Monday, July 19, 2010
Misoprostol for miscarriage management: the facts and the fiction
This is my latest Youtube video presentation. It explains the truth behind often repeated misinformation about misoprostol.
Misoprostol for miscarriage management is underused despite evidence of its efficacy and safety. It is an ideal alternative to D&C. It can also prevent Asherman's syndrome which mainly occurs from D&C, a blind surgery. This clip clarifies concerns about misoprostol which may be hindering its use by clinicians and patients alike.
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One week ago, I had a miscarriage at 7 weeks, and was prescribed one tablet of Misoprostol 200mcg to use vaginally to expel any remaining tissue. One of the many horrible side effects of misoprostol is birth defects. My husband and i would like to TTC as soon as we can. Do i need to wait for a certain period of time for the Misoprostol to pass, or was my dose low enough for us to safely start trying within the next couple of weeks?
ReplyDeleteHi. I usually avoid answering medical questions since I am a doctor but not of medicine, nor is this a support group for patients to exchange experiences. However, your message warrants a response for educational purposes. There is a lot of misinformation about misoprostol.
ReplyDeleteFirst of all, 200 mcg of misoprostol (cytotec) is not what is recommended for missed (also known as silent) miscarriage. In fact, the dose of 200 mcg of misoprostol is not used to my knowledge for any indication. It is too low for termination, miscarriage induction, and even cervical ripening, while being too high for labour induction. According to current guidelines, the correct dose for missed miscarriage at your stage is at least 600 mcg in two doses three hours apart.
Misoprostol does not have many ‘horrible’ side effects. Like any drug, or indeed any medical procedure, it needs to be used correctly and under medical supervision. Surgical curettage has more potentially ‘horrible’ outcomes than a drug that is also being used safely for treating gastric ulcers. I am sure you would have been given informed consent for misoprostol use and offered standard care curettage if you were negative about misoprostol. Meanwhile many women who miscarry are given no option other than curettage and are not told about the possibility or true incidence rate of Asherman’s syndrome or other complications from it.
The ‘birth defects’ to which you are referring would only make sense in the context of a viable (living) fetus. Of course women with viable pregnancies they wish to retain should not use misoprostol (or have a D&C!) for any reason. However, you had a miscarriage which means that the fetus either died at some stage up to 7 weeks or perhaps never even formed (blighted ovum). Damaging the placenta and/or fetus either mechanically from a D&C or with drugs such as misoprostol without performing a complete evacuation could obviously leave the fetus with injuries and result in birth defects. Doctors are very careful to prevent this situation. Misoprostol cannot cause future birth defects because it is not stored in the body. It has a half-life of 20-40 minutes, therefore there will be no trace of it in your body by the time you are next ovulating (note that ovulation is often delayed after a miscarriage). So to answer your question, it is safe for you to try to conceive within a few weeks, and even if you were given a higher, correct dose.