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Miscarriage is unfortunately a very common occurrence in obstetrics affecting 15-20% of
all pregnancies. A woman with a miscarriage can take a medication called misoprostol
to miscarry at home. Misoprostol, also known by the trade name “Cytotec”, stimulates
the uterus to expel the pregnancy. Misoprostol is a synthetic prostaglandin that mimics
the natural prostaglandins (hormones) produced in the body during a natural
miscarriage. This medication is FDA approved for ulcer treatment. It has been well
studied for treatment of miscarriage but is not FDA approved for this indication. The
misoprostol tablets are most commonly placed in the vagina for absorption but can also
be dissolved under the tongue or swallowed.
One of the medical terms for termination of pregnancy is “abortion”. An “abortion” can
be due to miscarriage or it can be elective for an unwanted pregnancy. The terms
“abortion” and “miscarriage” are used interchangeably in medical terminology. Do not
be alarmed if you see the term “abortion” on your medical records.
Benefits
Treatment with this medication allows a woman to have her miscarriage in a timely
fashion in the privacy of her own home. A spontaneous (naturally occurring) miscarriage
commonly takes 2-4 weeks to occur on its own. Some women find it very stressful to wait
that length of time before completion of their miscarriage. The medication has minimal
side effects. The success rate is 80-90%, the remaining patients may require a D and C if
all the tissue does not pass.
Risks and Side Effects
Side effects are more common with oral than with vaginal dosing. Side effects tend to
be mild but can include nausea, vomiting, diarrhea, fevers and chills. Serious
complications such as infection or heavy bleeding are rare and occur in less than 1% of
women. If bleeding is heavy or pain is severe, you may need to come to the ER to have
a D and C performed.

What to Expect
You will be given tablets of misoprostol to place into the vagina, dissolve under your
tongue or swallow. Your doctor will instruct you as to which route is best for your type of
miscarriage. Vaginal administration of the tablets causes the least amount of side
effects. They are easily placed in the back of the vagina. Lie down and place each
tablet one at a time into the vagina. Push the tablet to the top of the vagina with your
finger. The tablets will gradually absorb, they will usually not fall out. You can get up and
move about. Within a few hours you will start to have cramping and light bleeding. This
will progress until there is heavier bleeding then finally passage of tissue that appears
whitish. After tissue is passed, your pain and bleeding should lessen. You may take pain
medicine during this time.
You may be asked to repeat the dose as instructed by your doctor if the miscarriage
does not occur. Most women will pass tissue within the first 24-48 hours. You can expect
to have bleeding heavier that a period for 3-4 days then it should lighten. On average
women will bleed about 10-14 days. You can expect to resume a normal periods in
about 6 weeks. You should contact your OB/GYN case manager or come to the
emergency room if you are saturating a pad an hour for more than 2-3 hours or have
severe abdominal pain. If you do not pass tissue after the first week, you can choose to
have a D and C, repeat the misoprostol, or wait for a spontaneous miscarriage to occur.
At any time during this process, we are always available via the emergency room or your
OB/GYN case manager to perform a D and C if the bleeding or pain becomes too
severe to handle at home.