Need to take Cytotec to start miscarriage--advice?

[Anonymous]

Guess I wasn't listening too well after getting the bad news....

I just had my first ultrasound at 8+ weeks (because the two previous appointments had been cancelled). No heartbeat and they say baby stopped growing around 6 weeks. They've given me a prescription of Cytotec to start the miscarriage process because my body hadn't started on its own after over two weeks. Can anyone tell me realistically what to expect? How many hours before the process kicks in? I guess the holiday weekend provides me with a time to work on this but I don't even know when/how/what.

Please help.

[Anonymous]

I just did this last weekend. I had waited two weeks to naturally miscarry (I found out at 7.5 weeks that there was an empty sac).

After 2 weeks, just daily spotting and cramping. Trying to avoid a D&C, so asked for the cytotec

So my doctor prescribed 4 pills of cytotec. He told me to do it on a day I didn't have to work. He said that some doctors tell patients to do it vaginally, but he thinks it works better between the cheek and the gum.

I put two pills between left cheek and gum and two pills between right cheek and gum. Held them there to dissolve for 30 minutes and then swallowed what was left of them.

I took prescription strength ibuprofen about a half hour BEFORE taking the cytotec.

The cramping wasn't nearly as bad as I thought (probably because I took the ibuprofen first). I expected it to take longer, but after 2 hours, I already noticed a lot of blood, clots and placenta.

You really need to have large maxi pads on hand and check at least once every hour to see if you've soaked through. My doctor said that if I was soaking through more than one an hour, then I should call the office.

The bleeding and clots passing continued pretty much for the next 24 hours and then tapered off significantly. The doctor said I'd have some stomach upset, but it wasn't too bad, mainly bloating and gas and slightly loose stools.

I'm not sure, actually, if I passed the sac. Sometimes stuff came out while I peed (sorry if TMI) and I didn't see it all before it slid down the toilet drain.

I did the cytotec on Saturday, and now, Tuesday, I'm still bleeding and cramping a little, but nothing major, more like the backend of a normal period. I'm hoping most everything passed.

I feel a lot better. The bloating I've had for the past two weeks has gone down a LOT, so I think it has helped.

I have to go back in a couple weeks to get a sonogram to see if it has all passed. I'm really hoping I don't have to get a D&C, but honestly, I'm not positive one way or the other.

I had kind of hoped for more resolution with the cytotec, but I'm still glad I did it. My doctor only gave me one dose. Some do two. Maybe two would have been better. Or maybe I would have bled too much. I don't know.

I hope that helps. If you have any specific questions, just post.

Best of luck.

[Anonymous]

PP here again.

One more thing, make sure your husband, boyfriend or someone who knows what is going on is home when you do the cytotec, because if you bleed too much, you'll need someone to drive you to the hospital.

And as I said, taking something for the pain BEFORE taking the cytotec worked well for me. Make sure you ask the doctor for either prescription strength ibuprofen or some other pain killer to take before you take the pills.

I took the pills early afternoon and planned on a lazy day watching tv. Some women take them before bed, but I am glad I took them early in the day. By the time I went to bed, I knew what was happening, how my body was responding.

[Anonymous]

First off, OP- I am so sorry to hear of your loss.

I had a miserable experience with Cytotec - it didn't help expel everything and I spent a night on the bathroom floor vomiting and with diarrhea - sweats and shakes, just like a horrible stomach flu. I still ended up needing a D&C when all was said and done. For me, it was really difficult to have the physical pain (and still not passing the sac) on top of the emotional hurt. God forbid it ever happened again, I'd take a wait and see approach for a week or so and then definitely schedule a D&C.

That being said- not trying to scare you. Everyone has different reactions. Please do your research, though. Cytotec is some nasty stuff and has been linked to some pretty awful side effects. (Not that natural m/c or D&Cs are without risk)

I hope that you are able to start healing shortly and know that there are tons of us on this board who have been there and can truly empathize. Hugs!

[Anonymous]

Anonymous wrote:First off, OP- I am so sorry to hear of your loss.

I had a miserable experience with Cytotec - it didn't help expel everything and I spent a night on the bathroom floor vomiting and with diarrhea - sweats and shakes, just like a horrible stomach flu. I still ended up needing a D&C when all was said and done. For me, it was really difficult to have the physical pain (and still not passing the sac) on top of the emotional hurt. God forbid it ever happened again, I'd take a wait and see approach for a week or so and then definitely schedule a D&C.

That being said- not trying to scare you. Everyone has different reactions. Please do your research, though. Cytotec is some nasty stuff and has been linked to some pretty awful side effects. (Not that natural m/c or D&Cs are without risk)

I hope that you are able to start healing shortly and know that there are tons of us on this board who have been there and can truly empathize. Hugs!

