QuestionQUESTION: I made the worse decision of my life and had a medical abortion (methotrexate & cytotec) on 10/9/07 - my LMP was 9/2/07 and with a transvaginal ultrasound no gest. sac or anything was seen in my uterus. The MD said I qualified with the above method for aborting. I took the cytotec PO on 10/13/07 @ night and even though I had horrible cramps - nothing has happpened - no spotting at all - even after the injection of methotrexate. No bleeding. I go back on 10/16/07 - what now?? After having a mental breakdown for the last week I also found out that this doctor has been charge with abuse and neglect towards x2 pts in his care. I'm really scared. I personally know my own GYN MD - so I could never go to her. Does this method of medical aborting take several tries? Is it possible after this last week there may now be a gest sac with a possible heart beat? I can't believe what I have done.
ANSWER: Dear Nicole,
There are two possibilities: 1) the methotrexate didn't work. This is fairly common with methotrexate, and you may need a second injection. 2) you have an ectopic pregnancy. The chances of this are less than 1/200. If you do have an ectopic pregnancy, methotrexate is the best treatment. However, it is important for you to find out what is going on. You need to get another ultrasound, and take blood tests, and follow your hormone levels to see if they are going up or down.
You are too early for there to be a heartbeat.
It would probably be best to go back to where you got the methotrexate, unless you feel like you got bad care. From what you've told me, there is nothing to indicate that anything was done wrong. I don't know where you live, but you can also try earlyabortion.com and gynpages.com to find a second opinion.
Please let me know what happens,
Doctor Joan
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QUESTION: (You will need to look at my first question to get my full story from the beginning..Is it possible for implantation in the uterus to have occurred between now and when I recv'd my first transvaginal ultrasound & methotrexate?(10/9/07) If so do they still repeat that type of medical abortion or do they do another method? Another concern: if I get another shot of methotrexate follow'd by cytotec 4 days later will I bleed? Does bleeding indicate the abortion or can a very early pregnancy just get absorbed into the uterine lining? I just need to know when will I start bleeding because all the information I read indicates that is the abortion. I just seem really confused as to why the methotrexate didn't work - what didn't it do? And since I haven't had a period since 9/2/07 why didn't the cramping from the cytotec cause me to bleed? Another question, with a "failed medical abortion" does that mean after another round of the above medical abortion method there is still a living fetus in me? I don't want this guy to do any type of surgical abortion on me - I would rather go to my GYN MD and try and present myself as a failed pregnancy that needs a D&C. Is that possible? I don't think I could tell her what I did...!!!
AnswerDear Nicole,
There are two possibilities of a medical abortion failure: the methotrexate did not work at all, and the pregnancy is growing. At this stage there would be the beginning of a gestational sac - no embryo. The second would be that the medication worked, but your uterus has not yet shed the lining. This means that the cells that were forming the pregnancy stopped dividing. (There is also the third possiblity I mentioned before - that this is an ectopic pregnancy).
I think it is worth you going back to the office that did this, as they should be able to assess the situation best.
IF YOU HAVE A SAC: possible treatments are medical abortion with mifepristone (RU486); medical abortion with methotrexate (doesn't work as well as RU486); a procedure (aspiration procedure - see earlyabortion.com) or surgical abortion.
IF YOU DO NOT HAVE A SAC: you need to be evaluated for ectopic pregnancy, or maybe the medication worked and you haven't shed the lining, or maybe you are still to early. All of this can be assessed with following blood tests.
IF THE PREGNANCY ENDED BUT YOU HAVEN'T BLED YET: you can just wait, or you can go to your gyn and you don't need to tell her the whole story.
Where do you live? I may be able to help you find someone to work with.
Don't be so hard on yourself! This is a very difficult situation and it't much harder when you don't trust the medical care you are receiving. So far, I think you are getting good care, but I think you should go back to the office where you got the injection. Let me know what happens.
Doctor Joan
