# Please help me argue my case! Update post #16



## 2sweetboysmom (Aug 1, 2006)

PLEASE ladies, send on your research regarding cytotec. I am on medi-cal (state funded welfare insurance) The only thing they want to do is a D&C or D&E in office (vastly cheeper than a hospital induction) All of the Dr's here are fearful that they will not be paid due to the condition of California's economy
I am very concerned about cuts and scars to my cervix and uterus. Especially since I am multi para and am now 16 weeks pregnant (soft urerus) I would be perfectly happy to simply take the pills and bring the labor on at home . I need medical journal type info to try to plead my case in the morning (my last chance) ANY info you can send me regarding the benefits cytotec vs.surgical management of missed miscarriage of would be helpful.
Thanks,
Joy

About me, incase it may make a difference:
Gravid 9 Para 3
Baby appears to have ceased growing at 11w6d. (I already have an IUGR baby)
Baby is assumed to have died at 14-14.5 weeks.
Placenta and urerus measure 16 weeks
I REALLY need to bury my baby...Concerned that there will be nothing to bury if there is a D&C/E.
I have been morbidly afraid of D&C et all since I first heard of it at age 13.
I would VASTLY prefer a hard painful labor with NO medical form of pain control than to be under general or receive a D&C etc.

If you do not want to post your links here, or if you have text to share with me, my PM box is basically empty so feel free to spam me with links and text.

THANKS again!


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## lisa_nc (Jul 25, 2008)

I would NOT do cytotec at home at your gestation. We lost our son at 14+ weeks in October due to an abruption and I took it to deliver the placenta. I hemorrhaged and had to call 911. Really, it is my humble belief that you should be monitored if you are doing this in the second trimester. The OB who gave it to me said that there wasn't much research for late miscarriage and misoprostal. She gave me about a 25% chance that it would work. It did, but I should NOT have been doing it at home alone. If you are really adverse to the hospital (which I TOTALLY understand), I would make sure that you have someone with you at all times who can help you. I am more concerned with the placenta size rather than the size of the babe. In the second tri, those placentas really don't want to let go.

I would not have an D&C if I could help it either, but if you don't have any other choice you still have a right to the fetal remains. Make arrangements prior to have them go to a funeral home. You have a right to take care of your baby as you see fit.

You have a right to refuse the D&C even on medi-cal. They can't MAKE you do it. Hugs, mama. Strength to you for tomorrow.


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## mrsbabycakes (Sep 28, 2008)

Here is my experience with D&C, plus some research I found on pubmed. I had a missed miscarriage at 9 weeks with a 8 week fetus. I chose to do a D&C because I was concerned about Cytotec causing hemorrhage (my doctor said my baby's size was "borderline" for safe Cytotec induction) and I wanted to get it over with. My D&C was done without anesthesia and I was not "put under" for the procedure. The pain was manageable. It was uncomfortable, but not horrific. My husband was a good distraction. I was told by my doctor that the risk of permanent damage was the same for cytotec and D&C. Also, not to mention that a lot of women who use cytotec (aka misoprostol) have to get a D&C anyway. I figured it was worth the time I would lose to just go for the D&C anyway. I'm very happy with my choice.

Quote:

We aimed to compare patients' health-related quality of life after a misoprostol strategy to a curettage in women with early pregnancy failure after failed expectant management. METHODS: A multicentre randomized clinical trial was performed in The Netherlands. In all, 154 women with early pregnancy failure confirmed at ultrasonography who had been managed expectantly unsuccessfully for > or =1 week were randomly assigned to undergo either treatment with misoprostol (n=79) or curettage (n=75). The main outcome measures were health-related quality of life and satisfaction with treatment. RESULTS: In the misoprostol strategy 47% of the women needed additional curettage, as compared to 4% after curettage. In both groups, health-related quality of life was impaired most severely 2 days after treatment. In the misoprostol group, health-related quality of life was more severely impaired; after 2 days this was due to more pain and after 2 and 6 weeks this was due to a worse general health perception. Health-related quality of life was temporarily significantly more impaired in women in whom misoprostol failed as compared to women in whom misoprostol treatment was successful. In both treatment groups, an equal percentage of women (58%) would choose the same treatment in the future. In women treated with misoprostol, however, this choice depended on the initial success of misoprostol: in cases where misoprostol had caused complete evacuation, 76% of the women would opt for the same treatment, whereas only 38% of women who needed curettage after unsuccessful misoprostol would do so (P<0.01). CONCLUSION: Our study shows that, although both the misoprostol strategy and the curettage strategy resulted in complete evacuation in the end, women are willing to accept some disadvantages of misoprostol to avoid curettage. A treatment inconvenience using misoprostol is accepted as long as initial evacuation rate is high. This finding should be an integral part of counselling women when deciding upon management of early pregnancy failure. Graziosi GC, Bruinse HW, Reuwer PJ, van Kessel PH, Westerweel PE, Mol BW., Misoprostol versus curettage in women with early pregnancy failure: impact on women's health-related quality of life. A randomized controlled trial, 2005 Aug;20(8):2340-7.