Sorry op have been there twice. First time took drug,second time d and c. D ANC is a million times easier, go that route if you can

[Anonymous]

I just wanted to put my 2 cents in, a d&c at that point in office is no big deal really easy and you are fine when you leave the office. Actually when the Xanax wears off. The cytotec option sounds horrible.

[Anonymous]

Just had to chime in -- I got Asherman's Syndrome (scar tissue) from a properly-done D&C.

For my next m/c I insisted on Cytotec.

I had a "good" experience -- as good as the miscarriage of a wanted pregnancy can be!


What made my experience good was, I think:

1) I took Zofran and Percocet 30 min BEFORE I took the Cytotec. Did I mention I took it BEFORE? Take it BEFORE!

2) I dipped the pills in white vinegar (5% acetic acid) and then inserted them vaginally. There is some evidence that this is the quickest way to completion.

http://www.ncbi.nlm.nih.gov/pubmed/20063994

I would absolutely do it vaginally, not orally, sublingually or buccally (is that word? In your cheek). Unless you like vomiting. Also, there is just no reason to take it systemically rather than putting it closer to where you want it to be.


I took the Zofran and Percocets, inserted the pills, took a nap, got up an hour and a half later and passed the sac and a lot of tissue. Two days later I had an ultrasound and my uterus was clean as a whistle.

I vastly preferred being at home with all my comforts to being at a hospital waiting for hours wearing a gown. And the cost was... $16. My co-pays for the D&C were closer to $1000.

So some people do have good experiences with Cytotec. And if you are prone to scarring, it is safer than a D&C. Asherman's is a sucky disease. It costs me my fertility.

Please ask if you have any questions. I wish doctors were more educated about the proper use of misoprostol/cytotec. They are really not. I had to education my SG doctors.

I far preferred being

[Anonymous]

I did this a few years ago. The doctor had told me to take the pills vaginally the night before I wanted results, but I waited until about 4 am and then went back to sleep for a few hours. I also took a combination of prescription painkillers, prescription anti-nausea drug, and Advil. The pain was still excruciating for about an hour, but once I passed the sac at about 9 am it was over. I did continue to pass tissue for 24-48 hours, so you will want to stay close to home for a day or two after taking the pills. I would also advise against taking it "the night before," because some people respond more quickly than others, but once you respond, it goes quickly. You don't want to be dealing it in the middle of the night.

I would do it again in a heartbeat b/c I have heard too many stories of D&Cs leading to Asherman's. I (and many others) think D&Cs lead to Asherman's far more often than doctors admit.

[Anonymous]

I am one of the previous posters who had d and c. I went on to have two healthy kids and didn't have to take any narcotics. Really don't think infertility is a a common side effect, but talk to your doctor if you have concerns.

[Anonymous]

Anonymous wrote:I am one of the previous posters who had d and c. I went on to have two healthy kids and didn't have to take any narcotics. Really don't think infertility is a a common side effect, but talk to your doctor if you have concerns.

I am the another PP who had an uneventful D&C. It cost me a $25 copay for in office and literally period cramps are more painful than the procedure was. (I just wanted to mention this, because while the lady with asherman's had a bad result, she is definitely not the norm and she seems to like to try and scare people out of a minor procedure.) Really a pedicure can end up in an amputated foot, but it doesn't stop me from getting them.

[Anonymous]

I had a decent enough experience with Cytotec (like PP said, as "good" as a miscarriage experience can be) and would do that again over a D&C. Relatively low amount of pain but a lot of blood and it was spread over the course of a couple of days - so really stay away from work.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I am one of the previous posters who had d and c. I went on to have two healthy kids and didn't have to take any narcotics. Really don't think infertility is a a common side effect, but talk to your doctor if you have concerns.

I am the another PP who had an uneventful D&C. It cost me a $25 copay for in office and literally period cramps are more painful than the procedure was. (I just wanted to mention this, because while the lady with asherman's had a bad result, she is definitely not the norm and she seems to like to try and scare people out of a minor procedure.) Really a pedicure can end up in an amputated foot, but it doesn't stop me from getting them.

I am the first PP who mentioned Asherman's, the one who used acetic acid. It's the second time I've ever posted about it on DCUM, so I'm not sure why you think you know who I am and that I "like to try to scare people out of a minor procedure".

It may be a minor procedure, but it does carry risk. Doctors around here are woefully ignorant. I guess I just selfishly and bitterly… don't want other women to lose their fertility if they don't have to.

