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You have opted to use medical management in the treatment of your miscarriage. Other options incllude surgical evacuation of your uterus and expectant management. Medical management is 80-90% effective when used correctly. Studies have shown that women who use medical management are highly satisfied because they feel that they have some control of the process. They are able to avoid a surgical procedure, and they can experience this difficult time in private presumably your provider has already explained your options and the procedure to you. The information below is meant to clarify any questions that you may have, provide instructions on when you should seek help, and give you contact information. At some point during this process your provider will have checked your bloodtype and you should receive medication if your blood type is negative.
24-hour contact information
All hours:
Immediate emergency: Call 911 in cases of very heavy bleeding or other immediate emergency.
When to call the clinic / doctor on call • If you bleed heavily and you soak more than 2 maxi-pads in an hour for 2 hours in a row,
please call the clinic at any hour of the day or night. This does not mean you will definitely need to come to the hospital. • If you have fever or chills more than 24 hours after misoprostol. Low grade fevers can be
normal only in the hours after using misoprostol.
• If you have foul smelling vaginal discharge or increasing abdominal pain after you pass the
• 24-72 hours after misoprostol to report your symptoms and schedule any necessary follow-up before your final appointment in 2 weeks. • Make sure that you clarify your blood type with your provider so that you can receive the appropriate medication if your blood type is negative.
When to go to an emergency roomIf think you are bleeding very heavily and/or you are feeling dizzy, weak or light headed. If you are bleeding heavily but are not sure if it is too much, you may call the emergency telephone numbers above and discuss it with a health professional. You might be directed to an emergency room. If you cannot reach a doctor and you are concerned, go to the emergency room.
The day you use misoprostol
As the provider or the clinic staff explained in the clinic, you will place the misoprostol pills in your
vagina at home.
Preparing for your misoprostol insertion 1. You should have a phone, a bathroom and your support person nearby for the day. You also
should have your misoprostol tablets, pain medication, and maxi-pads.
2. If you are hungry, eat a light meal before you start and drink plenty of water during the day.
3. Since the process may take 5-7 hours or more, we recommend placing the tablets in the morning How to place the misoprostol in your vagina
Wash your hands. While lying down or standing, hold 1 pill between your first and second fingers
(your point and your middle finger) and push the pill high up into your vagina with one of the fingers.
Repeat this procedure with all 4 pills. You may do regular activities around the house after placing the
misoprostol.
Do not put anything in your vagina from the time you put in the misoprostol untill you stop
bleeding. (This means no sex or tampons, until you stop bleeding which may take 2 weeks or more.)
If you have no response to the initial dose of misoprostol, you may repeat it 24 hours after your initial
dose. You should follow the same instructions as with the first dose. If you have no response to the
misoprostol after 2 doses, call your provider who will then schedule an evacuation procedure.
What to expect after the misoprostolAbdominal cramping and pain and moderate to heavy bleeding are normal parts of the process during the hours when your uterus passes the pregnancy. Most women pass blood clots.
1. Cramping usually starts between 30 minutes to 7 hours after you place the misoprostol in your
2. Bleeding usually starts between 30 minutes to 10 hours after you place the misoprostol in your
vagina. Although most women bleed for about 2 weeks, some bleed for a shorter period, and others bleed for a longer time (about 10% of women bleed lightly for one month or more). These variations are normal. Some women will have a “second wave” of heavier bleeding after the bleeding slows down, but bleeding should not be heavier than a period for more than a few days.
3. Heavy bleeding and strong cramps usually last from 1 to 4 hours. Call if you soak through more
than 2 large maxi pads per hour for 2 hours in a row.
4. For pain: Resting and using a heating pad or hot water bottle may help. Ibuprofen usually helps
with the pain. If your pain is not manageable with ibuprofen, use a stronger medication (Vicodin or Tylenol with codeine) as prescribed.
Ibuprofen (Motrin, Advil, etc.) you may take 800 mg of ibuprofen (4 over-the-counter tablets) every
6 to 8 hours. You may take the first pills as soon as you feel you need something for pain. Ibuprofen usually does not cause side effects such as sleepiness, nausea or dizziness.
5. Other misoprostol side effects: These side effects are common and usually only last 1 to 4 hours.
If any of these side effects make you very uncomfortable, you may treat your symptoms with over-the-counter medicines. Call if over-the-counter medications do not relieve your symptoms.
a. Nausea or vomiting: Over the counter treatment: Benadryl 25 mg to 50 mg every 6 hours as
needed, or Dramamine 25-50 mg every 6 hours as needed. b. Diarrhea: Over the counter treatment: Imodium 2 tablets (4 mg) once.
c. Fever, chills in the first 24 hours: Over the counter treatment: Tylenol 500 to 1000 mg every
4 hours, Ibuprofen up 800 mg (4 over-the-counter tablets) every 6 hours. If you have already taken Tylenol of Ibuprofen for pain, do not take more of the same medication for fever or chills. Call the clinic if your fever is higher than 101 F (or 39 C) after you take Tylenol or Ibuprofen.
How to tell if you passed the pregnancy
Most women have bleeding and painful cramping. As you pass the pregnancy the bleeding is usually
heavy and the cramping very strong. This usually lasts 1-4 hours. Most women pass some blood
clots into the toilet, and often the pregnancy is in one of those clots. After the pregnancy passes, the
cramps decrease and the bleeding slows down quite a bit. After passing the pregnancy, within a few
hours, cramps and bleeding should be much improved.
The last part of the process is to confirm with a health professional within 24-72 hours that you
passed the pregnancy. You will be instructed regarding a follow-up appointment as needed.
**There is often a small amount of pregnancy tissue (mostly uterine lining) that continues to pass as
long as you have bleeding. You may even have a “second wave” of heavy bleeding after your final visit.
You may use the same criteria to call the clinic. Some of the “failures” with misoprostol are when a
woman passes the pregnancy but needs still needs a uterine evacuation due to continued bleeding.**

Source: http://campuslifeservices.ucsf.edu/dmx/PatientEd/SDOBG0485.pdf