Need to take Cytotec to start miscarriage--advice?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:
You do realize that the particular cite for "up to 30 percent",is from an article that is more than 30 years old. Medicine has advanced quite a bit since 1982. Not to mention the fact we have no idea what the sample size was the article looked, etc. . .

You'd think so, wouldn't you? But the fact is that D&Cs are now almost always performed exactly the same way as they were in 1982: "blind", by feel, scraping with a curette. The only ones I know who are performing guided D&Cs are Asherman's specialists.

I'm sorry that you suffered with its universally described elsewehre as a "rare" side effect of d&c. However, I do think you are scaring off others from a procedure that is much quicker and for many women, much less painful both emotionally and physically than the alternative with a bare minimum of medical fact and a lot of personal emotion. D&C also makes it far easier for the doctors to procure a tissue sample to determine the cause of miscarriage.

I am absolutely not telling anyone to trust my "personal emotion". My personal emotion is driving me to tell women to educate themselves about the very real and underreported risks of D&C. Look at the information out there and decide what risks you're comfortable with. Here are some more recent references:

2007: "In the present study, 37.6% of the women subjected to curettage following abortion had IUA [Intrauterine Adhesions]."
http://www.ncbi.nlm.nih.gov/pubmed/18094891

The is the only study I know of that followed women after D&C regardless of whether or not those women were trying to conceive, and that diagnosed them via the gold standard, a hysteroscopy.

2014: "In a recent meta-analysis, the pooled prevalence of IUA after miscarriage was found to be 19%, the vast majority of which developed after treatment with dilation and curettage (D & C)... In women with early pregnancy loss after in vitro fertilization (IVF), the prevalence of IUA has been reported as high as 38%."
http://www.ncbi.nlm.nih.gov/pubmed/24959821

It is absolutely true that if you want to test the tissue, you've gotta do a D&C. That's part of the cost-benefit calculation.

Neither of these abstracts discloses how many d&cs the patients has and the first is from a foreign country. If I had access to the full copies of each, I'm sure that I could find other ways they are not completely on point. My original point stands -- if this is a concern, talk to your doctor, not some random internet poster with a bias. For many women, the d&c is preferable to the drugs -- it was for me and I did both.

Okay, well, OP didn't ask about getting a D&C. She asked about taking cytotec. I'm not the PP quoting statistics. I'm the one trying to avoid a second D&C. I had no problem with the cytotec. I just won't know until the follow-up sonogram if it cleared everything.

I don't know if you can say, based on your own anecdotal experience that many women prefer the d&c. Personally, I didn't think the cytotec was a big deal. I wish I would've done it the first time before doing the D&C.

How is your anecdotal experience more valid than mine? Or even some of the other posters with asherman's?

It seems like you are trying to scare OP away from taking the cytotec, when that is what her DOCTOR recommended. And not all women have a horrible experience taking it. I didn't.

[Anonymous]

Anonymous wrote:
Neither of these abstracts discloses how many d&cs the patients has and the first is from a foreign country. If I had access to the full copies of each, I'm sure that I could find other ways they are not completely on point. My original point stands -- if this is a concern, talk to your doctor, not some random internet poster with a bias. For many women, the d&c is preferable to the drugs -- it was for me and I did both.

Because science only counts if it happens in America?

My original point stands: if this is a concern, don't blindly assume that your doctor is up-to-date on this particular area of research. Most gynecologists, most OBs, and most reproductive endocrinologists are not.

It sounds like OP's doctor at GW -- which, coincidentally, houses an Asherman's specialist -- is up-to-date on this issue and has recommended the Cytotec. It's a bit unusual to hear that, and I hope it means that the tide is turning as awareness of Asherman's grows.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

I call bs on your 30 percent statistic, particularly for women in the US going to a high end doctor/hospital. I think you have your own personal agenda.

(I'm the PP you're replying to)

Totally okay! It's good to be skeptical of the statistics I'm quoting here. But don't stop there. Please look for yourself and decide whether or not you trust the source.

The wikipedia article on Asherman's syndrome is a convenient directory of links:
http://en.wikipedia.org/wiki/Asherman%27s_syndrome

The 30% I quoted was from

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.

Wikipedia by itself is not authoritative, but it is a handy way to find primary sources.

As to "high end doctor/hospital", it's unfortunately a myth that only badly-performed D&Cs cause Asherman's. It's more likely to be something intrinsic about some women's uteruses and how easily they develop scar tissue. Only using suction (as opposed to curettage) is also not a surefire way to avoid AS.

I guess I do have an "agenda" in that I hope by sharing my crappy experience I can help another woman to hang onto her fertility. Or do you think I'm being paid by big pharma to boost the sales of misoprostol? 800 mg (4 tablets) costs about $7. No one's getting rich off of it.

You do realize that the particular cite for "up to 30 percent",is from an article that is more than 30 years old. Medicine has advanced quite a bit since 1982. Not to mention the fact we have no idea what the sample size was the article looked, etc. . .