"AS has a reported incidence of 25% of D&Cs performed 1–4 weeks post-partum,[9][10][17] up to 30.9% of D&Cs performed for missed miscarriages and 6.4% of D&Cs performed for incomplete miscarriages.[18] In another study, 40% of patients who underwent repeated D&C for retained products of conception after missed miscarriage or retained placenta developed AS.[19]

In the case of missed miscarriages, the time period between fetal demise and curettage may increase the likelihood of adhesion formation due to fibroblastic activity of the remaining tissue.[7][20]

The risk of AS also increases with the number of procedures: one study estimated the risk to be 16% after one D&C and 32% after 3 or more D&Cs.[21] However, a single curettage often underlies the condition."

http://en.m.wikipedia.org/wiki/Asherman's_syndrome

When I went into my D&C, my doctor pooh-poohed my questions about scarring. I was so upset about miscarrying after IVF and didn't ask too many questions when he told me that the risk was tiny. It's not tiny.

Medically, Cytotec is the lowest-impact and lowest-risk option. It's the conservative choice. But it doesn't really fit our medical model as well as D&C does.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I am one of the previous posters who had d and c. I went on to have two healthy kids and didn't have to take any narcotics. Really don't think infertility is a a common side effect, but talk to your doctor if you have concerns.

I am the another PP who had an uneventful D&C. It cost me a $25 copay for in office and literally period cramps are more painful than the procedure was. (I just wanted to mention this, because while the lady with asherman's had a bad result, she is definitely not the norm and she seems to like to try and scare people out of a minor procedure.) Really a pedicure can end up in an amputated foot, but it doesn't stop me from getting them.

I am the first PP who mentioned Asherman's, the one who used acetic acid. It's the second time I've ever posted about it on DCUM, so I'm not sure why you think you know who I am and that I "like to try to scare people out of a minor procedure".

It may be a minor procedure, but it does carry risk. Doctors around here are woefully ignorant. I guess I just selfishly and bitterly… don't want other women to lose their fertility if they don't have to.

"AS has a reported incidence of 25% of D&Cs performed 1–4 weeks post-partum,[9][10][17] up to 30.9% of D&Cs performed for missed miscarriages and 6.4% of D&Cs performed for incomplete miscarriages.[18] In another study, 40% of patients who underwent repeated D&C for retained products of conception after missed miscarriage or retained placenta developed AS.[19]

In the case of missed miscarriages, the time period between fetal demise and curettage may increase the likelihood of adhesion formation due to fibroblastic activity of the remaining tissue.[7][20]

The risk of AS also increases with the number of procedures: one study estimated the risk to be 16% after one D&C and 32% after 3 or more D&Cs.[21] However, a single curettage often underlies the condition."

http://en.m.wikipedia.org/wiki/Asherman's_syndrome

When I went into my D&C, my doctor pooh-poohed my questions about scarring. I was so upset about miscarrying after IVF and didn't ask too many questions when he told me that the risk was tiny. It's not tiny.

Medically, Cytotec is the lowest-impact and lowest-risk option. It's the conservative choice. But it doesn't really fit our medical model as well as D&C does.

I've never had a D&C and don't have Asherman's, so I don't have an axe to grind, but when I was trying to choose between a D&C and cytotec, I did a lot of research and saw studies like the one PP mentions. Yes, plenty of people have D&Cs with no complications, but there is a growing body of evidence to suggest that the procedure is much riskier than doctors acknowledge, and the stakes (a fertile uterus) are quite high. I think doctors like D&Cs because they are quick and allow the doctors maximum control. Cytotec is painful, can fail, and sometimes leads to inconvenient phone calls from panicked women who have taken it and don't know whether what they are experiencing is normal. But I agree with PP that it is the conservative choice, next to watchful waiting.

[Anonymous]

OP here. I cannot tell you all how grateful I am to ALL of you for your comments. My Dr--the head of genetics at GW--strongly recommended against the D&C, at least at first, so I don't think I could get one right now. He said my only two options at this point are to take this medicine OR wait and see. But the baby has already been dead for over two weeks and I just don't think psychologically that I can take much more waiting. I'm also 41 and hoping that I can try again, when I am emotionally ready, and the thought of spending more weeks in this condition is unbearable.

This pill sounds so scary. Some people were "ok" (comparably) but some of you had awful experiences. I'm disturbed that my Dr. didn't offer me any prescription strength pain killers, nor did he give me any instructions about how to take this thing (orally, vaginally), etc.!

[Anonymous]

OP- 16:20 here from yesterday. In whatever you decide, please make sure that you call the doctor's office again to get explicit instructions on how to best use the Cytotec before you start. Best of luck to you- and again, I am so sorry for your loss. Not sure if this is/isn't appropriate, but just wanted to let you know that I am 37 weeks today with my rainbow baby-- and I hope that's the outcome for you, too!