Mifepristone + Misoprostol Instructions for Miscarriage - Kamm McKenzie OBGYN

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Mifepristone + Misoprostol Instructions for Miscarriage

Patient Information Sheet for Medical Management of Miscarriage

  • Testing has demonstrated that you have a miscarriage.  
  • You have been given a dose of mifepristone (also called Mifiprex) today.  Mifepristone blocks a hormone needed for your pregnancy to continue. When you use mifepristone on Day 1, you also need to take another medicine called misoprostol 24 to 48 hours after you take mifepristone, to cause the pregnancy to be passed from your uterus.  The American College of OBGYN supports the use of this combination of medications as an effective treatment of miscarriage.
  • You have been given a prescription for misoprostol (also called Cytotec) as well as prescriptions for pain relief and nausea.  We would advise you to fill all of the prescriptions given to help diminish the side affects of the miscarriage. 
  • 24-48hr AFTER you took the mifepristone in our office, place four misoprostol tablets as far back in the vagina as you can.  Lie down for about an hour after insertion of the medication. This medication causes the onset of uterine cramping and the subsequent passage of the pregnancy tissue.
  • You will need to be able to relax and care for yourself for at least 6-12 hours after the misoprostol pills have been inserted.  You should begin to have some bleeding or cramping within the first few hours. Do not put a tampon into your vagina. You should wear a pad (sanitary napkin).  Be sure to take the prescribed pain and nausea medications as needed. If you get diarrhea, you can use any over the counter anti-diarrhea medication.
  • Vaginal bleeding and passage of clots can occur anytime after you insert the misoprostol.  It is normal for the bleeding to get very heavy (even soaking 2 thick pads an hour for 2-4 hours) in the 12 hours after inserting the misoprostol pills. After this episode of heavy bleeding, you will continue to have bleeding like a period for up to 2 weeks, gradually slowing down each day.
  • If you do not have heavy bleeding 24 hours after placing the pills, you should repeat the dose (a refill was provided on your prescription).
  • Call the office for the following:
    • You are soaking more than 2 pads an hour for more than 4hours.
    • You feel faint, dizzy, short of breath, or have chest pain.
    • You develop a fever greater than 100.4 degrees F
    • You develop severe abdominal pain that is not controlled with the pain medicines prescribed to you.
  • A follow-up sonogram should be done within 1-2 weeks of taking the medication to confirm that misoprostol was effective in expelling your miscarriage and that all of the pregnancy tissue has been passed.
  • Do not have any sex or use tampons until after you have been seen at your follow-up appointment and have been given permission to do so.

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