Expert: Pat G - 3/15/2010

Question
QUESTION: Hello Doctor,
i am 5 weeks pregnant, i went to a gynacologist yesterday and she inserted 6 small pills in my vagina due tow hih i had a lot of white stuff on my underwear .. this  was done at 6 pm sh then told me to take 6 pills orally which i think were misoprostol at 6am, its been 8 hours after i swallowed the medicines and i still do not have any pain or ramping or bleeding, what do i do? I'd also like to inform you that i live in a place where abortion is illegal. The doctor i went to helped somebody get an abortion which was successful which was also the reason that I trusted her.

ANSWER: Hello, natali,

I hate to say this, but the doctor you went to has committed malpractice. Putting pills in the vagina can cause a woman to get toxic shock syndrome. This is caused by Clostridium sordellii. Toxic shock syndrome will kill a woman within hours. You are in grave danger.

Have a friend stay with you. If the friend notices anything abnormal about you, or your behavior, or if you start to feel sick, you should be rushed to the emergency room. Your friend should tell them to look for Clostridium sordellii and treat for it immediately. A woman's body doesn't fight back. So it will have to be aggressive treatment to save your life. It wouldn't hurt for you to get tested for Clostridium sordellii right now. Don't expect to experience a fever. A fever only happens when the body is fighting back. Because the body doesn't fight back in this case, that's why it kills so quickly.

I am aware that abortion is illegal in UAE. The laws protect women from unscrupulous abortionists, who hurt and kill women. This just demonstrates how necessary this law really is, because it is intended to protect women like you. This woman should be prosecuted. Seriously. She can hurt other women.

Taking just misoprostol often won't cause an abortion. Instead, it causes birth defects, which can be serious. Not every baby has these birth defects, but if they occur, they can result in microcephaly, which causes mental retardation and shortened arms and legs.

If these pills do cause cramping or bleeding, you are also in grave danger. You could bleed to death, or the pills could cause your uterus to rupture. The manufacturer of the pills says that they are NOT SUPPOSED TO BE TAKEN BY A PREGNANT WOMAN, ever.

It makes me sick to think of what this woman has done to you.

If you continue to have no symptoms from these pills, count yourself lucky and leave things alone. Find a decent doctor and ask him to take care of you and check and make sure you both are all right. Having an abortion to conceal a pregnancy is always a bad idea, because of how often there is serious harm to the woman. When this happens, people will find out. If you are facing social difficulties if your pregnancy becomes known, I recommend you try to go to another country where you will be safe, and stay there until your baby is born. Then if you cannot care for your baby, you can put him or her up for adoption and return home.

I will pray for you. Let me know if you need any other kind of help. And please let me know how you do. I want to know that you are OK.

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

QUESTION: Hi Docyor,
your reply is so disturbing I have no idea about what i should do now, if i go to a hospital and i m in a serious condition and pregnant i will be reported. I cannot let that happenm so do you think i should go to a doctor nearby who i generally go to and tell him about the situation and get the clostridium sordeli checked?
and why would she want to kill me? I knew her because my friend was pregnant and we luckily found her to get the abortion done, i saw the pills she gave my friend , however they were different, there were 2 that she needed to swallow hour after the other and then i think she inserted 4 in her vagina the following day and the bleeding started in about 15 minutes and she then followed some anti biotics prescribed by the same doctor and she had a successful abortion.

ANSWER: Hello, Natali,

Your friend may not have had Clostridium sordellii in her body. If that is the case, then she would be able to take the pills and she would be OK. The doctor obviously doesn't know what the dangers are. Either that, or she has decided that if you are in danger of what your family might do to you, it is preferable to take this risk.

I can readily understand how you feel. These pills don't always kill women, just sometimes. That's one reason people are still using them. Some women get away with it. I don't think the doctor wants to kill you. I think that she has compromised her medical ethics, and she hopes she will get away with it. Sometimes she does. But she is responsible to read the prescribing information of the drugs she gives, and they specifically say that this drug should never be given to a pregnant woman. If she chooses to ignore that, she is being highly negligent. There are some doctors who think they're doing women a favor by providing abortions. In the UAE, pregnancy outside of wedlock can sometimes result in families harming their daughters because of honor. So it's a serious problem. But I personally don't see why a woman should have to choose between her family and her life, or between one situation where she might be killed, and another situation where she might be killed. Obviously at some point, things have to change, but we have to deal with the situation as it is right now.

