A pregnant Winnipeg woman wants answers after she said her doctor accidentally gave her a drug that's commonly used in Canada for medical abortions.
The mistake could have had serious consequences for Serissa McKay’s baby boy, due to be born July 16.
Misoprostol is approved for treating stomach ulcers, although it’s commonly used in medical abortions and to induce labour, said family-planning specialist and McMaster University Prof. Dustin Costescu, because it softens the cervix and brings on contractions.
"It is clearly contraindicated in a setting of a wanted pregnancy," said Costescu. The Free Press was referred to him by the Society of Obstetricians and Gynaecologists of Canada, which sets the country's clinical standards.
"It is very effective at ending a pregnancy, regardless of gestational age."
McKay, who was 36 weeks pregnant, wasn't ready to give birth and didn't want to end her pregnancy when she went to a doctor appointment June 21.
The 21-year-old first-time mother-to-be said she was scheduled for a routine pre-birth vaginal exam. That’s why she didn’t think it was odd when the receptionist handed her two packets, each with four, small hexagon-shaped tablets and told her to put four of them into her vagina at that time and four in her vagina eight hours later.
The odd part, McKay said, was when she got a phone call while she was in the washroom just after she had inserted the pills. She said the receptionist wanted to confirm she was in fact McKay, then asked her if she’d already inserted the pills.
When McKay told her she had, she said the receptionist told her to immediately come out and the doctor would remove them. She said the receptionist made her feel bad for not recognizing the pills or realizing they weren't for her to take.
The Free Press is not naming the doctor or clinic because neither party could be reached for comment Wednesday.
"It was actually pretty painful," McKay said of the removal process.
McKay said the doctor carried on as if it was a routine appointment, asking her if she had any questions or concerns.
"What will happen? I took pills that I wasn't supposed to, so what should I watch for?" McKay said she asked the doctor.
She said the doctor told her to watch for cramping and signs of labour — and admitted the drugs had been intended for a woman who had suffered a miscarriage.
"I was pretty much in shock," McKay said, "It didn't really hit me until I actually got home."
Costescu said McKay's description of the pills matches misoprostol, as does the receptionist's instructions to insert half now and the remaining pills eight hours later. The drug only comes in two doses — 100 micrograms and 200 mg — so at minimum McKay inserted 400 micrograms into her vagina, at most, 800 mg.
That's well above what Costescu said doctors would use if they were trying to induce someone.
"With labour induction at term, it can be used in as small as 25 to 50 mg," he says, "So you use an eighth or even a 16th of the dose you use in first trimester."
However, Costescu said it's not common practice in Canada for doctors to use the drug to induce labour unless its a stillbirth.
Studies have shown in cases where misoprostol is used but the fetus doesn't die, it can cause birth defects, he said. It can also cause stress to the baby by bringing on "excessive contractions." In labour, contractions are necessary to deliver the baby, but too many can "cause complications for the baby, up to and including demise."
McKay and her partner, Daniel Monkman, are still in shock. He jumps every time she groans or aches or moves in a funny way, she said.
McKay has filed a complaint to the College of Physicians and Surgeons of Manitoba, which regulates the profession. The college did not return requests for comment from the Free Press Wednesday.
McKay's concerned neither the doctor nor clinic are taking her complaints seriously based on the conversations she said she's had in the last week. She said she's asked to switch doctors, but was told she'd first have to speak with her doctor first.
Even if she did switch, McKay said they told her the doctor could still wind up delivering her baby depending on when he arrives and which doctors are on call at the facility at the time.
"I don't want that at all," she said, fingers pressing into her belly. Her baby boy favours leaning deeply to one side or the other and is kicking more and more these days.
Costescu said he's likely going to be fine since McKay hasn't had any reactions in the week since the accidental insertion. That's probably because the doctor removed the pills so quickly. When inserted vaginally, misoprostol usually takes 40 to 60 minutes to take action, he said, with "peak onset about one to two hours after."
McKay is two weeks from her due date and is not comfortable with her doctor.
"You’re supposed to trust your doctor," McKay said.
The Winnipeg Regional Health Authority did not answer questions about policies on switching care providers in cases in which a patient has filed a complaint against a practitioner.
"It's something to be taken seriously," Costescu said.