Medical management

During medical management of an early pregnancy loss, a medication called misoprostol is used to encourage uterine cramping that will lead to the miscarriage. It is 60 per cent effective with one dose and up to 85 per cent effective after a second dose.

About misoprostol

This option allows you to plan your miscarriage at a time that best meets your needs. You can be in your own home, with support from family, friends and early pregnancy loss program nurses.

Misoprostol should not be used:

if you are allergic to the medication
with an ectopic pregnancy
if you have an intrauterine device (IUD)

Misoprostol is used with caution if your medical history includes:

uterine infection
severe asthma
severe irritable bowel syndrome
bleeding disorders
uncontrolled epilepsy
heart disease

Side effects

Possible side effects of misoprostol include:

diarrhea
nausea
headache, dizziness, chills, rash and fever (less common)

Taking misoprostol

Set aside two or three days for your appointment and the miscarriage. A support person will need to be with you after you take the medication.

You will receive a prescription for misoprostol and Tylenol 3. We suggest you buy advil, gravol and personal lubricant

Tell your nurse if you are allergic to any of these medications.

How to take misoprostol

You can take the misoprostol at home following these steps.

Use your finger to gently push four tablets (800mcg) into your vagina, as high as possible so the tablets are close to your cervix. You can use personal lubricant to make this more comfortable.
Lay down for 60 minutes so your body can absorb the medication. The cramps usually start within three to 12 hours.
Take the second dose (4 tablets) as prescribed.

Caring for yourself

It is important to take care of your body during and after a miscarriage. You can support your body by:

drinking extra water to stay hydrated
eating healthy meals
avoiding vigorous exercise until your bleeding has completely stopped for 2 weeks. After two weeks of no bleeding you can increase your activities.

While you are bleeding:

use pads instead of tampons
shower instead of having a bath
do not use hot tubs or swimming pools
do not have sexual intercourse until your bleeding has completely stopped for 2 weeks

What to expect during the miscarriage

Bleeding, tissue and cramping

A miscarriage happens as the uterus contracts and the cervix opens. You may feel lower pelvic pressure and blood clots may come out. Clots are usually dark red, flat and break apart easily.

At the peak of the miscarriage, the cramping will be the worst and the bleeding will probably be heavier than your normal period for two to three hours. You may have some gushes of blood that fill one or two maxi pads within an hour. You will likely pass some clots. They may vary from the size of a coin to the size of the palm of your hand. Try to assess the amount of your bleeding on a pad and not in the toilet.

Tissue may also come out and appear red with white or grey parts and feel firm. You may see a small sac with fluid inside. The size of the tissue will vary with how far along your pregnancy is. The tissue may be as small as a coin or as large as the palm of your hand. It may come out all at once or a bit at a time.

Managing pain

Controlling the pain is important. You can choose to rest, change positions and apply heat for the cramping.

You may also wish to take pain medication such as ibuprofen (Advil or Motrin) or acetaminophen (Tylenol). You may alternate between these pain medications. It is important to follow the recommended amount listed on the package.

Nausea and diarrhea

You can take medication for your nausea such as dimenhydrinate (Gravol). Follow the recommended amount listed on the package.

Nausea and diarrhea should stop in 24 to 48 hours.

After the miscarriage

Once most of the pregnancy tissue has passed, your pain should decrease. You may have some milder cramping for 24 to 48 hours.

Bleeding can vary from a moderate amount to spotting for a few days or weeks, and you may pass small clots for a few days.

Collecting pregnancy tissue

If you wish, you can collect the pregnancy tissue (remains). This is a personal decision and we will support you whether you decide to collect the tissue or not. You can take care of the remains yourself or call the early pregnancy loss program and arrange to bring them to the hospital.

If you wish to bring the remains to the hospital, place them in a plastic container with a lid and store them in a cool place (such as the refrigerator) until you can bring them to the hospital. We offer hospital burial at no cost. Call the early pregnancy loss program to discuss your options and make arrangements.

There are no tests for the remains that can show the specific reason for the miscarriage.

Contraception

Use contraception to prevent pregnancy until after your first period following the miscarriage. Wait one menstrual cycle before trying to get pregnant again. Talk to your primary healthcare provider about this at your follow-up appointment.

Tender breasts

It is normal to have tender breasts, and this should go away in a few days.

You may also see fluid leaking from your breasts. Wear a well-fitted bra that is not tight and put a cotton pad inside, if needed.

Tiredness

It is important to get plenty of rest.

Make sure you eat healthy foods, drink lots of water and continue your prenatal vitamins until the bottle is finished.

You can go back to work, school and driving as soon as you feel ready. Our team can give you a note for time off work if you need one.

Coping with loss

There are a wide range of feelings you may have after your pregnancy stops growing. You may feel fear, relief, guilt, anger, shock or even numbness. All feelings are normal and okay to have, and your partner’s feelings may be very different from your own.

Often, no reason for a miscarriage can be found. Give yourself time to feel sad, cry and talk about your feelings and what happened. It is hard to know how long it will take for you to feel better, but it may help to:

talk to someone who will listen and understand
be kind to yourself. Do not expect too much of yourself and try to be with people who are caring
get in touch with a support group or talk with other people who have experienced a miscarriage

When to get help

Emergency department

Go to the nearest emergency department if you:

have very heavy vaginal bleeding (soaking through four large pads in two hours)
have dizziness that does not go away with rest or causes you to faint
do not get better as expected or you cannot manage at home

Primary healthcare provider

See a primary healthcare provider, such as a family doctor, if you:

have signs of infection:
- new, increasing or foul-smelling vaginal discharge
- a fever over 38oC or chills
are not able to drink fluids
have pain that does not get better after you take pain medication
have bleeding and cramping for more than two weeks

Follow-up care

The nurses at the early pregnancy loss program will contact your regularly to monitor your symptoms and provide emotional support. We will arrange follow-up care and tests based on your symptoms.

We will ask you to see your primary healthcare provider four weeks after your miscarriage, or sooner if you wish.

Emotional support and bereavement care are part of the healing process. Call the early pregnancy loss program for support or to ask questions.