Cytotec (misoprostol) is a medication often used for medical abortion. It works by softening the cervix and causing uterine contractions to expel pregnancy tissue. However, in some cases the body can develop a resistance to Cytotec, preventing it from working effectively. Here we’ll examine why resistance happens and the options for overcoming it.
How Does Cytotec Work?
The active ingredient in Cytotec, misoprostol, is a prostaglandin. It stimulates the uterus to contract and the cervix to soften and dilate. This empties the uterus, terminating the pregnancy in a process similar to natural miscarriage.
Cytotec tablets come in 200mcg doses. For medical abortion, the typical regimens are:
- 800mcg vaginally or sublingually, repeat in 3-4 hours
- 400mcg sublingually or buccally every 3 hours up to 5 doses
This stimulates strong enough contractions in most cases to complete the abortion.
What Causes Cytotec Resistance?
In some cases, a woman’s body does not respond as expected to Cytotec. Reasons this may happen include:
- Gestational age: The uterus may be less responsive in later first-trimester pregnancies.
- Fibroids or polyps: These can interfere with contractions.
- Scarring: Prior procedures like D&Cs, LEEPs, or cesarean sections can cause scarring that affects contraction strength.
- Medications: Anti-inflammatories like ibuprofen may reduce effectiveness.
- Individual variation: Some women’s bodies have lower sensitivity to prostaglandins for unclear reasons.
When the uterus does not contract adequately in response to original Cytotec, complete abortion may not occur. This is known as Cytotec resistance.
How Common is Cytotec Resistance?
Most studies estimate Cytotec resistance in early medical abortions occurs in around 2-5% of cases. Rates may be higher in certain populations and are higher later in the first trimester.
Being aware of the potential for resistance can allow proper planning and management if it does occur.
Signs of Potential Cytotec Resistance
Signs that the Cytotec may not be working as expected include:
- Little to no bleeding after taking the full dose
- Pregnancy symptoms continuing more than 24 hours after starting
- Pregnancy still visible on ultrasound after 7-14 days
- Passage of little or no tissue
- Prolonged heavy bleeding suggesting incomplete expulsion
If these occur, Cytotec resistance should be suspected. Further steps can then be taken.
Overcoming Cytotec Resistance: The Options
If Cytotec does not terminate the pregnancy as planned, there are a few options available:
Additional Doses of Misoprostol
Taking additional doses of 400-800mcg Cytotec every 3-4 hours allows another chance for the uterus to respond. This works in some cases.
Switch to Alternative Prostaglandins
Alternate prostaglandins like dinoprostone may be more effective when Cytotec fails. These are administered vaginally for 12-24 hours.
Surgical Aspiration
If prostaglandins fail to work, surgical aspiration provides a definitive solution. This gentle suction procedure safely empties the uterus.
Expectant Management
Rarely, pregnancy tissue may still pass naturally over days to weeks without further intervention. But medical management is typically recommended.
The best approach depends on each unique case. An exam and ultrasound can help determine the safest course.
Improving Cytotec Effectiveness
To facilitate the best response to Cytotec and avoid potential resistance, the following tips can help:
- Use vaginally rather than orally when possible for higher uterine concentrations
- Warm the medication to room temperature before vaginal insertion
- Consider adding ibuprofen or NSAIDs for more coordinated contractions
- Use misoprostol together with mifepristone if accessible
- Follow exact recommended dosing for gestational age
- Stay well hydrated by drinking fluids
- Have any fibroids or polyps removed prior if feasible
- Follow up within 7-14 days to confirm completion
While resistance is uncommon, being aware of the possibility and solutions allows appropriate planning and action if needed for a successful outcome.
Frequently Asked Questions
What percentage of women are resistant to Cytotec?
Studies show around 2-5% of women don’t respond as expected to Cytotec for medical abortion in the first trimester. Rates are higher later in pregnancy.
Can anything reduce the effectiveness of Cytotec?
Yes, taking anti-inflammatories like ibuprofen may interfere with Cytotec’s action. Uterine scarring can also inhibit contractions.
How long does it take for Cytotec to work?
Most women abort within 24 hours of starting Cytotec. If pregnancy symptoms continue after 24 hours, resistance should be suspected.
What are signs that Cytotec didn’t work?
Lack of bleeding, ongoing pregnancy symptoms, no passed tissue and continuing visible pregnancy on ultrasound may indicate Cytotec failure.
What are the options if Cytotec fails?
Additional Cytotec doses, switching to a different prostaglandin, surgical aspiration, or rarely expectant management are options for Cytotec resistance.
How-Cytotec-Works
- Contains misoprostol, a prostaglandin
- Softens the cervix
- Stimulates uterine contractions
- These effects empty the uterus, terminating pregnancy
Typical-Cytotec-Dosing-Protocols
- 800mcg vaginally or sublingually, repeat in 3-4 hours
- 400mcg sublingually/buccally every 3 hours, up to 5 doses
Reasons-Cytotec-Might-Not-Work
- Advanced gestational age
- Uterine fibroids or polyps
- Scarring from prior procedures
- Medications like NSAIDs
- Individual variation in prostaglandin sensitivity
Signs-of-Potential-Cytotec-Failure
- Little or no bleeding after full dose
- Ongoing pregnancy symptoms >24 hours
- Still visible pregnancy on ultrasound after 1-2 weeks
- Passage of little or no tissue
- Prolonged heavy bleeding
Options-for-Overcoming-Cytotec-Resistance
- Additional doses of misoprostol
- Switch to a different prostaglandin
- Surgical aspiration
- Rarely expectant management
Improving-Cytotec-Effectiveness
- Use vaginally rather than orally
- Warm tablets to room temperature pre-insertion
- Consider adding NSAIDs
- Use with mifepristone if accessible
- Follow exact dosing guidelines
- Stay hydrated with fluids
- Remove any fibroids/polyps beforehand
- Confirm completion with follow-up