Quote:

Surgical Compared With Medical Management

Surgical evacuation had approximately 1.5 times the success rate of medical methods (risk ratio 1.44, P < .001). There was again significant heterogeneity across studies (P < .001 for heterogeneity). The overall risk difference was 32.8% (P < .001; Fig. 1C), corresponding to a number needed to treat of 3. The largest study 23 gave similar estimates to those of the meta-analysis. Patient satisfaction did not differ significantly between medical and surgical management, although the trend favored medical management (risk difference -9.92%, P = .25); again there was significant heterogeneity across studies (P < .001 for heterogeneity). Nonsignificant trends were seen for less frequent moderate or severe bleeding (risk difference 2.19%, P = .21) and more frequent emergency curettage (risk difference -2.36%, P = .13) with medical management. No differences were found in rates of PID (risk difference 0.64%, P = .60), blood transfusion (risk difference 0.12%, P = .89), nausea (risk difference 11.3%, P = .69), and vomiting (risk difference -1.51%, P = .34). Diarrhea was addressed in only one small study and occurred in 1 of 40 women given prostaglandins and none treated surgically (Table 2).....

Based on the available data, patient satisfaction differences seemed to be small with the various methods. However, satisfaction data have been reported only in the minority of trials, and thus larger differences may have been missed. There are data from women who were randomized to expectant management and eventually needed to undergo surgical evacuation, which show that they present the most profound anxiety and depressive reactions.....

The 3 management options did not demonstrate significant differences in terms of major complications, with the possible exception of an approximately 3% lower rate of moderate or severe bleeding with medical management as compared with expectant management and possibly also surgical management. The incidence of most major complications is relatively rare and the corresponding CIs are considerably wide. A large number of patients would be needed to detect definitive differences for major adverse events.

Sotiriadis A, Makrydimas G, Papatheodorou S, Ioannidis JP., Expectant, medical, or surgical management of first-trimester miscarriage: a meta-analysis, Obstet Gynecol. 2005 May;105(5 Pt 1):1104-13.


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## dinahx (Sep 17, 2005)

Mama, please look on Pubmed! (http://www.pubmed.com)

The research I did suggested that Cytotec is WAY safer, as D&C/Es will cause Asherman's syndrome in 30.9% of the women that have them for missed miscarriages.

I would demand to be offered this option as an inpatient. There is PLENTY of research on misoprostol for induction on Pubmed. At 16 weeks, IMO, you should also be offered Cerverdil & Pit if you want it too. We have the right to refuse invasive procedures if we are against them. I agree, I have been upset by the idea of invasive instrumental surgery from a very young age.

I just had an expectant m/c with the option of Cytotec induction. I actually had 200 mcg, but it didn't do too much as mostly I was complete. PM me if you need any help researching tomorrow.


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## zensven42 (Oct 26, 2006)

Sorry to seem ignorant, but I can't find good info. Won't your body automatically deliver the baby now that it has passed? Why is medical intervention necessary?


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## brightonwoman (Mar 27, 2007)

I don't really know much about cytotec except that I've heard it's scary...

I've had three miscarriages near the gestation taht you're at (12, 13, and 15 weeks). One was sudden and at home--I had a tiny body to hold, but I also had an ER trip for severe bleeding.
With the next (missed) I opted for a D&C, but subsequently regretted it.
With the third (missed) it was diagnosed via u/s, and I waited it out. It took 3 weeks to begin actually bleeding but I'd take the waiting and the natural process and yes, even another ER trip if I had to rather than another D&C. D&C is not horrible from a physical perspective, but I found it emotionally much harder because I had no closure.

How long has it been since you had the diagnosis? Most women--once they know that the baby has died--will miscarry on their own within a week or two. Occasionally as long as 3 weeks, but that's truly rare. IMHO waiting is the safer and healthier option--both emotionally and physically. The one thing is that if it does take a while to start miscarrying, the fetus may begin to decompose prior to delivery (sorry, i know that's an awful thought, but it is something to be aware of...)
Also there are herbs that help with miscarriage--I want to say lobelia and false unicorn, but I am not sure so definitely talk with someone over in health and healing who would know more on that! Also herbs that help induce labor--blue and black cohosh I think? if they can induce it at full term, I bet they can induce it now...

