hello there..
thanks for writing to us.
What I interpret as that you have taken self medication for abortion. But wanted to know how did you confirm your pregnancy as its important to get an ultrasound abdomen before taking any abortificient. This is because at times pregnancy happens elsewhere than the uterine cavity called as the ectopic pregnancy wherein abortificients fail to induce bleeding.
Now since you have taken the drug , I should say you have taken it in the wrong way as you have used both oral and vaginal routes making an excess of the required dose.
For termination unwanted pregnancy up to 12 completed weeks with Misoprostol alone you have to take it as follows :
vaginally of 800mcg repeated up to 3 times at 6 or 12 hour intervals depending on the bleeding
or
800mcg orally (sublingual) at 3-hour intervals
The oral use of Misoprostol is better accepted and have the same effectiveness. But side effects like diarrhea, cramping, pain, nausea vomiting are more with oral use.This might be the reason you are having the diarrhea you mentioned.
Bleeding usually starts within 4 to 7 hours after taking the Misoprostol, though it can be as early as an hour or late as 24 hours. It generally lasts 7 to 14 days.
Now since you have not had bleeding , I suggest you see a gynecologist personally. Donot take any further medication on your own. Let her examine you internally. If your cervix is dilated , its probable that you would expel soon. Further intake of misoprostol should depend on your XXXXXXX findings.
In case you have no such findings, you should get an ultrasound done and management further would be decided according to it.

Self medication for abortion can at times be XXXXXXX due to the risks of heavy bleeding, continued bleeding, incomplete abortion and shock .
So please see a gynecologist personally soon. Till then wait for your bleeding to start and do not take any further dose.

take care

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Hello there.

Thanks for writing back.

Bleeding can start as late as 24 hours after the first dose of misoprostol. I am not asking you to take repeat dose as the way you had taken was wrong and took both orally and vaginally, making the total dose at a time to be around 1000ug and repeated the dose within an hour orally.

The regime to take misoprostol was as I mentioned in my previous answer. Proper dose and interval between doses is a must for effective abortion. Ultrasound is a must prior to any abortion procedure. So please do not take any further steps on your own.

You should see a gynaecologist at the earliest. Let her examine you internally to see for any changes of the cervix. If your cervix is dilated and soft, it’s likely you would expel and dose can be given accordingly.

If no such changes are present, you take an ultrasound. Depending on the size and state of pregnancy on the ultrasound, you can start a fresh cycle of misoprostol in the proper dose and interval as recommended for abortion.

But I don’t want you take any self medication. Let your gynaecologist assess you internally and decide further. At times failed medical abortion is taken for surgical evacuation.

Do not delay.

Take care.

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Hello there..

Kindly refer to the second line of my first answer to your query stating why ultrasound is a must before any abortion procedure ("This is because at times pregnancy happens elsewhere than the uterine cavity called as the ectopic pregnancy wherein abortificients fail to induce bleeding").

Now please XXXXXXX a gynecologist. NO abortificient helps in ectopic pregnancy. I asked you before also how you confirmed your pregnancy or you did not confirm it all??
If delayed, ectopic pregnancy can land into complications like rupture leading to bleeding inside the abdomen and shock.
I would reiterate that you XXXXXXX a gynecologist now that you have an ultrasound in hand. Complex adnexal mass suggesting ectopic pregnancy has to be confirmed by blood test called beta hcG. Ectopic pregnancy is surgically managed by a laparotomy (opening the abdomen). Very rarely its medically managed.
But misoprostol has no role in ectopic pregnancy.
Do not delay in meeting a gynecologist.
As if you have ectopic pregnancy, its serious and needs early intervention.
All the best and wishing you speedy recovery.
take care.

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Hello there.

