Use of deadly Cytotec on the rise

AN ILLEGAL but profitable over-the-counter trade in the abortion-inducing drug Cytotec, coupled with an increase in prescriptions to pregnant women and girls, is fuelling a growing underground abortion market in Trinidad and Tobago. This trend is a source of great concern in local medical circles since the drug is considered an extremely dangerous method of abortion induction and has been linked to several deaths and cases of infertility. Cytotec, originally developed to treat gastric ulcers, is routinely being administered orally, or inserted vaginally, as an abortion method. However, the drug has been linked to a range of life-threatening complications, including uterine rupture, severe bleeding, retained placenta and shock.

In fact, Searle, the US pharmaceutical company which manufactures Cytotec, has placed warnings on the drug label that it is “contraindicated in women who are pregnant” and “not for use in women of childbearing potential.” According to a Searle information leaflet for Cytotec, the drug “produces uterine contractions, uterine bleeding and expulsion of the products of conception. Miscarriages caused by Cytotec may be incomplete.” The pharmaceutical firm further warns: “Uterine rupture has been reported when Cytotec was administered intravaginally in pregnant women to induce labour or to induce abortion beyond the first trimester of pregnancy. “Uterine perforation has been reported following administration of combined vaginal and oral Cytotec in pregnant women to induce abortion. In each of these reported cases, the gestational age of the pregnancies was unknown.

“One case of amniotic fluid embolism, which resulted in maternal and fetal death, has been reported with use of misoprostol (Cytotec) during pregnancy.” Searle adds: “Cytotec may cause the uterus to rupture (tear) in pregnant women if it is used to bring on (induce) labour or cause an abortion after the first trimester of pregnancy. Miscarriages or rupture of the uterus may result in severe bleeding, hospitalisation, surgery, infertility or death.” Although abortions are illegal in this country, there is increasing evidence that doctors are prescribing Cytotec to patients who want to terminate pregnancies. Violet D’Ornellas of the Emmanuel Community, a Roman Catholic pro-life organisation based in Woodbrook, told Sunday Newsday she has seen prescriptions written by reputable medical doctors for women who want to end their pregnancies.

“One woman came in and told me, ‘You know, I have a prescription here. The doctor gave me this because I want to have an abortion but my heart isn’t settled with this.’ When I look at it, it is for Cytotec,” she said. “When I told her what it was, she said, ‘Oh my God! This doctor not only want to kill my baby, he want to kill me too!’” According to D’Ornellas, who has been counselling women and girls with crisis pregnancies for more than 20 years, apart from that ‘‘legitimate’’ method of dispensing the drug, many people can walk into certain pharmacies well known for this purpose in the illegal abortion trade, and purchase Cytotec without a prescription. She has linked this increased availability of the abortion pill to a marked decrease in the number of women and girls who turn to pro-life groups like the Emmanuel Community for advice and support.

“There has been a big change in the amount of girls seeking help. For instance, Mary Care has a home on Gallus Street (Woodbrook) and they find that they are almost empty. I am accustomed seeing a minimum of five girls a week. That has dropped to maybe one or two a month because of Cytotec.” D’Ornellas added: “People now go to the drug store, buy a tablet, and it is dangerous. We have to reveal the dangers. Cytotec can actually cause a mother to bleed to death, yet she can go in and buy this without any prescription . . . girls are just going into the drug store and buying this tablet. “They’re supposed to have controls but this is a big moneymaking thing.” Risks associated with Cytotec are heightened by the way it is dispensed locally. Pregnant women are self-administering a drug which should be given under strict medical supervision and, unlike other methods of induction, there is no way to stop its action.

A woman taking the drug in the privacy of her home can begin experiencing strong uterine contractions and her uterus can rupture, resulting in severe injury and death. It can cause such heavy bleeding that to save the mother, her uterus must be removed, leaving her incapable of bearing another child and disrupting her natural hormones. In addition, the violent contractions increase the risk of deadly amniotic fluid emboli. Sunday Newsday understands that some pharmacists have raised alarms about the illegal over-the-counter sale of Cytotec but the practice continues unabated because there is little risk of detection, or prosecution of offenders. President of the Pharmacy Board of Trinidad and Tobago, Wazir Hosein, said pharmacists caught dispensing third schedule drugs like Cytotec without a prescription face heavy penalties, including being struck off the Register of Pharmacists. “The challenge is in getting proof,” he said.

According to Hosein, when the Pharmacy Board receives complaints, the offenders are called in and questioned and an investigation takes place. However, there are very few people in Trinidad and Tobago who are willing the “blow the whistle” on this illegal activity, he said. In addition, the Food and Drug Division of the Ministry of Health, which has the authority to intervene and crackdown on the practice, is severely hampered by a shortage of staff and a heavy workload. Hosein said it is “not all that easy” to get Cytotec and he is convinced that in the vast majority of cases it is dispensed by prescription. He is aware, however, of cases where patients go to pharmacists and beg to be supplied with drugs for which they do not have prescriptions, so it is possible that this is how some pregnant women are getting access to Cytotec. He said because of the risks associated with the drug, some local pharmacies don’t even keep it in stock and others post signs in their business places warning of the dangers associated with its use.