I am with you 110% on wanting to have an un-medically-managed miscarriage. And honestly, you should be able to. Doctors like the paycheck for doing surgery, and most women want the convenience of getting it overwith...when I told my Dr I wanted to go home and wait it out he was very surprised and said that i was rare to choose that...but seriously I don't think you're likely to endanger yourself. Worst case scenario--you end up with an incomplete micarriage (ie, retained placenta or something) and you end up having to get a D&C or cytotec then. Um, not any wose than where you are now, and if it means you'll get to see your little one at home in between, i'd say it's a whole lot better.








s, by the way. I'm so sorry you're having to go through this. miscarriage sucks a lot.


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## mrsbabycakes (Sep 28, 2008)

Quote:


Originally Posted by *dinahx* 
Mama, please look on Pubmed! (http://www.pubmed.com)

The research I did suggested that Cytotec is WAY safer, as D&C/Es will cause Asherman's syndrome in 30.9% of the women that have them for missed miscarriages.

I would demand to be offered this option as an inpatient. There is PLENTY of research on misoprostol for induction on Pubmed. At 16 weeks, IMO, you should also be offered Cerverdil & Pit if you want it too. We have the right to refuse invasive procedures if we are against them. I agree, I have been upset by the idea of invasive instrumental surgery from a very young age.

I just had an expectant m/c with the option of Cytotec induction. I actually had 200 mcg, but it didn't do too much as mostly I was complete. PM me if you need any help researching tomorrow.









Interesting. Do you have the quoted research info (author, etc)?


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## dinahx (Sep 17, 2005)

I can give a quick look see but it was very readily available via pubmed. I mean, I know no medical person talks about Ahsherman's, an OB told me a D&C had NO risks, and never ever even mentioned Asherman's but the research tells another story as do many women.

I can't figure out what I was entering to find the info on pubmed during my research binge. But here is a wiki article that is heavily cited and IMO gives a good overview of the condition.
http://en.wikipedia.org/wiki/Asherman's_syndrome

Remember 69.1% of women DON'T get this syndrome, so don't over worry about it. It is just IMO what tips the scales toward medical or expectant managment in terms of safety for those concerned about future fertility. But yk, while I was burning up the computer researching alternatives, I learned my cousin Kim had a D&C and got pregant the next month and just delivered a fabulous baby girl, so you never know!


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## lemurmommies (Jan 15, 2007)

I'm so sorry for your loss mama.







I am sorry that I don't have any specific medical information, I just wanted to let you know that I had a Misoprostol induction for my loss in December, and in no way would I characterize it as "scary." I was, however, given the drug in the hospital under the supervision of an OB and L&D nurses, so perhaps that makes the difference.

I was 18 weeks, 2 days when I was induced. The whole process, from the first done of Misoprostol to delivery, took about 7 hours. I was given a shot of morphine for pain management at about hour 6, because natural birthing techniques just weren't cutting it. I delivered my daughter and the placenta soon after, and had no complications whatsoever.

In my case, a D&C or D&E weren't even really discussed as first-line options, only as options if the Misoprostol indiction didn't work. The OB on call the day I went in for the induction said that most doctors aren't used to doing such procedures on women so far along, and that is why he doesn't recommend it.

And for those who wonder how long it might take to have a natural miscarriage, when I delivered my daughter they estimated that she had passed away approximately 3 weeks prior. I had had no bleeding or cramping, and my cervix was completely closed. I don't know how long my body would have carried her otherwise.


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## millefleur (Nov 25, 2008)

Quote:


Originally Posted by *zensven42* 
Won't your body automatically deliver the baby now that it has passed?

Not necessarily.


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## dinahx (Sep 17, 2005)

I was told it would take between 2 and 6 weeks post demise, with risks increasing after week 4. I was SUPER worried, but I reminded myself: it was only a missed miscarriage in retrospect: if I hadn't found out, from advanced technologies and strong intuition it wouldn't have been missed, kwim? Mine also happened at almost 3 weeks post demise (appx), actually more like 17 days.


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## cristeen (Jan 20, 2007)

I definitely wouldn't suggest Cytotec at home. If for no other reason than that it may not be effective (still painful, just not effective). They attempted for almost 30 hours to induce me with Cytotec, and I never got past a 1. I was firm that I was having an induction and not a D&E though, so they eventually (after I hounded them) offered me manual dilation with a foley catheter. If you are dilated enough for them to insert it, it was much quicker and more effective for me than the Cytotec. And the foley came sliding out right in front of my son. I did not have any bleeding problems, and the placenta detached immediately. I was in the hospital for 2 days trying to be induced, which is probably why they don't want to offer it to you.