I understand your anxiety. If you have missed your periods and your urine test or blood test for Beta hcG is positive, then there has to be pregnancy somewhere. Now both your scans show no intrauterine pregnancy. In both there is an adnexal mass , one of which suggests it to be ectopic pregnancy. Also clinically , missing of periods , pain abdomen and beta hcG positive all indicate it to be ectopic pregnancy. Your second ultrasound shows ring of fire sign on doppler which is also present in ectopic pregnancy. A positive pregnancy test is not possible in corpus luteal cyst.
You have to follow it up with serial serum beta hcG levels. This is because your sonologist is still not sure.
An abnormal rise in blood beta hcG levels may indicate an ectopic pregnancy. The threshold of discrimination of intrauterine pregnancy is around 1500 IU/ml of β-hCG. A high resolution, transvaginal ultrasound showing no intrauterine pregnancy at this level indicates that you have pregnancy elsewhere that is ectopic. You have not mentioned your beta hcG levels.
An empty uterus with levels higher than 1500 IU/ml may be evidence of an ectopic pregnancy, but may also be consistent with an intrauterine pregnancy which is simply too small to be seen on ultrasound. If your are more than 6weeks and still no gestational sac is visualized, it suggests ectopic pregnancy.
Since your diagnosis is uncertain, it may be necessary to wait a few days and repeat the blood levels of beta hcG. This can be done by measuring the beta hCG level approximately 48 hours later and repeating the ultrasound. An abnormal pattern in the rise of this hormone can be a clue to the presence of an ectopic pregnancy.
Falling levels of beta hcG in ectopic pregnancy could be due to spontaneous abortion or rupture. In this case you can have intra-abdominal bleeding and shock if bleeding is severe. Deteriorating vitals (pulse rate, BP) are indicators of severe bleeding. So your gynecologist is right that falling levels can be due to resorption though its very rare. So you have to be under observation in the hospital in that case.
A laparoscopy or laparotomy can also be performed to visually confirm an ectopic pregnancy. But these are surgical procedures.
The advantage you have is your adnexal mass is very small. Provided you do not have other containdications of medical management of ectopic pregnancy, you can go for it. You can discuss it with your gynecologist and she would let you know the drug and dose. This drug has to be taken in the hospital under supervision and so I cannot mention it here.
You should follow your gynecologist advise rather than the sonologist as she is correlating your things clinically and its she who is going to manage. You should mention her about your self medication with misoprostol. Do not keep anything classified as it may prove detrimental to your health.
Wishing you all the best.

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Hello there.

Your beta hcG report is beyond the discriminatory level of 1500mIU/ml. At this level if there was an intrauterine pregnancy , it would be seen on scan. But since there is no visualization of intrauterine pregnancy , it suggests that adnexal mass is an ectopic pregnancy. This is because positive beta hcG is seen in ectopic alone and not in corpus luteal cyst.
Your management has to be under supervision of a doctor , be it medically or surgically. The medical management can be used to in small size mass (<3.5cm)with no heart beat and there should be no associated renal or liver disease. Although there is an advantage of the size in your case but medical management has a failure rate too. Once failed, it has to be treated surgically. You cannot take treatment as an outpatient in ectopic pregnancy. You have to be monitored even under medical management. Surgical management can be laparoscopically or by open surgery (laparotomy)
Quickest option would be go to your gynecologist and do what she says. Get yourself admitted and get the right treatment at the right time before you land into any complications. Your diagnosis and managment would be best made and clear only when you confide in your doctor.You tell everything to your gynecologist and let her decide if she can keep your parents unaware about it.

Wishing you all the best.
Please do not delay and do not take any more decisions on your own.
Follow your doctor's advice.

take care.

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Hello XXXXXXX.

Thanks for writing back. Its really good to hear from you again.

Smoking is no doubt INJURIOUS to health.
Women smokers have the risks of early menopause, infertility, cervical cancer, osteoporosis, lung cancer and heart disease
Cigarette smoking has an independent and dose related effect on the risk of ectopic pregnancy. It affects the motility of fallopian tube by damaging the ciliary action of the tube which leads to failure of movement of the egg to the uterus. This promotes the pregnancy to remain in the tube and hence ectopic pregnancy.
Also if you continue to smoke after your surgery, it would stress your body and can impair healing of tissues.
Past history of smoking affecting your surgery depends on how much your lungs and heart have been damaged by smoking. If you get fitness for surgery by anaesthesia doctors, you need not worry.
Its good that you have quit smoking.

Wishing you all the best for your surgery. I pray and hope that you recover soon.

Take care.

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