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Medical miscarriage management

You will be given medication called misoprostol, which allows the cervix (the entrance of the womb) to open and causes the uterus to cramp so the pregnancy will pass.

The misoprostol tablets are placed under the tongue or into your vagina, it’s up to you. If the pregnancy is less than 10 weeks, you can take these tablets home with you, so you can be in the comfort of your own surroundings to miscarry.

If the pregnancy is over 10 weeks you will need to come into a BPAS centre to receive the medication and to be monitored until the pregnancy has passed. This may mean an overnight stay so bring the items you will need.

If you choose to take the tablets by mouth you will be given 3 tablets. You will need to place the tablets under your tongue and leave them in place to dissolve for 30 minutes. You may then need to swallow the remainder of any pills.

If you choose to have the tablets placed in your vagina you will be given 4 tablets. You can place them in the vagina or if you prefer your healthcare professional can insert them for you. If your blood group is Rhesus-negative you will also have an Anti-D injection.

You will be given antibiotics to take.

However you choose to take the misoprostol tablets they will cause you to have cramps and bleeding. This usually starts about 2 hours after you have taken the tablets but can start sooner. The cramping is usually worse than period cramps and is bad enough that you will need pain medication. We will give you pain control medicine and also instructions on how to take medicines you can buy at the pharmacy.

If this treatment has not worked you may be advised to have a surgical treatment to complete the miscarriage.

For clients staying in a BPAS centre

You will stay at the centre until the pregnancy has passed, so bring an overnight bag.

Essential things to bring:

  • prescribed medicines including inhalers
  • stick on sanitary towels
  • extra underwear
  • slippers and nightshirt or t-shirt
  • toileteries and a towel

A nurse will be in attendance and your progress will be monitored. You can rest in bed or be up and about as you wish. The misoprostol will be repeated every 3 hours until the miscarriage is complete.

Many women will only require 1 or 2 doses of the misoprostol to enable the pregnancy to be passed. You may see large blood clots or the pregnancy but the nurse will try to make sure that you see very little, however, sometimes this is not possible as events can be rapid.

Sometimes the placenta does not come out at the same time as the pregnancy. In this case, you may need more misoprostol or need to be taken to the operating theatre. On rare occasions you will need to be transferred to a local NHS hospital for further treatment.

You will not need a follow up appointment if you have had medical miscarriage management at a BPAS clinic.

Pain control

During a medical procedure, most women will have strong cramping, similar to period pains. There are many ways to lessen the pain:

  • wear comfortable clothes
  • stay in a familiar and relaxing place
  • apply a heating pad or hot water bottle to your lower stomach
  • use pain medicine like ibuprofen or codeine

Once the cramping and bleeding begins you may see large blood clots of tissue as the pregnancy passes and you will probably need pain medication.

Most women pass the pregnancy within 4 hours after taking the medication. For others it can be quicker or take longer. Every woman is different but most women pass the pregnancy within a few days.

It’s normal to have some bleeding or spotting for up to 2-3 weeks following the miscarriage. For some women light spotting can continue until the next period. You should use sanitary pads as it makes it easier to keep track of your bleeding. 

Side-effects

It is normal for you to have bleeding and cramping. You may also:

  • Feel dizzy
  • Feel nauseous or vomit
  • Have a headache
  • Have diarrhoea
  • Have temporary flushes or sweats

You may feel more at ease if you have someone with you while the pregnancy passes.

You should start to feel better each day after the pregnancy has been passed. Some mild abdominal cramping is normal and can be managed with painkillers such as ibuprofen.

Breastfeeding

If you are breastfeeding, a little of the misoprostol will be present in the breast milk after you take it. In rare cases, the medication may cause your infant to have diarrhoea. To reduce any risk you can choose to wait 6 hours between taking the misoprostol and breastfeeding.

Please let us know if you are breastfeeding so we can work out the best plan together.

Read about follow up instructions by treatment type here

Read about miscarriage recovery here.