22 y.o. married female, approx 5'1, approx 63kgs,

type 2 diabetic (diagnosed at age 9), and at-risk hypertension (medications have been discontinued for High BP for about 1 year due to controlled BP)

medications taken for diabetes: humalog and humilin both 30 units 2x a day.

glucose levels are not under complete control, averaging at 180-220.

Last menstrual period recorded was December 12th, 2011.

Had unprotected intercourse twice in december: 16th and 24th, taken 2 emergency oral contraceptive tablets of Levonorgestrel USP...0.75mg first on January 2nd, 2012 and again another 2 tablets on January 15th 2012.



Suspected pregnancy due to missed menses approx 1 week. January 21 had done home pregnancy test and was confirmed Positive. Same day, was prescribed Cytotec 3 tablets by doctor to be swallowed (all 3 tablets at the same time) whole with glass of water. in evening immediately 1 hour later, excruciating abdominal pain occured on pain scale of 1-10, 1 being least painful and 10 being severely painful, a rating of 8 describes pain. Also symptoms of heavy nausea and left breast pain occured. Doctor reported that after 12 hours of taking Cytotec, bleeding should occur. Now it has been close to 22hours since taking Cytotec and no bleeding has been discovered. What is best way to start the bleeding? Should Cytotec be taken again? Or should another 24 hours be waited on before doing anything else? It has been reported that 80% women who have taken Cytotec will bleed within 6hours, 90% in 24hours, and 97% in 48 hours.