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## dinahx (Sep 17, 2005)

Oh this is SO crazy! They really have to get together and agree as a profession about what our options for m/c are!!! I ASKED about a Foley and they looked at me like I had two heads and that had NEVER been tried before. Ugh. Glad you found something that worked though.

I feel like you can refuse a D&C/E just like anything else and there are plenty of other options, even for hemorrhage, they can use Pit injections OR Rectal Cytotec to arrest bleeding.


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## brightonwoman (Mar 27, 2007)

Quote:


Originally Posted by *lemurmommies* 
And for those who wonder how long it might take to have a natural miscarriage, when I delivered my daughter they estimated that she had passed away approximately 3 weeks prior. I had had no bleeding or cramping, and my cervix was completely closed. I don't know how long my body would have carried her otherwise.

One m/c was diagnosed 3 weeks after the fact--I do not know how long it would have taken to miscarry on my own (I had the D&C with that one)

my next one was diagnosed at around 1wk after fetal demise, and I didn't start bleeding for 3 more weeks.

I just remember that before we started using machines to peek into our insides, there was no such thing as a 'missed miscarriage'...either there was a miscarriage or there was not. Some women's bodies hold onto a fetus for longer than others, but sooner or later it's going to come out. I like to leave all doors open--sure, medical intervention might be necessary at some point, but there's no need to assume that it will be.


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## Manessa (Feb 24, 2003)

First, I want to let you know how sorry I am for your loss. When I was 16 weeks 5 days, I had a cytotec induced miscarriage at home. The experience was far from "scary". The entire thing took about 2.5 hours from the time that my water broke until I delivered. My cramping was very managable and I didn't take anything for the pain. I did have a lot of bleeding and some big clots, but nothing that was worrisome. I was able to do everything on my terms and bury my baby at home. I don't regret it for one minute. That being said, I did have to have a *D&C* this week (7 weeks after my miscarriage) for retained placenta. The OB that did the procedure said that can be a problem when pregnancies end that far along. If I had to do the whole thing over again, I wouldn't change a thing. You can PM me if you want. Good luck and







s


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## 2sweetboysmom (Aug 1, 2006)

Sorry for the delay in letting you know how things went...I wrote a long and detailed account on Thursday when I got home from the hospital, only to have it eaten by cyber-space.









Thank you all for all of your help and thoughts.
The Dr I finally saw on Wednesday morning was willing to order a cytotec induction.
I entered the hospital at noon and took a 200 mcg pill at 1pm. At 4pm they placed a 200mcg pill vaginally. I had nothing worse than light menstrual type cramping and no bleeding. At 6:59pm I was standing up trying to get some kind of labor going, and thinking it was going to be a long night, suddenly I felt LOTS fo blood flowing out. I paged the nurse, she came and checked me, 1cm but soft. She said to try pushing. At 7pm Our Michael Sean was born. I continued to bleed a lot, I kept feeling 'blub, blub, blub'. As I was receiving my 4th chux pad in 5 minutes the DR arrived and asked if he could currate to remove the placenta (which we all understood at that point was partially detached but not budging any further) I said yes.
He was excedingly gentle. I know this because at no point induction or D&C did I take any pain meds or sedatives. I would have felt it if He had injured anything. (I actually found it less painful than an HSG I had years ago) The pain was never more than I could deal with with early labor type breathing.

Our little man (yes another boy!) had obviously been struggling for quite a while, but the Dr felt, and it agreeed with my feeling, that he did not die till 15 weeks +. He was 3.5 inches long (like a 12 weeker), less than a 10th of an ounce (waaaay too light for a 12 weeker) had clearly defined boy bits, and no deterioration to his skin. The placenta measured 15-16 weeks and there was no obvious problems with it
We are burying him on Monday morning in the local cemetery, in the baby section but near my great grand-mother.

I am doing well. Dh and I still desolve into tears at least once a day but I am a bit more functional. I am feeling like the return of blood iron is taking a while, I am really tired. So I am going to go get some Floridix today. Though I would have prefered no D&C, I know it was needful in this case. And, perhaps most important to me just now, I have a whole baby to bury.

Thank you all again.

Joy


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## dinahx (Sep 17, 2005)

Oh mama, I am so glad you got to meet your sweet son!







s:


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## Amy&4girls (Oct 30, 2006)

Joy I am so glad you got to meet Michael. Still praying for you and your family.


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## Manessa (Feb 24, 2003)

Be kind to yourself. I'm so glad that everything went so well


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## millefleur (Nov 25, 2008)

Michael Sean
















for you, Joy!


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## lisa_nc (Jul 25, 2008)

Hugs, mama.


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