Help my friend get an Extrauterine pregnancy abortion in China? IKYANMD
January 8, 2013 9:21 AM   Subscribe

Help my friend get an Extrauterine pregnancy abortion in China? IKYANMD

We are in China. And I know you are not my doctor.

She went to the doctor, they said they needed to check her HGC level (or something similar), if it's below 1000, she can just take some medicine (Mefipristone) to kill the fetus. They said if it's over 1000 they can not give her any medicine to kill the baby (it wouldn't be useful with HGC level over 1000 they say) and she would be forced to have surgery for extrauterine pregnancy, which is dangerous according to google/wikipedia.

They said they can't and don't give Methotrexate (which I think according to wikipedia is the best medicine for extrauterine abortions) in China, it's illegal in 100% of cases (according to our bottom of the rung doctor in our small city in China)

We are waiting 2 days for results of HGC level, to see how to proceed, if HGC level is below 1000 they suggest just taking Mefipristone to kill the fetus, which I understand as per google/wikipedia is meant to abort any normal fetus, not meant for extrauterine fetus. If it's above 1000, she has surgery to remove the fetus (not a normal abortion surgery)..

My questions:

How successful is Mefipristone in aborting extrauterine pregnancies?
What is this HGC thing they are talking about and what should I know about it?
We have 2 days to make decisions and figure things out, and I want to calm and console this young couple.

Any suggestions for my friend and her boyfriend?

I suggested to them that we go to Guangzhou, but they are strongly against it, because of money concerns, and her parents, and classmates and teachers finding out.
posted by crawltopslow to Health & Fitness (39 answers total) 5 users marked this as a favorite
It's HCG, not HGC. (It's a pregnancy hormone that increases with gestation.)
posted by taff at 9:34 AM on January 8, 2013

This is not an abortion. This is a non-viable pregnancy that could seriously harm your friend if she does not have it appropriately treated.

Your friend needs to listen to her doctors. Surgery is likely the safest course of action here --- I am not a doctor or a medical professional, but I hang around a lot of messageboards with a lot of women who have been pregnant and who have had ectopic pregnancies (the most common type of extrauterine pregnancy). In some cases, women were lucky to have only lost a fallopian tube.

Any surgery is dangerous, but you have to weigh the risks of the surgery with the risks of the need for the surgery. If I were in your friend's situation, I'd be demanding the surgery as soon as possible. And I say this as someone who has had a c-section that was a root cause for post-traumatic-stress-disorder.
posted by zizzle at 9:38 AM on January 8, 2013 [10 favorites]

IANAMD, but as far as I'm aware, mefipristone is COUNTER-INDICATED for ectopic pregnancies. I'm concerned that they would even suggest that--it's a high risk for sepsis! It's not the same thing as methotrexate at all, though apparently some doctors have experimented with using the two in combination:

Edited to add: a friend had an ectopic pregnancy not long ago, methotrexate was successful. But if needed, surgery is way less dangerous than doing nothing, that's for sure.
posted by like_a_friend at 9:45 AM on January 8, 2013 [1 favorite]

To reiterate what other people have said: a pregnancy that takes root outside of the uterus (usually in the fallopian tube, very rarely in the abdomen) is a medical emergency that kills the woman more than 1 time in 10 without treatment, and even if she survives it's with serious consequences to her health. Methotrexate is what I'm familiar with to resolve an ectopic pregnancy without surgery, and it's quite successful as long as 1) the pregnancy is early enough 2) there is supervision so that 3) there can be multiple courses of treatment if necessary. Mefipristone is something else entirely.

Your friend's health is very much in danger. IANAD and I don't know much about the medical system in China, but the HCG (human chorionic gonadotropin, it's a hormone produced only in pregnancy) level doesn't need to take two days, it can be done rapidly, and this is a condition that should be taken extremely seriously. If she has any kind of abdominal pain, bleeding, fever, nausea, or shortness of breath, she needs to go to the ER.
posted by KathrynT at 9:49 AM on January 8, 2013 [3 favorites]

Ectopic pregnancy is a potentially life threatening condition and she needs to be very carefully monitored to make sure the termination is successful, but drugs might work. Mifepristone is effective in many cases by itself for early normal termination but is often given in combination with other drugs to make it more effective. It depends on how far along she is (that's why they're testing her HCG levels). If it were me I would want to avoid the risk of surgery unless I was in the hands of a very competent doctor, but mifepristone is used all over the world all the time and requires no special skill from her providers, but she will need a few followup visits to make sure she is no longer pregnant and did not get an infection.

