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So can we talk about cytotec... - Page 4

post #61 of 65
if all of those things are in place, it can be a fabulous option (if non-medically necessary induction is ever a fabulous option) OR, as has been repeatedly shown right here in this thread, it can go horribly wrong.

Hi. When I was 19, I had a missed miscarriage. According to ultrasound, the fetus had no heartbeat and stopped developing around 9 wks, and I was now 12 wks (and yes, sure of my dates).

I was prescribed cytotec and went home and took ONE pill. I then panicked at the pain I was about to go through, and somewhere in my totally uninformed, uneducated 19 yr old head, I knew this was a bad option. I went to my father's hospital (he's a surgeon) the next day and had a D&C performed, it went well. Two days later, I woke up with a fever and a very strange pain in my lower abdomen. I was rushed back to the hospital just in time to be intercepted at the ER by a huge, terrible car accident with multiple victims.

I sat in that ER with nothing but one dose of tylenol with my fever creeping upwards, dealing with the most unimaginably horrific pain I've ever felt, INCLUDING PITOCIN INDUCTION, in my life. I begged and begged for drugs or to die but my cries fell on deaf ears as I was just a teen and they were so busy. Once they finally gave me some IV pain relief and did an ultrasound it was clear that I wasn't faking it- I had a blood clot the size of a softball "behind" my cervix (this is what I was told and I still don't understand if that meant inside my cervix or uterus). Another D&C had to be performed. My ob-gyn said he'd never seen that happen before (and he's a very experienced, great guy) and that it had to have been the cytotec. I've been tested since for clotting disorders (none) and had a subsequent spontaneous, uncomplicated miscarriage, followed by an uncomplicated pregnancy and vaginal delivery via pit induction. It wasn't me, and it wasn't the doc- it was the med. I wonder how many people seeing these great inductions are following up to see how the recovery was.

I would never take cytotec again. Not to birth in a nice birth center, not to get on a plane, not to induce miscarriage, not ever. I'd easily choose a c-section even if I were 44 weeks pregnant and 7 centimeters dilated if my only choices were 25 mcg cytotec or a section. Not worth it to me- it's proven it's unpredictability enough for me for one lifetime.
post #62 of 65
I cannot believe that the physician blamed the above story on the cytotec. He's off his rocker. The D&C would be the primary culprit. You can develop a blood clot after any type of uterine procedure, including birth (natural labor or otherwise), a D&C, a section, or a miscarriage. I'm not saying that you are lying or misrepresenting anything; I'm saying the doc here was incorrect. He's a experienced OB/GYN and hasn't ever seen a large blood clot in the uterus (ie behind the cervix) after a D&C? I haven't spent a whole lot of time in the hospital at births and women's procedures and *I've* seen them--though I've only seen them in the ER. If a D&C is done and everything isn't completely removed (and sometimes even when it is), a clot can form. They can get huge--the largest I've ever seen was the size of a grapefruit. Your fever makes me think infection--which correlates with a potential complication of a D&C as well as retained fragments. Maybe your father's friend was trying to cover his a$$, if he or a colleague was the one to perform the D&C? It makes his stats look bad if one of his clients develops and infection or a clot post D&C, even though those things can happen no matter how well he performed the procedure.

We follow up on all our births, of course. 1 day, 2 day, 2 wk, 6 wk, and 12 wk postpartum visits. We have no documentation that cytotec (or castor oil) inductions have any more difficult recoveries. We have mixed data on whether cytotec inductions prevent postpartum hemorrhage or contribute to increased postpartum bleeding--we just don't do enough to have a good sample, and some years the data seems to go one way, some years the other. We haven't yet identified a trend, if there is one.

In any case, what a terrible experience for you. I can totally understand being gun shy of cytotec after that. I stand by my opinion though that cytotec can be completely appropriate under certain circumstances, and that if I had to be induced, if the choice were between cytotec, rupture of membranes, pit, or cervidil, I would choose the cytotec. If I had your history, I would probably avoid the cytotec, too, even if in my head I still had all the knowledge and experience I have now. You have to do what you feel is best for you, you know?
post #63 of 65
yes he did say he had NEVER see what happen to me happen. and so did all the nurses!!! they acted like they had no idea why I was there and when I would tell them it was a total shock. also every ob/gyn and midwife who I have described this story to were confused and did not understand what caused it. so if you're saying you see huge softball/grapfruit sized blood clots forming routinely after d&cs then you're the first one. my understanding is that the cytotec wasn't blamed for the clot itself but for the bleeding. I had a ton ton TON of bleeding after my d&c, enough to make me concerned enough to call the dr but he said it was normal...then the next day all this happened. I would think fever=infection except no one said it was infected and there was no other evidence that it was, I didn't leave the hospital on abx, and the fever disappeared immediately after that 2nd d&c. who knows?
post #64 of 65
Regardless of whether or not the cytotec caused the clot, you said you got an entire pill all at once--four times the standard dosage. That should never have happened.

My first birth was also cytotec-induced. I would have blamed cytotec for the awfulness of it if this birth hadn't been so easy. Now I know that lack of good positioning, going into labor with an unripe cervix (even at 9 days past my due date--induced for gestational diabetes), AROM at 1 cm to try to get things moving on their own, epidural at 2 cm, posterior baby, pushing for two hours, etc. were the reasons why it was so awful. With this birth, I was only in upright, hands and knees positions, started out 1.5 cm dilated, allowed water to break on its own, listened to my body more, and had a wonderful experience. Nope, I think the epidural was a much more dangerous decision the first time than the cytotec.
post #65 of 65
I wouldn't say I see it routinely at all; but I can think of 3 times in the last 6 years that I've seen it after a D&C, spontaneous miscarriage, or a birth. One mom had a bleeding disorder, but the other two did not. Mostly if there is a complication, there is bleeding and/or infection. Usually the bleeding does not result in a clot; it's just bleeding, you know?

Don't quote me on this, because where I work we never give cytotec for miscarriage, but I think that in the event of an early miscarriage, the dose of cytotec given is much, much higher than the dose given in labor. Somewhere along the lines of 400-800 mcg; meaning 4-8 pills.

I don't want to sound cavalier about cytotec--it is potent and frequently abused and misused in the medical and birthing community. I feel the same way about epidurals and pitocin, though. I honestly feel that all three of those have a place in a birth setting, but in a very limited and restricted role. None of them should be routine. None of them should be used lightly, or without complete informed consent. I know that isn't how they are used, though.

I don't want to necessarily sound supportive of the use of cytotec, either. I just feel it is the lesser of two evils, when compared to pitocin. I think we need to be able to use some sort of induction agent for the rare birth that needs to be induced. But if it came down to it, I'd support banning its use rather than the continued unrestricted use that it currently enjoys. I wish ACOG would just get around to setting a firm, conservative standard that would at least protect women against the large doses. When I hear about women getting a whole pill, or a dose every 4 hours until labor sets in (sometimes upwards of 4+ doses) or when it is used concurrently with pit, or with an epidural (so the woman can't tell you about the contractions) it just makes me want to scream. If those uses continue to be the standard, I'd just as soon see it banned. If ACOG or the FDA would have the balls to set up some strict guidelines on its usage, it'd be so much safer.
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