Suggest Dosage Of Zoetic For Vaginal Bleeding

Brief Answer:
It has got very good results

Detailed Answer:
Hi XXXX, I hope I have written your name correctly, if not please correct me.

You seem to be on the correct line of treatment and hence there does not seem to be any cause to worry.

The medicines your girlfriend has taken are Mifepristone and Misoprostol - the combination of medicines used for termination of pregnancy before 9 weeks of pregnancy. This combination of medicines is very effective in causing complete abortion. Had she taken zytotec by mouth or in the vagina? What was the dose of these tablets? In what dose did she take Mifreprin tablets?

Though the literatures do not mention the exact period required for completing the process, usually, our experience is that it is complete by 7 days. If she does not start bleeding before that, it is advisable that she reports to her Gynaecologist for further help.

Regarding the follow up visits, there are different guidelines; however, I feel you should visit to your Gynaecologist for follow up latest by 14 days of first tablet taken.

An ultrasonography after the bleeding stops will confirm the diagnosis of complete abortion.

Of course, you had another alternative to take progesterone for withdrawal bleeding. Since the pregnancy test was negative, you could have gone for ultrasonography and if the uterus had no pregnancy in that, progesterone could have caused withdrawal bleeding.

Anyway, according to many guidelines, there is no necessity of confirmation of pregnancy to use Mifepristone/Misoprostol combination. So what ever medicines your girlfriend has taken are correct medicines. Now just wait for a week's time and she will be through all this ordeal.

I would like to give you an advice about the birth control. Please do not use the termination of pregnancy as a birth control method. It insults the woman's reproductory system. There are many good, safe and reliable methods like intrauterine devices (IUD), birth control pills, condom and many others which give effective birth control and still do not affect the pleasure of sexual act. Please follow one of these methods with the advice of your Gynaecologist.

I am sure you have got the requested (and even unasked) advice also. If any more explanation is required, please furnish me with the information I have asked for. Also please up date me with the outcome of this abortion. I shall be awaiting your next message.

Wish you a very happy life together!

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Brief Answer:
Correct Dose

Detailed Answer:
Dear XXXX,

Mifepristone (Mifepron) 200 mgs orally as single dose followed by Misoprostol 400 microgms orally single dose 24-48 hours after taking Mifepron is correct dose. You have been given that. The bleeding may start any time - may be within 24-48 hours usually not later than 7 days.

If she does not get bleeding within 7 days, please report to your Gynaecologist who has prescribed you the medicines.

I would prefer you to have a follow up visit to your Gynaecologist even after complete abortion, 14 days after Mifepron.

I hope your queries are clarified. If there is any more information you need, I am always there for you XXXX.

I would appreciate your good review and 5 starts rating if you feel so.

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Brief Answer:
Go ahead with the prescribed schedule

Detailed Answer:
Dear XXXX,

Now that you have already consumed Mifepron 200 mg, that issue is over. Now you have to take zeotic 400 microgms. This tablet is to be take any time within 24 - 48 hours after Mifepron. We usually advice to take 36 hours after Mifepron. However, you may take it at 6:00 am, no issue.

In most of the cases we find the bleeding starts within 4 hours, however, it may start later also. If it is only very little bleeding, you will have to report to your Gynaecologist.

After taking these tablets, you may experience some side effects as:
1. Pain: Can be managed by hot water bottles fomentation, pain killers if needed
2. Bleeding: If it is unreasonable bleeding you will have to report to the doctor and may need a blood transfusion for profuse bleeding, which is very rare.
3. Fever: Some antipyretic medicine helps.
4. Nausea and Vomiting: Usually it is self limiting, at times may require anti-emetic medicines.
5. Diarrhoea: This is also self limiting, at times may require oral rehydration fluids.

These side effects are not so very common and usually do not require any treatment as such, however, I thought you must be aware of them.

I have got a feeling that by tomorrow morning, you should be through.

Please keep me updated about the outcome. I am keen to know it.

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Brief Answer:
Report to Gynaecologist if no bleeding after 72 hours.

Detailed Answer:
Dear XXXX,

I can understand your tension. However, please understand some more facts of the medicines you are taking and the situation you are in.

As I informed you previously, usually the bleeding starts by completion of 4 hours however, it may take more time up to 72 hours also. You may wait up to 7 days. If after 7 days also the bleeding has not started, you will have to report to your Gynaecologist who has prescribed you these medicines. There could be two possibilities:

1. If the bleeding does not start at all, the possibility of failure can be suspected and reported to the Gynaecologist. By ultrasonography, we understand whether the medicines have failed and the pregnancy is still continuing. If so, there are two options:
a. Effect the abortion by vacuum aspirator: It is a very simple and short procedure which most of the times does not require any anaesthesia and within a short time, the patient can walk home.
b. Repeat administration of Misoprostol (Zytotec) to complete the abortion.
2. If the bleeding is lighter than expected bleeding or no bleeding and on clinical examination and ultrasonography, it means there is no evidence of intrauterine pregnancy. Then a rare condition of pregnancy outside the uterine cavity (ectopic pregnancy) may be suspected and treated accordingly on its merits. This usually needs a surgical intervention.

If the bleeding does not start even after 72 hours, you may think on the lines of reporting to your Gynaecologist. Till that please be patient and remain composed.

Some how, I have got a feeling that by the time you get this message, your bleeding might have started.

Please keep on informing me the progress. If you undergo ultrasonography, please update the images and reports for my review. I am always available for you XXXX.

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Brief Answer:
Ultrasonography is better option for confirmation of pregnnacy

Detailed Answer:
Dear XXXX,

I would appreciate if you mention the precise timings for the medicines and the time lapse. It is not possible for me to figure out exactly how much time has lapsed after each medicine you have taken.

Your urine pregnancy test was negative; still for some reason, you have opted for these medicines. Now if at all you have to get the pregnancy or abortion confirmed, I would advice you to go for ultrasonography. Can you get it done immediately? Please upload the images and report for me to review. Tell the ultrasonologist to locate the pregnancy - whether in the uterus or outside the uterus. Then only you may repeat zytotec tablet.

If pregnancy is intrauterine and undisturbed, you may take another tablet of zytotec - with your gynaecologist's advice only.

For extrauterine pregnancy (ectopic) please do not waste any time and rush to the Gynaecologist.

I hope I have given you quite a clear advice. XXXX, please do not become panicky. Calm mind only can take correct decisions. Remember, I am always available for you. I am awaiting for your ultrasonography reports or the news that you have started aborting.

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Brief Answer:
It is high time you report to Gynaecologist

Detailed Answer:
Dear XXXX,

If this dose has failed, you can repeat zytotec 400 mcg once more again.

However, I am also surprised. Your both the urine pregnancy tests have reported negative. Still you have not got your menses even after Mifeprin and zytotec. This is something which is suggesting some other diagnosis than uterine pregnancy. That is why I had suggested you to go for ultrasonography to confirm whether the pregnancy is somewhere outside the uterus. In ectopic pregnancy, usually the pregnancy test becomes weak positive - late. Please do not ignore and get ultrasonography done.

If ultrasonography also reveals that there is no pregnancy even outside the uterine cavity also, then you will have to report to the Gynaecologist and get complete work up done for any hormonal imbalance leading to loss of menses. Probably you may advised blood examination for FSH, LH, Oestrogen, Progesterone, Prolactin hormones and may be Thyroid function tests.

Please now do not try to manage this at domestic level and report to the Gynaecologist.

After all these tests are done, please upload the reports on HCM forum for my review.

For any further guidance, I am available for you always, XXXX.

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