If she has any new symptoms such as fever or abdominal pain she needs to get to an emergency room immediately. Have a plan for getting to the nearest facility equipped to deal with emergency surgery.
posted by slow graffiti at 9:50 AM on January 8, 2013 [6 favorites]

IANAMD, but I have had surgery for an extrauterine pregnancy. Given a competent surgeon, the surgery is much less dangerous than not doing anything.

I second that 2 days is a LONG time to be waiting on the HCG level. They should be able to evaluate that more or less immediately. For me, it took about four hours from hitting the door of the ER with abdominal pain to being in the operating room getting anesthesia (this was in the US). Treatment with drugs wasn't an option for me; my tube was ruptured.

Often (at least in the US) this surgery is done laparoscopically, which means small incisions, lower risk. I did not get that surgery - too much blood in the abdomen and the surgeon couldn't see. I ended up with a pretty big incision and about 5 weeks of recovery. My point is that I'm totally fine now. I'm not sure what you're reading that is telling you the surgery is dangerous, but surgery for this condition is not inherently any more dangerous than getting other surgery, and it a whole lot better than the alternative outcomes.

I do think it is strange that the doctor is saying methotrexate is illegal. I don't think it is a controversial drug, really.

Is there any way for them to get a second opinion from a different doctor?
posted by jeoc at 10:22 AM on January 8, 2013 [2 favorites]

Generally two days is needed to establish the level of acceleration shown by two separate levels of HCG that indicates whether the pregnancy is viable, ectopic, miscarriage etc.

From what i have heard about China a larger regional hospital may be necessary if the pregnancy is advanced enough to require surgical removal of the ectopic fetus. I suggest getting a confirmation of ectopic pregnancy and an attempt to estimate gestational age via an experienced ultrasound professional but medicine is under regulated and not respected or compensated in China so I don't know how reliable that would be.
posted by hobo gitano de queretaro at 11:11 AM on January 8, 2013

If your friend's HCG level is below 1000, this is most definitely an embryo, not a fetus. HCG levels take off and skyrocket pretty quickly, and I don't understand waiting 2 days after the reading since the levels could be much, much higher after 2 days.
posted by parrot_person at 11:20 AM on January 8, 2013

If she's afraid of her parents finding out just tell them it's a cyst that's going to burst. It's not far from the truth and I'm sure her parents would rather her live.
posted by bleep at 1:45 PM on January 8, 2013

The first google result for 'methotrexate China' is 'Leukaemia drug Methotrexate recalled in China, 2007' so it seems quite possible it is not available.
posted by jacalata at 1:50 PM on January 8, 2013

Your friend needs emergency surgery. Now.
I have friends in Bejing, who are too far away to help you, but actually, you should have better access to medical service. Contact your embassy right now.
posted by mumimor at 2:51 PM on January 8, 2013

I doubt they are relying on HCG levels to estimate fetal age which would be crazy because they vary widely early on. An ultrasound, likely an external one and a vaginal ultrasound would be far far more appropriate to use the see the gestational age and size of the fetus to decide if surgery is needed.

For a very early pregnancy, especially if she has signs of a miscarriage such as bleeding, they might be using HCG levels two days apart to look for a drop in HCG levels, indicating a natural miscarriage is underway.

Best case scenario, the doctor is trying to help her avoid surgery and needing to go to another city's hospital because they think she may miscarry the fetus safely, which can happen and hopefully will.

But they should definitely prepare for surgery. Her life and future fertility is at risk, she must be prepared for the high chance that she will need surgery quickly and the risk of surgery is far lower than a bad ectopic pregnancy.

I don't know what medical privacy rules are in China, but if she has a sympathetic doctor, she should be able to explain it as emergency abdominal surgery. The cover story to use for something like this is straightforward - I had abdominal pains, the doctor discovered a dangerous lump and they had to remove it immediately. That is almost exactly the truth because this is not a viable pregnancy.
posted by viggorlijah at 5:28 PM on January 8, 2013

I am not a doctor, but I have volunteered in reproductive health services for years and assisted in surgeries. Surgery for an ectopic pregnancy is not dangerous (any more than all surgical procedures always are). Ectopic pregnancies are very, very dangerous. Your friend needs surgery, now. This will kill your friend if it is allowed to progress. It is a ticking time bomb -- her fallopian tubes are thinner than a shoelace and there is a rapidly growing fetus inside one of them. It will rupture and cause infection and kill her. Mifepristone would accelerate this process, by making her uterus begin to contract!

Methotrexate is used in the US in ultrasound guided injections to the fallopian tubes (to the fetus itself) to make the fetus stop dividing and can sometimes be used as a less invasive way to stop a VERY EARLY ectopic pregnancy without surgery here that way. It does not appear to be available in China, so that is out. It is not used as a pill here for this purpose to my knowledge. No pill can help her.

