancy induction. However, because the drug is FDA approved for other uses, it's use in labor induction is not questioned. Again, I don't have a source in front of me, so don't quote me on that one.

My recommendation would be to look for the issue in a library, check on-line and do some quick research. You may also want to call a midwife and ask some questions.

This is your decision to make, It's your body and you need to make the right decisions for you. If your concerned about the effects of this drug on future pregnancies, then you do owe it to yourself to research it and make an educated decision.

Please take care of yourself now. It's very important to keep hydrated and eat healthy. Your in my thoughts.


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## mamajuice

Hi Amy
I had a missed miscarriage in June at 12 weeks and my midwife's backup ob recommended cytotec prior to the d&c. Regretfully, I didn't research enough and inserted the cytotec vaginally the night before my scheduled d&c. Over the next 5 hours I bled uncontrollably, passing tissue, the baby, huge blood clots...ending in a 4 am emergency d&c. It was so emotionally and physically horrible. I still carry a ton of grief over this. I wish I'd listened to myself and let the miscarriage happen naturally or had at least insisted on laminaria to open my cervix. The dr. , who sold cytotec as the "new and preferred" drug to dilate, failed to mention that I just might go into a full blown miscarriage - in fact - he was quite shocked when he got the page to go to the hospital. Since then, I've found great amounts of info on the dangers of Cytotec. It is not approved by the FDA for use in dilation - either for D&C or inducing labor and I just read that the manufacturer is strongly urging drs to not use it for these purposes. Here is the letter from their attorney to health care providers which is really scary when one considers that drs are using it anyway. NOte the date...august 2000!

Searle Cytotec Misuse Warning Letter to Doctors

August 23, 2000

Re: Cytotec (misoprostol)

IMPORTANT DRUG WARNING CONCERNING UNAPPROVED USE OF INTRAVAGINAL OR ORAL MISOPROSTOL IN PREGNANT WOMEN FOR INDUCTION OF LABOR OR ABORTION

Dear Health Care Provider:

The purpose of this letter is to remind you that Cytotec administration by any route is contraindicated in women who are pregnant because it can cause abortion. Cytotec is not approved for the induction of labor or abortion.

Cytotec is indicated for the prevention of NSAID (nonsteroidal anti-inflammatory drugs, including aspirin)-induced gastric ulcers in patients at high risk of complications from gastric ulcer, e.g., the elderly and patients with concomitant debilitating disease, as well as patients at high risk of developing gastric ulceration, such as patients with a history of ulcer.

The uterotonic effect of Cytotec is an inherent property of prostaglandin E1(PGE1), of which Cytotec is stable, orally active, synthetic analog. Searle has become aware of some instances where Cytotec, outside of its approved indication, was used as a cervical ripening agent prior to termination of pregnancy, or for induction of labor, in spite of the specific contraindications to its use during pregnancy.

Serious adverse events reported following off-label use of Cytotec in pregnant women include maternal or fetal death; uterine hyperstimulation, rupture or perforation requiring uterine surgical repair, hysterectomy or salpingo-oophorectomy; amniotic fluid embolism; severe vaginal bleeding, retained placenta, shock, fetal bradycardia and pelvic pain.

Searle has not conducted research concerning the use of Cytotec for cervical ripening prior to termination of pregnancy or for induction of labor, nor does Searle intend to study or support these uses. Therefore, Searle is unable to provide complete risk information for Cytotec when it is used for such purposes. In addition to the known and unknown acute risks to the mother and fetus, the effect of Cytotec on the later growth, development and functional maturation of the child when Cytotec is used for induction of labor or cervical ripening has not been established.

Searle promotes the use of Cytotec only for its approved indication. Please read the enclosed updated complete Prescribing Information for Cytotec.

Further information may be obtained by calling 1-800-323-4204.

Michael Cullen, MD
Medical Director, U.S.
Searle
5200 Old Orchard Road
Skokie, Illinois, 60077

Phone: (847) 982-7000

Fax: (847) 470-1480

Sources: Fox News, October 16, 2000

Sorry for the lengthiness of this ... but I hope the info is helpful to you. Blessings and best wishes...melissa


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## AmyG

Thanks. I had the D&C today, and I did it w/out the Cytotec. They were going to have me take it orally, but I was still concerned. The OB said his job would have been easier if I had taken it, but I'm glad I didn't.

I really wanted to miscarry naturally, but I'm going to be 15 weeks tomorrow and I was concerned that I was too far along. Even if I didn't hemhorage or get an infection, it would have been really painful with a lot of blood.


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## Ms. Mom

Amy, I do hope your feeling better. Both emotionally and physically. You've been in my thoughts.

Please know that no matter what, you made the right decisions for you. Only you know what your body needs and it sounds like you put a lot of thought into it.

Cynthia Mosher found a link to the Mothering Article on Cytotec for us (thanks). I wanted to post it hear, because I found it very informative. Sorry, I didn't find it sooner for you, but you really made some good choices.

http://www.mothering.com/11-0-0/htm...ytotec107.shtml


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## LizD

I just had an abortion at 22 weeks and had the laminaria inserted on day one, early morning on day 2 I put in 4 cytotec tablets vaginally. At the office the doctor broke the water and administered more cytotec both vaginally and orally. It took a few hours but went well. I experienced some blood loss after the birth and before the D&E but nothing too excessive. I don't know if this was chance; I am well-informed on the cytotec scandal and would not ever use it in term labor, but trusted this doctor and am thankfully healing well.


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## Ms. Mom

LizD - Thank you for sharing your experience. I think Cytotec is a drug that needs a LOT more research.

I'm glad your healing well. Please take good care of yourself. Your body has been thorugh a lot and healing fully will take time. Keep your body hydrated and make sure your eating regular meals. Get as much rest as you can and try to take some time out for yourself so you can reflect and work through this loss.

You'll be in my thoughts.


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## hiswife

Wow. You are very courageous LizD I never would have had the courage to have an abortion so far along (I'm scared of surgery). I had a missed miscarriage and have been waiting it out, but am considering using the cytotec to "stir things up" because I'm worried for infection and such.


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