Cytotec Letters to Midwifery Today Magazine
The following letters appeared in the Networking
section of the Spring, 20001 issue of Midwifery
Today Magazine.
Misoprostol (Cytotec)
"I was 18 weeks pregnant when the baby died
inside me. I went to the hospital to get it aborted.
Having had four previous cesareans, I had no doubts
that I would be having another one again this
time. A special doctor was brought especially
to see me and talk to me about a new medicine
used for induction of labor. The doctor assured
me that it was the best way to go- a straightforward
procedure, no side effects and no cuts and I should
be home with my children in a few hours. It was
Friday and that doctor was not supposed to be
working on that day, so the doctor suggested that
I should go home with the dead baby inside me
and come back on Monday in order to be under her
care.
I returned to the hospital on Monday (January
11, 1999); they told me that I would be included
in a trial and got me to sign a consent form which
very clearly stated that there were no risks or
side effects. Over the weekend I felt as if something
was moving inside me, so I could not go ahead
with the abortion without making sure that the
baby was dead. The doctor agreed to perform an
ultrasound on me, and she did so herself. The
ultrasound report stated that the placenta completely
covered the internal cervical os in the midline.
At about 10 a.m., a nurse came with the first
dose of the drug. She pushed her hand inside me
three times and when she finished, I asked her
how many tablets she inserted. She said that it
was a secret. Fifteen minutes later I started
to bleed heavily- the blood was coming out like
a river, with a continuous non-stop heavy bleeding
and indescribable pain. The doctor came a few
hours later and inserted the second dose herself.
The nurse kept on changing bed sheets totally
covered in blood one after the other, and at about
11:30 p.m. the doctor came with the third dose
of the drug and again inserted it inside me herself.
At that time and after nearly 16 hours of heavy
bleeding, I was totally unconscious and of course
unable to say no.
My husband was next to me the whole time and
the doctor kept on telling him, "Nearly there,
half an hour and the baby will be out." One
hour from the last dose I was taken into the operating
theater in an attempt to save my life. After three
hours in the operating theater, 39 units of blood
transfusion and a total hysterectomy, I stayed
in the hospital for 11 days of which five were
in the intensive care unit.
Since my ordeal I continue to suffer from severe
headaches, chest pain and vomiting; I am extremely
nervous and can no longer have any patience with
my husband or children. My relationship with my
husband and my children has suffered dramatically
and an ultrasound taken two weeks ago showed two
damaged ovaries that must be removed by surgery.
Not many women fully understand the devastating
effects- emotionally as well as physically with
respect to hormones- when a woman loses her uterus.
Every day I wake up with one thought in my mind-
that it would be better if I died.
In an attempt to try and establish negligence
against the doctor and the hospital I visited
many gynecologists. None have believed that I'm
still alive, neither could they believe that there
could be such a doctor who would tolerate such
an ordeal for an animal, let alone for a human
being. All have confirmed that I should have never
been given this killer drug, and have said they
would write a report establishing negligence against
the doctor and the hospital. We pay their fees
and wait for the report; something happens after
we leave their clinics and for some reason every
one of them changes his mind. Obviously we became
aware that there must have been some authorities
that have communicated with them to prevent them
from writing reports to establish and prove negligence
against the doctor and the hospital.
I am a woman who had death in the uterus in the
second trimester of pregnancy; multiple cesarean
sections (four); the placenta totally covering
the internal os of the cervix, which is the only
natural exit of the fetus; and with a history
of protein-C deficiency. Was I a suitable applicant
for this trial?"
Tahany Hassan
Sydney, Australia
A response from Marsden Wagner, MD- pediatrican,
neonatologist, perinatal epidemiologist, and former
Director of Women's and Children's Health for
the World Health Organization.
"Regarding the letter from Tahany Hassan,
I have had the opportunity to review her records
and want to make three points:
1) Using misoprostol (Cytotec) during pregnancy
to aid in the abortion of a dead fetus is an indication
completely different than using this drug to induce
labor at the end of pregnancy. I have written
extensively on the dangers of Cytotec induction
at the end of pregnancy but using Cytotec for
medical abortion earlier in pregnancy or using
it with postpartum hemorrhage are different issues
with different scientific research papers and
different risks.
2) In the case of Ms. Hassan, she had many contraindications
to being given Cytotec including four previous
cesarean sections and having a proven placenta
previa. She should have never been asked to participate
in this experimental trial.
3) I have read the informed consent statement
which Ms. Hassan was asked to sign when she was
recruited into the trial- it is a joke and a scandal.
It reads like a sales pitch, not information on
a powerful drug, and never states what the known
risks of this drug are."
Marsden Wagner MD, MSPH
Washington, D.C.
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