Instructions for using vaginal misoprostol in medical abortion

Instructions for Using Vaginal Misoprostol in Medical Abortion
Some women bleed after taking mifepristone. However, in almost all cases you must use the second medication, called misoprostol, to complete the abortion. You should use the misoprostol even if you have had bleeding after taking mifepristone in our office. You will insert 4 misoprostol pills into your vagina. You should use the misoprostol any time between _________________________ and _________________________ . (time and date)
Preparation:
Most women will experience cramping and bleeding within a few hours of inserting misoprostol. The cramping and bleeding
are usually heavier than what you might have during your period. Cramping may start before the bleeding. Some women expel
blood clots that range in size from small (the size of a quarter) to quite large (the size of a lemon). The bleeding usually
decreases after the pregnancy is expelled. About 90% of women expel the pregnancy within 24 hours of taking vaginal
misoprostol. Other side effects that may occur after using misoprostol include: nausea, vomiting, diarrhea, warmth or chills,
headache, and tiredness. These side effects usually last for a fairly short time and go away on their own. Because of these side
effects, it may be a good idea to insert the misoprostol when you have several hours with no other responsibilities. You will also
want to have plenty of large maxipads, as well as medication for pain, and other comfort measures, such as a heating pad, hot
water bottle, and warm liquids, ready before you insert the misoprostol. Be sure to drink plenty of non-alcoholic, caffeine-free
beverages (e.g. water, juice, sports drinks) to avoid dehydration.
Some women find that it helps to have a partner or friend with them when they use the misoprostol. Some women may prefer
to have privacy, but have someone they know they can reach if they need help. While it is rare to have an emergency, it is
important that you make plans ahead of time about how to call us and how you would get to our office or another medical
facility if you needed to.
How to Insert the Misoprostol:

1. Empty your bladder.
2. Wash your hands.
3. Push the four misoprostol tablets one at a time up into the vagina as far as you can using your finger.
4. Your health care provider may recommend that you lie down for about 30 minutes after you insert the misoprostol.
Sometimes the tablets come out when your bleeding starts or if you are up and about. If the tablets fall out while you are
bleeding, do not worry. In most cases, enough of the medication will have been absorbed. If the tablets fall out before your
bleeding starts, you may reinsert them or call us for instructions on what to do.
Some women wonder if they will see pregnancy tissue as they bleed. You may see a sac that is white or grayish and looks
somewhat like a grape. You may see only blood clots. An embryo is approximately the size of a grain of rice at the time
when medical abortion is most commonly provided, and is typically not seen. When it is seen, it is generally limited
to women who are close to 63 days gestation.
Call Us If:
1. You are soaking through two or more large maxipads each hour for 2 hours in a row, or the bleeding seems heavier than
2. You have severe pain and pain medication is not helping.
3. You have severe diarrhea or vomiting that lasts several hours.
4. You feel faint, lightheaded, or dizzy.
5. You have a fever of 100.4°F or more that lasts several hours.
6. You have a fever that starts a day or more after you take misoprostol.
If you have any concerns or questions, please contact us at ______________________________. There is someone available to
answer your call 24 hours a day.
The Days After Using Misoprostol:

You may have some bleeding or spotting for several more days or a few weeks after using misoprostol. Most women find that
their pregnancy symptoms decrease. While you can return to your normal activities, you may be more tired than usual for a few
days. You might want to avoid strenuous activities or exercise until your follow-up visit. You can get pregnant very soon after
an abortion, even before your next period comes. Most providers recommend that you not have intercourse until after your
follow-up visit. Your provider will advise you how and when to begin contraception to avoid unintended pregnancy.
Follow-up Visit:

Your follow up visit is scheduled for ______________________________________ . It is very important for you to return to
the office for a check-up to make sure that the abortion is complete. For some women, even if they have had bleeding, the
abortion may not be complete. The only way to know for sure is to come back for a check-up. If the pregnancy is still growing
at the time of your follow-up visit, it is strongly recommended that you have a vacuum aspiration, sometimes called a surgical
abortion, because the medication can cause birth defects in this pregnancy if it continues. We can also provide you with
contraceptive information and arrange for you to have the contraceptive method(s) of your choice at the time of your follow-up,
if we haven’t done so at your first appointment.
These education materials are intended as guidelines and do not dictate an exclusive course of management. These materials contain recognized methods and techniques of medical care that represent currently appropriate clinical practice. Variations in the needs of individual patients and differences in the resources available to clinical providers may justify alternative approaches to those contained in these materials. These materials are not intended as a substitute for the advice of a health care provider. Neither the National Abortion Federation, its officers, employees, or members are responsible for adverse clinical outcomes that might occur in the course of delivery of abortion services in which they are not expressly and directly involved in the role of primary caregiver.

Source: http://www.prochoice.org/pubs_research/publications/downloads/professional_education/medical_abortion/vaginal_miso.pdf