Misoprostol Medication for Managing Miscarriage

How Medical Management of Miscarriage Works

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Cytotec (misoprostol) is a medication used to manage a miscarriage when hCG results or ultrasound tests confirm the diagnosis of either a missed miscarriage or blighted ovum. Your doctor may give you this alternative to a dilation and curettage procedure (D&C) or a potentially long wait for a miscarriage to begin naturally.

Misoprostol for Managing Miscarriage

Misoprostol is labeled as an ulcer medication but has been found to be helpful in miscarriage management. Its use for management of missed or incomplete miscarriages is considered to be "off-label" by the Food and Drug Administration (FDA), but it has been well-studied and is widely recommended. Off-label use is legal and not considered experimental when it is backed by scientific evidence.

Misoprostol is sometimes used in combination with mifepristone, an antiprogesterone drug that is also known as Mifeprex or RU486. Another possibility is gemeprost, but this drug may trigger more severe side effects in some cases.

Doctors may also use a medication to end a confirmed ectopic pregnancy that is not posing an imminent risk to the woman's health, but the drug, in this case, is usually methotrexate.

Misoprostol in the First Trimester

Medical management of miscarriage makes the most sense in cases where the miscarriage is confirmed but the bleeding has not yet started.

How it works: Your doctor prescribes one or more medications that cause your cervix to dilate and your uterine lining to shed. This medication may be oral or vaginal, depending on the specific protocol. You may be advised to take ibuprofen an hour before the misoprostol in order to reduce cramps. With the vaginal application, you place four of the pills in your vagina and lie down for 30 minutes while the medication is absorbed. If you are taking the pills by mouth, they should be taken with food but not with antacids or calcium.

You should wear a night-time capacity sanitary napkin when you take the pills so you are prepared for the bleeding that will result. The miscarriage-related vaginal bleeding and cramps usually begin within one hour to four hours of the administration of the drug. The cramps may last for three to five hours. The bleeding is often the same as menstrual bleeding but may be more than you usually experience. Similar to a natural miscarriage, the bleeding lasts for one to two weeks, often with starts, stops, and spotting.

If bleeding doesn't start after 24 hours, contact your doctor or consult the instructions you were given. Often, another dosage of the pills is recommended.

Side effects of misoprostol can include pain, nausea, vomiting, and diarrhea. Your doctor may give you options for how to treat these expected problems.

According to research, the success rate for completing a miscarriage after using misoprostol is roughly 71 percent to 84 percent. The majority of women who choose medical management for their miscarriages are satisfied with the choice when interviewed later.

Risks of Using Medication to Manage a Miscarriage

The risks of using medication to expedite a miscarriage (rather than having a D&C) are about the same as the risks of miscarrying naturally. There's a small chance of hemorrhage, infection, and needing a D&C later on if tissue remains in the uterus. Obviously, a D&C carries some small risks also, so the choice is up to you and your doctor—except in those cases where medical emergency necessitates a D&C. Length of bleeding for a medically induced miscarriage is about the same as for a miscarriage that happens without intervention (about two weeks).

See your doctor or get emergency treatment if you have any of these symptoms after taking misoprostol:

  • Heavy bleeding that soaks more than two menstrual pads per hour for two hours in a row
  • Heavy bleeding that returns after two weeks after the medication
  • Bleeding that continues for more than two weeks
  • Fever and/or chills lasting form more than 24 hours
  • Foul-smelling vaginal discharge

Second Trimester Use of Misoprostol

Doctors may also prescribe misoprostol, sometimes alongside mifepristone, to induce an impending stillbirth or second-trimester miscarriage when an ultrasound reveals a baby with no heartbeat or otherwise definitive evidence that a pregnancy is not viable. In these cases, the experience is basically an induction of labor and women will most likely need to check into a hospital for the procedure, whereas medical induction of first trimester miscarriages can often be done on an outpatient basis.

A Word From Verywell

If you have been diagnosed with a miscarriage and have not yet made a treatment decision, talk to your doctor about your options. These medications should be used only under a physician's supervision.

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