Misoprostol Medication for Managing Miscarriage

 

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Misoprostol, a prostaglandin E1 analogue, has been used off-label for many years as a safe and effective treatment for first trimester incomplete miscarriage. Misoprostol binds. Misoprostol, a prostaglandin analogue, is commonly used for the medical management of miscarriage to induce myometrial contractions to aid the expulsion of pregnancy tissue. 8 However, misoprostol is not always effective, and 15–40% of women require an additional dose of misoprostol, thus prolonging the duration of treatment. 9.

Protocols for Medication Management of Early Pregnancy Loss. January 03, 2019. Clinical protocols for medication management of early pregnancy loss. One protocol for using mifepristone and misoprostol and one protocol for using misoprostol only.

Sources: Prine LW, MacNaughton H. Office Management of Early Pregnancy Loss. Am Fam Physician. 2011. They were randomized to receive either 200 mg of mifepristone orally, followed by 800 μg of misoprostol vaginally, or just 800 μg of misoprostol. Alternatively, 600 mg misoprostol can be administered sublingually.

Treatment may be repeated twice with a 3 h interval but more studies are needed to evaluate the additional efficacy of repeated doses of misoprostol. Course of treatment. The diagnosis of missed.

The chart, divided into stages of pregnancy, outlines recommendations for dosages and routes of administration for misoprostol use for several indications including medically induced abortion, clinical management of miscarriage, cervical preparation for surgical abortion, fetal death, induction of labor and management of PPH. Use birth control that you can trust to prevent pregnancy while taking misoprostol. You may need to have a pregnancy test while taking misoprostol. Talk with your doctor. Start taking misoprostol only on the second or third day of your next normal menstrual period after the negative pregnancy test.

10 rows · Misoprostol dosage graph Figure 1: Safe single doses of vaginal misoprostol for producing. Misoprostol 800 micrograms vaginally, with one repeat dose as needed, no earlier than 3 hours after the first dose and typically within 7 days if there is no response to the first dose* A dose of mifepristone (200 mg orally) 24 hours before misoprostol administration. Medical management of early pregnancy loss is an alternative to uterine aspiration, but standard medical treatment with misoprostol commonly results in treatment failure.

List of related literature:

Medication treatment involves taking a drug, such as misoprostol, that causes uterine contractions and miscarriage, and can be used only early in the pregnancy.

“Our Bodies, Ourselves: Pregnancy and Birth” by Boston Women's Health Book Collective, Judy Norsigian
from Our Bodies, Ourselves: Pregnancy and Birth
by Boston Women’s Health Book Collective, Judy Norsigian
Atria Books, 2008

Prostaglandin medications (e.g., misoprostol [Cytotec]) may be given and are usually effective in completing the miscarriage within 7 days (Cunningham et al., 2014).

“Maternity and Women's Health Care E-Book” by Deitra Leonard Lowdermilk, Shannon E. Perry, Mary Catherine Cashion, Kathryn Rhodes Alden
from Maternity and Women’s Health Care E-Book
by Deitra Leonard Lowdermilk, Shannon E. Perry, et. al.
Elsevier Health Sciences, 2014

Recently, intravaginal misoprostol (PGE) has been recognized as a safe and effective alternative for pregnancy termination for fetal death when used in doses of 100-200 mg every 6-12 h37,38,

“Clinical Maternal-Fetal Medicine” by Hung N. Winn, John C. Hobbins
from Clinical Maternal-Fetal Medicine
by Hung N. Winn, John C. Hobbins
Taylor & Francis, 2000

Misoprostol can be used orally, vaginally, or buccally.

“Pfenninger and Fowler's Procedures for Primary Care E-Book: Expert Consult” by John L. Pfenninger, Grant C. Fowler
from Pfenninger and Fowler’s Procedures for Primary Care E-Book: Expert Consult
by John L. Pfenninger, Grant C. Fowler
Elsevier Health Sciences, 2010

Several protocols are available for the use of these medications; one evidence-based approach recommends taking 200 mg of mifepristone orally on Day 1 given by the clinician followed by 800 mcg of misoprostol buccally on Day 2 (24 hours later) at the patient’s home.

“Encyclopedia of Family Health” by Martha Craft-Rosenberg, Shelley-Rae Pehler
from Encyclopedia of Family Health
by Martha Craft-Rosenberg, Shelley-Rae Pehler
SAGE Publications, 2011

Prostaglandin medications (e.g., misoprostol [Cytotec]) may be given orally or vaginally and are usually effective in completing the miscarriage within 7 days (Cunningham, Leveno, Bloom, et al., 2010).

