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Misoprostol for Missed or Incomplete Miscarriage

How Medical Management of Miscarriage Works

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Updated September 10, 2009

Updated September 10, 2009

In the past few years, it's become more common for doctors to offer medications to manage a miscarriage when hCG results or ultrasound confirm the diagnosis of missed miscarriage or blighted ovum. This gives women an alternative to D & C or a potentially long wait for a miscarriage to begin naturally.

The most common drug used for this purpose is a drug called misoprostol (brand name Cytotec), which is labeled as an ulcer medication but has been found to be helpful in miscarriage management. Misoprostol is sometimes used in combination with mifepristone, an antiprogesterone drug that is also known as Mifeprex or RU486. Another possibility is gemeprost, but this drug may involve more severe side effects in some cases.

Doctors may also use medication to end confirmed ectopic pregnancies that are not posing an imminent risk to the woman's health, but the drug in this case is usually methotrexate.

Misoprostol in the First Trimester

Medical management of miscarriage makes the most sense in cases where the miscarriage is confirmed but the bleeding has not yet started. The doctor prescribes one or more medications that cause the cervix to dilate and the uterine lining to shed. This medication may be oral or vaginal depending on the specific protocol. The miscarriage bleeding usually begins within a day or two after administration of the drug and progresses similarly to a natural miscarriage. Side effects of the drugs can include pain, nausea, vomiting and diarrhea.

According to research, the success rate for completing a miscarriage after using misoprostol is roughly 75 to 85% and the majority of women who choose medical management are satisfied with the choice when interviewed later.

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 chance of hemorrhage, infection, and needing a D & C later on if tissue remains in the uterus. Obviously a D & C carries some small risks also, so the choice is individual -- except in those cases where medical emergency necessitates a D & C. Length of bleeding for a medically induced miscarriage is about the same as for a miscarriage that happens without intervention (about two weeks).

Not every doctor offers medical management for first-trimester miscarriages at this time, but many do. If you have been diagnosed with a miscarriage and have not yet made a treatment decision, talk to your doctor if you want to explore medical management of miscarriage. These medications should be used only with a physician's supervision.

Second Trimester Use of Misoprostol

Doctors may also prescribe misoprostol, sometimes alongside mifepristone, to induce an impending stillbirth or second-trimester miscarriage when ultrasound reveals a baby with no heartbeat or otherwise definitive evidence that a pregnancy is not viable. In these cases, the experience is basically an induction of labor -- and women will most likely need to check into a hospital for the procedure, whereas medical induction of first-trimester miscarriages can often be done on an outpatient basis.

Sources:

Shankar, M., D.L. Economides, C.A. Sabin, B. Tan, and R.A. Kadir, "Outpatient medical management of missed miscarriage using misoprostol." Journal of Obstetrics & Gynaecology Apr 2007. Accessed 9 Jun 2008.

Le Roux, Paul A., Gurmit S. Pahal, Lizette Hoffman, Randa Nooh, Hazem El-Refaey and Charles H. Rodeck, "Second trimester termination of pregnancy for fetal anomaly or death: comparing mifepristone/misoprostol to gemeprost." European Journal of Obstetrics & Gynecology and Reproductive Biology Mar 2001. Accessed 9 Jun 2008.

Neilson, J.P., M. Hickey, and J. Vazquez, "Medical treatment for early fetal death (less than 24 weeks)." Cochrane Reviews Jul 2006. Accessed 9 Jun 2008.

Zhang, Jun, Jerry M. Gilles, Kurt Barnhart, Mitchell D. Creinin, Carolyn Westhoff, Margaret M. Frederick, "A Comparison of Medical Management with Misoprostol and Surgical Management for Early Pregnancy Failure." NEJM Aug 2005. Accessed 9 Jun 2008.

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