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Tilted Uterus? If You Are Miscarrying, You May Want to Skip The Medicated Miscarriage.

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image courtesy of istockphoto/JoseASReyes

image courtesy of istockphoto/JoseASReyes

The Reason for this Page

Over the years, as owner of The Misdiagnosed Miscarriage site, I've talked to many women who have been misdiagnosed and many women who have gone on to miscarry. Over time, it seems as if many of the women who are offered Cytotec (Misoprostol) go on to have the most difficult experiences. Miscarriage is difficult enough without adding in increased risk of Emergency Room visits, black outs and increased pain.

Today, I noticed a study that I think really deserves more attention. This study talks about the high failure rate of Misoprostol in women with a tilted uterus and since up to 1 in 3 women have a tilted uterus, this is worth taking note of.

What is Misoprostol?

Misoprostol is a medication that may be taken sublingually (under the tongue), orally or inserted vaginally to dilate the cervix, cause contractions and start the miscarriage process. However, this is an off-label use This drug is actually approved to prevent ulcers and decrease the symptoms associated with ulcers.

Because the use of Misoprostol for miscarriage is not at this time approved by the FDA, if used, it should only be used under a doctor's care and careful supervision. Side effects include nausea, vomiting, diarrhea, chills.fever and, or rare occasions, death.

Illustration showing an anteverted (forward-tipped uterus).  The top of a  retroverted uterus would lean back toward the rectum.

Illustration showing an anteverted (forward-tipped uterus). The top of a retroverted uterus would lean back toward the rectum.

What is a Tilted Uterus?

Approximately 2/3 of women have a uterus that is tipped forward toward the bladder. This is known as an anteverted uterus.

A uterus that is tipped back toward the rectum and spine is known as a retroverted uterus or tipped or tilted uterus. Roughly 1 in 3 women have a tilted uterus.

How do you know if your uterus is tilted?

Because a tilted uterus is so common, most doctors never even mention it to women. You need to ask during an exam or transvaginal ultrasound. If, during the ultrasound, they need to prop you on a pillow to get a better look, there is a good chance you have a tilted uterus.

I've written before on the tilted uterus because women who have a tilted uterus are far more likely to be misdiagnosed with a miscarriage as a result. If you've been told you have a blighted ovum, new UK guidelines (which I love) state that with a growing gestational sac, the doctor should wait until the sac measures 25mm and then wait one week further to verify the empty sac. This would put post women at about nine weeks. If you are miscarrying due to blighted ovum, waiting this long would take you out of the 'safer' time frame in which you may use Misoprostol, increasing your risk of serious side effects. Other than the risk of being misdiagnosed, this is the only other complication I know about with a tilted uterus in the first trimester.

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Study Showing that Misoprostol is not very Effective in Women with a Tilted Uterus

Here is the abstract of one recent study:

Efficacy of misoprostol in relation to uterine position in the treatment of early pregnancy failure.

In this study, researchers found that 72% of women with an anteverted uterus (forward facing) had a 72% chance of the miscarriage completing without intervention whereas, in women with a retroverted (AKA tipped or tilted) uterus, only 22% were able to miscarry without intervention.

Why this becomes important is because many women have told me that they have had natural miscarriages and medicated miscarriages and I keep hearing over and over how much more intense the cramping, bleeding and pain is during the medicated miscarriage. Women have reported blacking out, becoming anemic, ending up in the ER and needing a D&C to clear out everything even after all of that. If you have a tilted uterus, according to this study, Misoprostol only works for about one in five women. Those are pretty poor odds.

Higher Risk of Complications In:

  • women who are more than eight weeks*
  • women with anemia
  • women with a tilted uterus
  • stomach/intestinal disease
  • prior c-section or any type of prior uterine surgery
  • five or more births

If the above describes your circumstances, you may want to discuss other options with your physician.

*First-trimester medical abortion with mifepristone 200 mg and misoprostol: a systematic review

Some Considerations when Deciding How to Miscarry

Why do women and their doctors sometimes choose a medicated miscarriage?

  • Women have specified they don't want to wait out a natural miscarriage
  • Avoids the invasiveness and risks from surgery as well as problems associated with anesthesia

However, studies have shown that the rate of success after eight weeks drops and more risk of complications (including the aforementioned increase in pain, bleeding and cramping).

While some of the information I've shared is anecdotal, shared with me by women who have had medicated miscarriages, the above study is worth noting if you have a tilted uterus.

Miscarriages are difficult and for women eight or more weeks pregnant, a medicated miscarriage may be even more difficult than a natural miscarriage and certainly more difficult than a c-section. And, whether eight weeks or not, if you have a tilted uterus, you and your doctor might want to consider an alternative to ending your pregnancy.

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