“Maternal Child Nursing Care” by Shannon E. Perry, Marilyn J. Hockenberry, Deitra Leonard Lowdermilk, David Wilson
from Maternal Child Nursing Care
by Shannon E. Perry, Marilyn J. Hockenberry, et. al.
Elsevier, 2013

This drug should not be given to women who are pregnant or who may become pregnant, because misoprostol may induce a miscarriage.

“Medicine for the Outdoors E-Book: The Essential Guide to Emergency Medical Procedures and First Aid” by Paul S. Auerbach
from Medicine for the Outdoors E-Book: The Essential Guide to Emergency Medical Procedures and First Aid
by Paul S. Auerbach
Elsevier Health Sciences, 2009

In early pregnancy (<63 days) mifepristone (200 mg) is taken orally followed by misoprostol (800 mcg) after 24–48 hours orally or vaginally.

“Crash Course Obstetrics and Gynaecology” by Sophie Kay, Charlotte Jean Sandhu, Shreelata T Datta, Philip Xiu, Ruma Dutta, Fevzi Shakir
from Crash Course Obstetrics and Gynaecology
by Sophie Kay, Charlotte Jean Sandhu, et. al.
Elsevier Health Sciences, 2019

● Misoprostol (Cytec®) is not approved for use in pregnancy but can be given rectally (800–1000 mg) if oxytocin has failed to work and PGF2 α is not available (NSW Health Department 2002).

“Midwifery: Preparation for Practice” by Sally Pairman, Sally K. Tracy, Carol Thorogood, Jan Pincombe
from Midwifery: Preparation for Practice
by Sally Pairman, Sally K. Tracy, et. al.
Elsevier Health Sciences, 2011

Studies with 800 mcg of misoprostol tablets used alone and placed in the vagina and moistened with saline for one, two, or three applications 24 hours apart report about a 90% effectiveness when given for a pregnancy of less than 8 weeks’ gestational age.

“Comprehensive Gynecology” by Gretchen M. Lentz, David M. Gershenson
from Comprehensive Gynecology
by Gretchen M. Lentz, David M. Gershenson
Elsevier Mosby, 2012

Oktay Kutluk

Kutluk Oktay, MD, FACOG is one of the world's foremost experts in fertility preservation as well as ovarian stimulation and in vitro fertilization for infertility treatments. He developed and performed the world's first ovarian transplantation procedures as well as pioneered new ovarian stimulation protocols for embryo and oocyte freezing for breast and endometrial cancer patients.

Mail: [email protected]
Telephone: +1 (877) 492-3666

Biography: https://medicine.yale.edu/profile/kutluk_oktay/
Bibliography: oktay_bibliography

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31 comments

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  • Eu sei quem ajuda a fazer, fiz com 3 semanas, Se alguém precisar
    21 980314123 o número da moça que me vendeu, ela se chama Joyce

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  • I am so sorry for your loss. Your story sounds so similar to mine. Me and my husband were TTC for a year and a half. This was our first baby and was told I am going through a missed miscarriage. I was 9 weeks measuring 5.5 weeks. My doctor also said my baby passed shortly finding the heartbeat at our last scan. I tried natural but ended up having an incomplete miscarriage so now I’m taking the oral form of misoprostol to get the rest of the tissue out. I’m 2 weeks in and so ready for this to be over �� Hope you guys are doing okay. Again I’m so so sorry for you loss

  • Thank you so much for sharing this. On the 11th of this month we discovered at what was supposed to be our 10 weeks and 4 day scan that I had suffered a missed miscarriage. The next day I had surgery to remove the baby. 5 days on my head is still spinning trying to process what has happened. I have never felt so alone but watching this video was so reassuring. I wish you all the luck in the world conceiving your rainbow baby ����

  • Eu comprei abortivo com a Tifanny deu tudo certo ela me ajudou na forma correta de usar saiu tudo fiz em casa e o procedimento foi rápido sem dor. Obrigada Tifanny (41)992822567

  • Anna, I forgot to telll you that I got pregnant for the second time at 39 and had a perfect pregnancy and a beautiful and healthy baby. Now he’s 10,so don’t get hopeless, I’m sure next time you’ll go through a nice and normal pregnancy.
    Los of love
    Viviana

  • So sorry for your loss. I admire your strength and greatly appreciate you sharing all this with us. Wishing you a speedy healthy recovery big hug

  • No one talks about taking the misoprostol and how it literally does feel like you’re the one choosing to end the pregnancy. I would google and YouTube so many miracle pregnancies after a death diagnosis. You really do try to rationalize it it any way possible. I had two missed miscarriages both at 11weeks. The babies stopped thriving at 8 weeks. First baby I gave birth to at home with the pill and the second I had a d&c. They both have their own cons:( but yea. I’m so sorry you had experienced this.

