Misoprostol Medication for Managing Miscarriage

Cytotec (misoprostol) is a miscarriage medication used when hCG results or ultrasound tests confirm the diagnosis of either a missed miscarriage or blighted ovum. A health care provider may give you this medication as an alternative to a surgical procedure called dilation and curettage procedure (D&C). Another option is to wait for a miscarriage to begin naturally.

Learn more about using miscarriage medication to manage pregnancy loss.

Using Misoprostol as a Miscarriage Medication

Misoprostol is labeled as an ulcer medication but has been found to be an effective option for medication abortion and miscarriage management. Using the drug for managing missed or incomplete miscarriages is considered to be an "off-label" use by the Food and Drug Administration (FDA).

However, using this medication to manage miscarriage has been well-studied, and experts widely recommend its use. Off-label use of misoprostol is legal and not considered experimental when it is backed by scientific evidence.

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

Miscarriage Medication in the First Trimester

Medical miscarriage management is often used when the pregnancy has been identified in the uterus, but it is not viable. In these cases, a miscarriage is confirmed, but the bleeding has not yet started.

How to take miscarriage medication

If you will be taking misoprostol to manage a miscarriage, the health care provider will prescribe one or more medications. These medications will cause cervical dilation and uterine lining shedding. You might take these medications orally or vaginally, depending on the specific protocol.

The health care provider might suggest that you take ibuprofen an hour before taking your prescribed dose of misoprostol to reduce cramps.

With the vaginal application, place four of the pills in your vagina. You will need to lie down for 30 minutes while the medication is absorbed.

After you take the medication

Wear a night-time capacity sanitary napkin when you take the pills to make sure you are prepared for the bleeding the medication will cause. Miscarriage-related vaginal bleeding and cramps will usually start within one to four hours of taking misoprostol. You might have cramps for three to five hours.

The bleeding is often the same as menstrual bleeding but might be more than you typically experience. Miscarriage bleeding can last for one to two weeks. You might have bleeding that "starts and stops" or spotting.

When interviewed about the experience later, the majority of people who chose medical management for miscarriages reported being satisfied with their choice.

When to call a health care provider

If bleeding does not start within 24 hours of taking your dose of misoprostol, contact the health care provider or consult the instructions you were given. Often, another dosage of the pills will be recommended.

Misoprostol can have side effects. Ask about how to how to manage them. Possible side effects of misoprostol include:

• Cramping and pain
• Diarrhea
• Nausea and vomiting
• Headache
• Constipation
• Indigestion
  

Risks of Using Miscarriage Medication

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 risk of the following:

• Hemorrhage
• Infection
• Needing a D&C later on if tissue remains in the uterus

Research also shows that taking the medication mifepristone before misoprostol makes medical management of miscarriage more effective, with fewer incidents of complications.

A D&C also carries small risks. Ultimately, the choice is up to you and a health care provider—except in cases where a medical emergency necessitates a D&C. The length of bleeding for a medically induced miscarriage is about two weeks (the same as for a miscarriage that happens without intervention).

When to Seek Emergency Help

See a health care provider or get emergency treatment if you have any of these symptoms after taking misoprostol:

• Bleeding that continues for more than two weeks
• Fever or chills lasting for more than 24 hours
• Foul-smelling vaginal discharge
• 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 taking the medication

Miscarraige Medication in the Second Trimester

Health care providers might prescribe misoprostol (sometimes alongside mifepristone) to induce an impending stillbirth or second-trimester miscarriage. This may happen after an ultrasound reveals a fetus with no heartbeat or otherwise definitive evidence that a pregnancy is not viable.

In these cases, the experience is similar to an induction of labor. A person will most likely need to check into a hospital for the procedure. By contrast, medical induction of first trimester miscarriages can often be done on an outpatient basis.

If you have been diagnosed with a miscarriage and have not yet made a treatment decision, talk to a health care provider about your options. If you choose medication, you will need to get a prescription. You might need to go to the hospital or the health care provider's office to have a procedure or to be monitored. Other treatments can be done at home with the health care provider's guidance.