Misoprostol Managed Miscarriage Protocol

Patient Information Sheet for Medical Management of Miscarriage

Misoprostol (brand name Cytotec) is a FDA approved medication, but not specifically FDA approved for the treatment of miscarriage.  However, the American College of OB/GYN does endorse using misoprostol as one option for treating an incomplete or “missed” miscarriage.  There have been several studies which have demonstrated its effectiveness and safety in treating miscarriages. 

Possible side effects from this form of therapy include diarrhea, nausea, rarely vomiting, and heavy vaginal bleeding.


  1. You will be given prescriptions for pain relief and nausea relief, as well as the prescription for the Misoprostol.  We would advise you fill all prescriptions given to you to help avoid any side effects from occurring.  These prescriptions may include:
    • Misoprostol 200ug, place 4 tablets in vagina at one time
    • Phenergan 25 mg, use 1 tablet every 8 hours as needed for nausea
    • Ibuprofen 600mg, take 1 tablet every 6 hours for cramping
    • Percocet 5/325, take 1-2 tablets every 4-6 hours as needed for pain
    • Imodium, take 1-2 tablets every 4-6 hours as needed for diarrhea
  2. At your convenience, when at home, place four 200ug tablets of Misoprostol as far back in your vagina as possible.
  3. Lie down for at least 1 hour after insertion of the medicine.
  4. Expect heavy vaginal bleeding (more than a heavy period), soaking two pads an hour for about 2-4 hours, while you are passing tissue.  This usually takes place about 6 hours after placement of the medicine, but the timing is variable.  During this time you will have the most cramping pain, be sure to take the pain meds as prescribed.  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.
  5. If you have had little bleeding within 24 hours, you may repeat Steps 2-4 and follow up as directed.
  6. Call the office if:
    • you are soaking more than 2 pads per hour for more than 4 hours
    • 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 by the pain medicines provided to you.
  7. You will need to be followed to ensure that you completely miscarried, as confirmed with an ultrasound.  The ultrasound should be performed 24-48 hours after the bleeding has become minimal.  Follow up is extremely important.

Computer Drive Office
3805 Computer Drive
Raleigh, NC 27609

Durant Medical Center
10880 Durant Road, Suite 224
Raleigh, NC 27614

Office Hours
Monday-Wednesday 8:00 to 5:00
Thursday 8:30 to 5:00
Friday 8:00 to 4:00

Phone: 919-781-6200
Fax: 919-783-1819

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