I'm sorry that you suffered with its universally described elsewehre as a "rare" side effect of d&c. However, I do think you are scaring off others from a procedure that is much quicker and for many women, much less painful both emotionally and physically than the alternative with a bare minimum of medical fact and a lot of personal emotion. D&C also makes it far easier for the doctors to procure a tissue sample to determine the cause of miscarriage.

I'm not the PP but after reading through this thread, YOU seem to be the one with the agenda. The other pp keeps saying "this is my experience" and "do your own research" and you keep coming at her like you have something to prove. It's weird.

You clearly preferred the d&c to the drugs. She didn't. Stop acting like her experience is not valid or that her complications were so rare as to not garner consideration.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

I call bs on your 30 percent statistic, particularly for women in the US going to a high end doctor/hospital. I think you have your own personal agenda.

(I'm the PP you're replying to)

Totally okay! It's good to be skeptical of the statistics I'm quoting here. But don't stop there. Please look for yourself and decide whether or not you trust the source.

The wikipedia article on Asherman's syndrome is a convenient directory of links:
http://en.wikipedia.org/wiki/Asherman%27s_syndrome

The 30% I quoted was from

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.

Wikipedia by itself is not authoritative, but it is a handy way to find primary sources.

As to "high end doctor/hospital", it's unfortunately a myth that only badly-performed D&Cs cause Asherman's. It's more likely to be something intrinsic about some women's uteruses and how easily they develop scar tissue. Only using suction (as opposed to curettage) is also not a surefire way to avoid AS.

I guess I do have an "agenda" in that I hope by sharing my crappy experience I can help another woman to hang onto her fertility. Or do you think I'm being paid by big pharma to boost the sales of misoprostol? 800 mg (4 tablets) costs about $7. No one's getting rich off of it.

You do realize that the particular cite for "up to 30 percent",is from an article that is more than 30 years old. Medicine has advanced quite a bit since 1982. Not to mention the fact we have no idea what the sample size was the article looked, etc. . .

I'm sorry that you suffered with its universally described elsewehre as a "rare" side effect of d&c. However, I do think you are scaring off others from a procedure that is much quicker and for many women, much less painful both emotionally and physically than the alternative with a bare minimum of medical fact and a lot of personal emotion. D&C also makes it far easier for the doctors to procure a tissue sample to determine the cause of miscarriage.

I'm not the PP but after reading through this thread, YOU seem to be the one with the agenda. The other pp keeps saying "this is my experience" and "do your own research" and you keep coming at her like you have something to prove. It's weird.

You clearly preferred the d&c to the drugs. She didn't. Stop acting like her experience is not valid or that her complications were so rare as to not garner consideration.

It's her inaccurate use of stats that I take issue with. And I'm the one whose encouraged people to speak with actual doctors, she says they don't know as much as she does.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

I call bs on your 30 percent statistic, particularly for women in the US going to a high end doctor/hospital. I think you have your own personal agenda.

(I'm the PP you're replying to)

Totally okay! It's good to be skeptical of the statistics I'm quoting here. But don't stop there. Please look for yourself and decide whether or not you trust the source.

The wikipedia article on Asherman's syndrome is a convenient directory of links:
http://en.wikipedia.org/wiki/Asherman%27s_syndrome

The 30% I quoted was from

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.

Wikipedia by itself is not authoritative, but it is a handy way to find primary sources.

As to "high end doctor/hospital", it's unfortunately a myth that only badly-performed D&Cs cause Asherman's. It's more likely to be something intrinsic about some women's uteruses and how easily they develop scar tissue. Only using suction (as opposed to curettage) is also not a surefire way to avoid AS.

I guess I do have an "agenda" in that I hope by sharing my crappy experience I can help another woman to hang onto her fertility. Or do you think I'm being paid by big pharma to boost the sales of misoprostol? 800 mg (4 tablets) costs about $7. No one's getting rich off of it.

You do realize that the particular cite for "up to 30 percent",is from an article that is more than 30 years old. Medicine has advanced quite a bit since 1982. Not to mention the fact we have no idea what the sample size was the article looked, etc. . .

I'm sorry that you suffered with its universally described elsewehre as a "rare" side effect of d&c. However, I do think you are scaring off others from a procedure that is much quicker and for many women, much less painful both emotionally and physically than the alternative with a bare minimum of medical fact and a lot of personal emotion. D&C also makes it far easier for the doctors to procure a tissue sample to determine the cause of miscarriage.

I'm not the PP but after reading through this thread, YOU seem to be the one with the agenda. The other pp keeps saying "this is my experience" and "do your own research" and you keep coming at her like you have something to prove. It's weird.

You clearly preferred the d&c to the drugs. She didn't. Stop acting like her experience is not valid or that her complications were so rare as to not garner consideration.

It's her inaccurate use of stats that I take issue with. And I'm the one whose encouraged people to speak with actual doctors, she says they don't know as much as she does.

Hey, my use of stats isn't inaccurate -- all you've been able to say about it is that one of the numbers was old and another one was foreign (!).

Maybe we can agree in this: people should speak with actual doctors, provided those doctors are knowledgable about Asherman's prevention.