Expert: Shan Yi Sheng - 2/13/2009

Question
QUESTION: Greetings. I was 5 weeks pregnant by ultrasound when I strated to take Misoprostol. Initially, I took 200mcg oral plus 200mcg per vagina every 12 hours. i experienced no cramping or pain.

The next day, I did 400mcg per vagina every 12 hours but still no change. i continued the regimen for 5 more days until the dose was increased to 800mcg per vagina every 12 hours for 3 doses. Last dose was yesterday. I experienced no bleeding nor pain. I don't know what to do now.

Please help

ANSWER: Dear Sharon,
this is extremely strange. No cramping with that dose !!!
You took a dose killing an elephant. (;-)
Anyway, I donot think that you are still pregnant.
Better have a new ultrasound made. Pregtest is no good as this will
stay positive for over 2-3 weeks.
Do not panic.
Dr Shan


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---------- FOLLOW-UP ----------

QUESTION: did an ultrasound and I'm 7 weeks pregnant. Does this happen? Is there a failure rate with misoprostol? Or am i doing something wrong? Other women get cramps with 400mcg vaginal only and i took 800 every 12 hours for 3 doses :(

please help

ANSWER: Hi Sharon, again,

yes there is a failurerate with misoprostol alone...Over 7 % failure
Bad for you. Some people do not respond to prostaglandins (like misoprostol)at all.
You need mifepristone to get a better result of about 98 %.
A 100 % you get with a curettage. Cannot you arange that ?
If in your country you cannot do so, you will have to travel.
I am sorry for you...!
succes anyway,
dr Shan

---------- FOLLOW-UP ----------

QUESTION: will it help if i take misoprostol both oral and vaginal? or since the vaginal regimen didn't work, should i not attempt to take it with oral? Like taking 4 tabs orally and 4 tabs vaginally? thanks .. this will be my last resort :(

Answer
Hi Sharon,

There is not much difference in effect because of the way of administration of the misoprostol. I prefer buccal (do not swallow)
but many colleagues do it otherwise; rectal, vaginally eg.
You seem to be absolute resistant to prostaglandins together with about 4 percent of all women.
So this, your proposed last resort does not do the trick.

Now, and sorry this makes it no better, the fetus could be harmed by
the dosage you took. So this might be a medical indication to have an
abortion.
Hopefully you can think of another solution and you may find a doc
to help you. Sometimes a financial stimulus helps.....
bye for now...

Dr Shan