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A miscarriage is the loss of pregnancy before 20 weeks. Pregnancy loss happens more often in pregnancies that are 13 weeks or less. It happens in 15 to 20% of all pregnancies. The reasons for pregnancy loss are unclear but know nothing you did caused the loss.
You have chosen treatment with a medicine called misoprostol. Misoprostol is often used with another medicine, mifepristone. These medicines can help an early pregnancy loss process to end faster.
What to expect from misoprostol treatment:
Cramping usually starts within 4 to 8 hours after misoprostol administration and lasts about 3 to 5 hours. You may have cramping for up to a week. Use a heating pad and ibuprofen to help with cramps. If cramping is so severe that you can’t do your daily routine, reach out to your healthcare provider.
Vaginal bleeding may be heavier than a normal period after your treatment. Bleeding should be heavy for up to 1 to 2 hours. If only experiencing spotting call provider to make sure everything passed. Bleeding may stop and start and will last 1 to 2 weeks.
Misoprostol may cause side effects of nausea, throwing up, and diarrhea. It can also cause shivering, fevers or chills. These symptoms should not last longer than 24 hours.
Make sure that you have your support person with you to assist you through process
Choose a time where you are rested and have had a good meal. Avoid taking at night.
If you received a dose of mifepristone from your doctor’s office wait 24 hours before using misoprostol.
Place misoprostol 800mcg (4 tablets of 200 mcg each) in the vagina. It does not matter where in the vagina you put the pills. Remain lying down for 30 minutes after placing tablets. It is alright if tablets fall out after 30 minutes. The medicine has been absorbed.
Misoprostol 800 mcg (4 tablets, 200 mcg each) place in your mouth between your cheek and gum. Leave the tablets there for 30 minutes. Once 30 minutes has passed, swallow the remainder of the tablets.
If no bleeding within 24 hours can repeat misoprostol dose (4 tablets).
If tablets don’t work after repeating dose or you feel it is taking too long, reach out to your health care provider to discuss options.
The following medicines may be ordered by your provider to help with misoprostol side effects:
Ondansetron (Zofran) 4mg disintegrating tablets with directions to take1 tablet 30 minutes prior to misoprostol then every 8 hours as needed for upset stomach and nausea
Promethazine (Phenergan) 25mg tablets with directions to take 1 tablet 30 minutes prior to misoprostol then
every 8 hours as needed for upset stomach and nausea
Ibuprofen (Advil or Motrin) 200mg with directions to take 3 tablets (600mg) 1 hour before misoprostol dose and every 8 hours as needed for pain/cramping. Take with food to prevent upset stomach.
When to call:
Temp over 101 F
Prolonged heavy bleeding (soaking more than 2 pads per hour for greater than 2 hours)
Lightheadedness, dizziness, fainting or you start to feel very ill
Severe pain that is not managed with the pain medicine ordered.
Foul vaginal discharge
What to expect after treatment:
Your next period should be 4 to 6 weeks after the miscarriage. If you do not get your period, please call.
No intercourse or use of tampons for 2 weeks. Severe infection may occur from intercourse.
You should feel well enough to go back to your normal routine within 48 to 72 hours. Intense activities such as horseback riding, jogging, and heavy exercise may increase bleeding and cramping.
Symptoms of pregnancy (i.e., breast tenderness, nausea) should go away within a week. If breasts become full or leak, wear a tight bra night and day.
Feelings after miscarriage can range from the blues to depression. The milder forms are more common. If you need support, there is help.
Please call your midwife or doctor. We have trained staff we can refer you to. Seeking help is the best thing you can do if you are having trouble handling these feelings on your own.
Keep follow up visits and lab appointments with your healthcare provider.
You may get pregnant again soon after pregnancy loss ends. Continue to take prenatal vitamin daily if you want to try again. Consult healthcare provider for birth control options if you are not ready for pregnancy.