In the past, alarms have been raised in this country about the use of Cytotec to induce abortions. In August 2002, the drug was linked to the death of a teenager who used it to end a pregnancy because, according to media reports, she was “too poor to pay a doctor and too afraid to tell her mother.” At the time of that tragic development, local pro-abortion group ASPIRE downplayed the risks associated with the drug and, in a letter to a daily newspaper, warned against attempts “to use this sad story to demonise Cytotec.” The group claimed at that time that since Cytotec had become available, the average length of stay for women admitted to local hospitals with complications of abortions had shortened considerably. According to ASPIRE, Cytotec is “far less harmful than other more invasive, traditional methods” and complications arise because the drug is being badly used.

In its August 2002 letter, the group stated: “Women typically use more of the drug the more advanced their pregnancy.” The exact reverse is the case! They should use much less of the drug as the pregnancy advances. “It is like picking a fruit. The greener it is, the harder one has to pull, but as it ripens, less and less effort is needed. “Even in the first ten weeks of pregnancy they should not use more than four tablets. After that the dosage drops by about half of the next four weeks.” However, research by Sunday Newsday showed that even in the legal abortion industry in the US, Cytotec is not a popular choice for inducing abortions and is only administered under close medical supervision.

One Florida abortion clinic, in its advisory on that method of terminating a pregnancy, said Cytotec is used alone, or in conjunction with other drugs, to soften and dilate the cervix in second trimester abortions. However, the patient must remain at the clinic after the drug is administered because “she may experience chills or a sensation of abdominal pressure and cramping.”

Abortion... How is it performed?

The following are most common methods of abortion used in the United States and other parts of the world where the procedure is legal. Reports from women who have undergone the procedure here, where it is illegal, indicate that these methods are used here by skilled and qualified medical practitioners. The following information was obtained from the web site prochoice.com and highlights the risks to women who undergo these procedures.
   
SUCTION ABORTION:
Also called vacuum aspiration, this is the most common abortion technique in use today. In this procedure a suction tube dismembers the body of the developing child, sucking the pieces into an attached jar. There is a risk that the uterus can be punctured during the procedure. Also, the abortionist must take care that all the body parts are removed from the womb, as infection and hemorrhage can occur if fetal or placental tissue is left in the uterus.
      
DILATION AND CURETTAGE:
In a D and C abortion, usually performed between seven and twelve weeks of pregnancy, the doctor inserts a curette, a loop-shaped steel knife, into the womb through the dilated cervix. As the curette scrapes the wall of the uterus, the baby is cut into pieces. Bleeding can be considerable. As with a suction abortion, there is a risk of infection or hemorrhage, so the abortionist must reassemble the body parts to make sure the uterus is empty.
      
DILATION AND EVACUATION (D and E):
This method is similar to a D and C, except that forceps must be used to grasp the baby’s body because of the child’s  advanced development. The baby is dismembered as the abortionist twists and tears the parts of the body and slices the placenta away from the uterus. Bleeding is profuse. Although relatively safe for the mother, the procedure is devastating to the hospital staff and many doctors refuse to do advanced D and E abortions.
      
SALT POISONING (SALINE INJECTION):
“Salting out” is the second most common method of inducing abortion and is usually used after sixteen weeks. The doctor inserts a long needle through the mother’s abdomen and injects a saline solution into the sac of amniotic fluid surrounding the baby. The baby is poisoned by swallowing the salt and his skin is completely burned away. It takes about an hour to kill the baby. After the child dies, the mother goes into labour and expels the dead baby. Saline injections have been outlawed in some countries because of the risks to the mother, which  can include lung and kidney damage if the salt finds its way into her bloodstream. In spite of the horrible burning effect, some babies have survived “salting out” and been born alive.
      
HYSTEROTOMY:
Similar to the Cesarean section, the hysterotomy abortion is a surgical procedure whereby the baby is removed from the mother’s womb and allowed to die by neglect or killed by a direct act. This method offers the highest risk to the mother and produces the most number of live births. Hysterotomy is used only for late term pregnancies, and is sometimes used if the salt poisoning or prostaglandin abortion has failed.
      
PROSTAGLANDIN ABORTION:
Prostaglandin is a chemical hormone which induces violent labour and premature birth when injected into the amniotic sac. Since prostaglandin results in an unusually high percentage of live births, salt, urea or another toxin is often injected first. The risk of live birth from a prostaglandin abortion is so great that its use is recommended only in hospitals with neonatal intensive care units. The risk to the mother is also greater with the use of prostaglandin; complications can include cardiac arrest.