Knowing whether or not you have Clostridium sordellii in your body could help you to know how great the danger is. If it's not there in the first place, you won't have a problem with that particular threat. But you need to know. There is not a lot of time. I'm wondering if you can go to the American embassy and explain the situation. If you tell them that you are in danger from your family, and that you went to a doctor who gave you instructions that could result in your dying from toxic shock syndrome, and you need to know if it is a danger for you in particular, and you wonder if they will help you find a doctor (American) who will be willing to test you for Clostridium sordellii. Doctors are not supposed to tell anyone else about the medical problems of their patients. If there were an organization in UAE that helps pregnant women, I'd send you there, but there isn't one that I am aware of. The American embassy is the next best thing that I can think of. I talked to my son, who has spent some time in the Middle East, about this type of situation that you are in, and he recommended that a woman in your position should leave the country and go to a country where she can be safe. If you can still do that, and you are well enough to travel, it would be the wisest thing to do, but you may or may not be able to do this. The only other thing I can think of is that you take your chance that you don't have Clostridium sordellii in your system, and if you do get sick, you go to the emergency room. At that point, the choices will not be good, and you do the best you can. Have a friend take you (perhaps the friend who went to this same doctor), and have her ask them to test for Clostridium sordellii. Perhaps they won't ask you why this is a problem, but if they do, you can say that you are afraid you may have it, but you don't know how you got it, or whatever you think is best.

I also wonder about how the law is enforced in UAE. In the United States, if a woman was willing to tell the police who did the abortion, they wouldn't arrest her. Do you happen to know how the law enforcement people would react in UAE?

One final thing you might try. I don't like to see you go back to the doctor who did this to you, but she already knows your situation. You can ask her to test you for Clostridium sordellii. Please give her this link, and ask her to look at it:

http://content.nejm.org/cgi/content/full/353/22/2352

If you don't experience any adverse effects, and you don't bleed, please don't do anything to yourself. Make arrangements to go to another country for the duration of your pregnancy. You can go there and be safe, and then give your baby away, and then return home.

I can hope and pray that you will be OK.

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

QUESTION: Hi doctor,
I really appreciate the time and the advice you've given me on clostridium sordellii, i wouldnt have known about it if it wasnt for you.. However I'd  like you to know that i do not want to keep the child,I want an abortion so if i cant get it here i will go to a country where its legal to abort.

The other thing is that it been almost 2 days since she inserted the pills, and i don't feel unusual so i doubt i have clostrisium sordellii, I even read blogs online which said that the FDA cheked the drugs misoprostol and mifepristone and they r not the reason for C.S
If i have to repeat the procedure which in this case is very likely because i am still not bleeding or cramping, and if i have no option but to go bak to her I would show her the link ask her to test me for C.S and probably take the pills bucally and let them dissolve in my mouth
does that sound Ok to you?
I even called the doctor who gave me these medicines to ask her why hasnt the pill worked on me, she said she would give it another day and do an ultra sound tomorrow, in the mean while i will talk to th doctor who i go to generally and ask him if he could help.
I'd also like you to know that i m a student and i cannot really travel out of the country with ease,i get limited pocket money which might not be enough for travelling and aborting, however i will keep you posted to every decision i take and you could guide me.
Thank you so much

Answer
Hello, natali,

First, it is important that you do not address me as "doctor". I am a woman who has done a lot of medical research and talked to a lot of other women, and I consult with doctors when I need an answer.

Don't believe some of these blogs. They don't know what they are talking about. The FDA is completely corrupt, so whatever it says cannot be trusted.

Clostridium sordellii is only one of the things that can go wrong. There are several other ways these pills can kill. And since you are going to school, you need to know that these pills could incapacitate you for weeks and totally wreck your current semester of study.

The safest thing you can do is to give the baby up for adoption. I'm serious! Abortion is always dangerous, and there are a lot of women dying from abortion.

The pills can also cause a woman to bleed to death. A lot of women are bleeding to death. You are aware, I am sure, that if you are bleeding heavily or hemorrhaging, going to class won't be an option.

I hope you will take care of yourself and not take chances. I want you to be well. You can complete your studies if you take care of yourself. And by the way, I got my degree after I had four children, and at the time, three of them were under the age of 5.

My only concern is your family situation. This is why I think it would be wise to leave the country and stay until after you have your baby. It's early enough that you should be able to complete this semester and then travel, if your semesters end at a time similar to ours. But we can talk about when they do end, and what can be done.

I appreciate the fact you will keep in touch and let me know what you are doing. I will be here for you. I just won't tell you something dangerous and deadly is OK. Fair enough?