From the Research
For managing vaginal bleeding after a miscarriage, misoprostol is typically recommended as the primary medication, with a standard dosage of 800 mcg administered vaginally, as evidenced by the most recent and highest quality study 1.
Medication Options
The following medications may be used to manage vaginal bleeding after a miscarriage:
- Misoprostol: 600-800 mcg administered either orally or vaginally, which may be repeated if bleeding persists after 24 hours 1
- Methylergometrine (Methergine): 0.2 mg given orally every 6-8 hours for up to 7 days to help the uterus contract and reduce bleeding
- Ibuprofen: 400-600 mg every 6 hours or acetaminophen 650 mg every 4-6 hours for pain management
- Tranexamic acid: 1000-1300 mg orally three times daily for up to 5 days to help blood clotting in cases of heavy bleeding
Important Considerations
It is essential to seek immediate medical attention if:
- Bleeding soaks through more than two pads per hour for two consecutive hours
- Large clots are passed
- Signs of infection develop, such as fever or foul-smelling discharge Complete follow-up care is crucial to ensure all pregnancy tissue has been expelled and to monitor recovery 1, 2.
Treatment Approach
Expectant management is the first-line approach, and is encouraged for 7-14 days after diagnosis of miscarriage 3. Medical management with misoprostol is a valid alternative to expectant therapy, with the advantage of better planning capability 1. Surgical management may be chosen by a woman if she has had a previous adverse or traumatic experience associated with pregnancy 3.