  • Eu estava desesperada descobri minha gravidez com 8 semanas… encontrei o contato da sindy wpp (85) 8188 2999 aqui no YouTube muitas meninas indicando. Entrei em contaro recebi muita atenção… ela me deu todo suporte comprei com ela meus remédios chegaram em 2 dias… finalizei meu procedimento no mesmo dia confiei nela meninas ������

  • Oh Anna, I’ve followed you on youtube and social media since before Jacob… I just want to give you a hug, this is so heartbreaking, this video made me cry

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  • Thank you for posting this, I’ve just found out I’ve had a missed miscarriage and waiting to see the doctor to go through my options ��

  • Dear Anna, thank you for sharing your hard way to go through.
    I wish you all the best, enough power for a next try soon!!! You’ll see everything is fine next time!!!

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  • Eu estava desesperada descobri minha gravidez com 8 semanas… encontrei o contato da sindy wpp (85) 8188 2999 aqui no YouTube muitas meninas indicando. Entrei em contaro recebi muita atenção… ela me deu todo suporte comprei com ela meus remédios chegaram em 2 dias… finalizei meu procedimento no mesmo dia confiei nela meninas ������

  • How long did it take for HCG to go back to normal? My process is taking too long and I’m getting frustrated.

    I found out I was pregnant on sept 20th. I had my first HCG done on the 23rd, 221. On October 1st I started bleeding heavily so they wanted me to do another HCG and ultrasound. My HCG was 13297 on the 1st. On the 7th I had another HCG with results at 2007. I was prescribed cytotec on the 8th but didn’t take it until the 9th. It was oral and the cramps were horrible but the diarrhea was the worst. I had another HCG on the 21st at 1447, again on the 23rd at 1487. The doctor gave me the option on d&c or cytotec again. I opted for the cytotec in hopes of not having a surgery medical bill. I asked for more pills this time in hopes of it working. I started it last Friday and it wasted until Saturday night. This time I didn’t cramp but the diarrhea was horrible. However, on Monday my HCG was 907 and today it was 727. I go in tomorrow for a follow up and he already said he wants me to do cytotec again. I am done with this and so over it. I really don’t want to do the cytotec again because the diarrhea. I literally couldn’t keep anything in me. I was in the restroom every 30 minutes. Maybe I should ask about inserting them instead of oral. Thought the YouTube videos I have seen it doesn’t seem to give people diarrhea when inserted but does when taken orally. I’m really worried that something is wrong. I do only have 1 ovary, I have done removed last November due to an 8.8 cm cyst. I just need some guidance please

  • You are such a strong women Saam. This video will educate and support so many women in so many years to come.
    Thinking of you always xx

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  • I don’t consume a lot of YouTube, and this is my first comment ever, but this video is so incredibly brave and generous and important that l feel compelled to thank you, Anna. Sharing something that painful and personal just to alleviate other people’s current or future struggles is true altruism. I am so very sorry for what you are going through, Anna. And very humbled by your courage. ❤️

  • I would like to refer Ms.Cindy. Mabait at di ka iiwan hanggang magsuccess, legit sya pati mga gamot. Salamat Ms.Cindy ito lang mattulong ko sainyo 09090988678

  • I am so sorry for your loss. I had to go to my EPU today for medical management. I took my 4 tablets at the hospital orally. Even thou I lost a baby 5 years ago, it was an ectopic and a completely different experience. Thank you so much for sharing your experience, I am so anxious of what to expect, but your video has really helped xxx

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  • My heart is shattered for you, nothing anybody will say can ease the pain you’re experiencing. I hope you and Brodie grieve the way you need to and your angel stays with you for eternity. So much love for you all ❤️

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  • You’re so brave for sharing this. I’m sorry you went through this, and I hope you have your rainbow baby soon and when you’re ready.
    I had an ERPC done on 17th Feb, 1 week after our dating scan where we found our baby had died at 6/7 weeks.
    Heartbroken doesn’t even cover it.
    But to make matters worse, we’re two and a bit weeks down the line and still getting strong positive pregnancy tests, so we went back today and had a scan done. Unfortunately there is still tissue left behind even after the surgery ☹️. Now got to go and have the surgery again next Friday
    So gutted and just feel angry now. I just want it over so we can go again.
    Well done for being so outspoken about an often taboo subject ❤️