Your friend needs to be in the hospital. Please tell people in the program. Your embassy, whoever. Get her help before something happens. The danger is not surgery. The danger is the pregnancy. This is serious; you shouldn't help her keep a secret that could kill her.
posted by sweltering at 5:39 PM on January 8, 2013 [1 favorite]

Can you share with us how you/she knows this pregnancy is extrauterine?
posted by sweltering at 5:45 PM on January 8, 2013

Sorry I was asleep.

We had ultrasound and the first one was unclear, a week later, it was clear, she has it stuck in the fallopian tubes.

We just red the medicine she was taking and it said it is contraindicated for extrauterine pregnancy!! The doctors here in Hainan are just so stupid!! She has been in pain all night (off and on) and she has already been in some pain for the past few days, but not as much as last night (after she took one dose of the medicine).

We are about to buy tickets to take a flight to Guangzhou, to see an international hospital that I had been to once before, with western, and western trained doctors.

My only worries are, it's 5 hours until our flight, and it's a 1 hour flight, then another hour to get to that hospital.. is this too risky?

I think it might be more risky doing the surgery here under the care of those stupid doctors who give her contra-indicated medicine...

Any one have any advice for me, or suggestions? If no one of you tells me not to do so, then in next few hours we'll be on the plane too Guangzhou.
posted by crawltopslow at 6:33 PM on January 8, 2013

We have already been to the best and second best hospitals in our province.
posted by crawltopslow at 6:37 PM on January 8, 2013

Can you call the hospital in Guangzhou and ask them?
posted by LobsterMitten at 6:42 PM on January 8, 2013

ok calling now
posted by crawltopslow at 6:48 PM on January 8, 2013

the one i know said they can't help, they're just a small clinic... here is a list of aproved hospitals that the embassy showed me when i called... which one should i go to???
posted by crawltopslow at 6:58 PM on January 8, 2013

Which one did you call? From that list I would try Guangzhou Women and Children’s Medical Center, 3807-6430 (Obstetrics and Gynecology Dept)

If that was the one you called, try calling one that has 'hospital' in the name?
posted by jacalata at 7:02 PM on January 8, 2013

Or, even if they can't help, ask them their recommendation for which hospital to go to.
posted by jacalata at 7:02 PM on January 8, 2013

We called, got transferred to the head nurse, who spoke with the doctor for obgyn, who said she does not agree that we should fly there, it is too dangerous/risky, that we should go to the nearest emergency room immediately.. and that's where we're going.. i'm taking my smartphone so i'll be able to respond to your guys posts.. i'm still very concerned about getting this procedure from under-trained, overconfident bottom of the rung doctors but at this point it seems like we don't have a choice..
posted by crawltopslow at 7:14 PM on January 8, 2013

Any surgery is better than dying from sepsis.

Keep us updated when/if you can. Praying for you and your friend.
posted by guster4lovers at 7:21 PM on January 8, 2013

We are at the hospital now. Next in line...
posted by crawltopslow at 7:39 PM on January 8, 2013

Fuck!! We saw the obgyn she ordered an immediate surgery. We went yo the surgery but the "beds " are already paid for and reserved by people with more money than us. But th beds are empty. Just reserved in case the pregnancy starts. .. they toldbus go home come back tomorrow
posted by crawltopslow at 8:12 PM on January 8, 2013

Are there other hospitals you could try in your city?
If your friend is a US citizen, can you call the embassy again for advice on whether there is a way to find her a bed?
posted by LobsterMitten at 8:15 PM on January 8, 2013

I am a usa citizen she is Not. I'm currently pulling some private strings "guanxi" to try to get a bed...
posted by crawltopslow at 8:25 PM on January 8, 2013

I don't know if this is possible but if I were in y'all's situation I would not leave the hospital. This is a situation that could get worse very quickly.
posted by KathrynT at 8:37 PM on January 8, 2013

They want us to chose between two different operation styles. One leaves a 10 cm scar. One leaves 3 almost invisible dot incision marks.

What are these different options?
And which should we do?
posted by crawltopslow at 10:00 PM on January 8, 2013

微创镜腔 is the 3 dots one. Or the normal options of normal extrauterine surgery
posted by crawltopslow at 10:03 PM on January 8, 2013

the 3 dots sounds like laparascopic surgery. I would go for that one, but be aware that they might not be able to do it if there's a lot of blood.
posted by KathrynT at 10:36 PM on January 8, 2013

the chinese you posted auto-translates to "minimally invasive mirror surgery," which makes me think even more that that is your laparascopic option. In addition to a smaller scar, that also has a much easier heal time. The downside is that the doctors have less visibility in the area, so if there are other things (fluid, weird anatomy) that compromise their visibility, it might not work, in which case they'll convert to an open incision.

Actual medical pros should feel free to correct me if I'm wrong!
posted by KathrynT at 10:39 PM on January 8, 2013

She's in surgery now. Laparascopic surgery now.
posted by crawltopslow at 2:24 AM on January 9, 2013 [2 favorites]

She got out of surgery. Everything went well, she's sleeping now. I came home to bed, the father is there with her.. They want to keep her in the hospital for up to a week?! What medicines should she be on now, anything we should know for post-op? I'm going to bed now, sooo tired,,. will be back on around 9AM Chinese time.
posted by crawltopslow at 6:04 AM on January 9, 2013 [6 favorites]

Let me disclaim again that I AM NOT A DOCTOR but the hospital stay might not be as outrageous as you think. When I was a kid, even routine surgeries often involved staying in the hospital for several days; that's changed in the past few decades in the States because of insurance companies trying to keep costs down. When a friend of mine had a laparascopic appendectomy, she was in the hospital for 2 or 3 days afterwards and frankly wished that she'd had more time. I don't know how an appendectomy compares to your friend's surgery, though.
posted by KathrynT at 9:19 AM on January 9, 2013

Looks like AskMeFi literally might have saved your friend's life. Wow.
posted by Dansaman at 9:51 AM on January 9, 2013 [1 favorite]

Yeah, I had got on this morning to thank you MeFites,.. If you are wondering if you deserve partial credit in saving a life, you don't, you deserve all the credit.

My friends came to me (seriously my friends) Cus they knew I knew more about China, and the medical system, my friends were a foreigner, and a young Chinese girl who was pretty clueless to the graveness of the situation.

Furthermore the whole thing was complicated by overwork understaffed under-trained poorly qualified doctors who also did not realize the graveness of the situation, prescribed a contra-indicated medicine, and who on several occasions told us to leave the hospital (during an emergency situation).

Before my friends contacted me their plan was to wait a few months and consider "keeping the baby" (which they didn't realize was not viable).

They decided to ask me on a whim for advice, just on whether to keep or abort their baby...

I read their paperwork, translated it to English took them to the hospital, the hospital seemed inadequate and we were all uninformed, so I decided to make an ask metafilter question..

I posted the question, went to bed, and forgot I had posted the question... I woke up in the morning opened my computer, and the metafilter page was already open, and I saw all the responses urging to seek immediate medical attention. So I went to their house immediately and took them to the hospital on my motorbike... She said she had been in extreme pain off and on all night, and there was some blood.. But they weren't going to go to the hospital because many Chinese people were telling her it's a normal part of pregnancy...

She got even worse in the hospital before surgery...

Everyone here deserves part of the credit for potentially saving this young girls life, and for saving the father from a life of misery.

I am heading over to the hospital now to check on them again...

I still have questions like what should we be focused on now that we are post-op? What drugs should be on, what pitfalls should we be aware of?

Thanks a lot everyone.
posted by crawltopslow at 5:13 PM on January 9, 2013 [7 favorites]

Drugs, pitfalls -- again, IANAD and I am basing this largely on the post-op care for a friend's laparascopic appendectomy, which may be very very different in ways that I am not aware of:

1. Her pain should be adequately controlled. As in, a little soreness is fine, but if she gets to the point of thinking "Crap, that hurts badly enough that I would really like it to stop," she needs more medicine.

2. She should be monitored for signs of infection around the surgical site. Redness and swelling that gets worse instead of better, pus or purulent material, pain that gets worse instead of better, fever -- all should be signs of concern.

3, and this may be appendectomy specific because it involves the GI tract: she needs to be pooping. Opiate painkillers can be constipating, and constipation can complicate abdominal surgery. Also, it is possible to injure the intestines during surgery, and a successful bowel movement is good evidence that that hasn't happened.

These may not apply in your case, and there may be other considerations I'm unaware of, but at least this could be a place to start.
posted by KathrynT at 9:18 AM on January 10, 2013

She should be extra careful about contraception for a while. I used to work as the receptionist in a GYN clinic where the doctor saw a lot of patients with ectopic pregnancies; these were generally women who were trying for a pregnancy, and the doctor invariably advised them to wait before trying again.

She might want to look for GOOD medical advice before she does try to get pregnant.
posted by snorkmaiden at 1:17 PM on January 11, 2013

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