From the Guidelines
Medications commonly used for managing a miscarriage include misoprostol (Cytotec) and mifepristone (Mifeprex), with the standard regimen involving taking mifepristone 200mg orally first, followed 24-48 hours later by misoprostol 800mcg. The most recent and highest quality study 1 does not directly address the medication for spontaneous abortion, but it discusses the importance of access to abortion care without unnecessary barriers. However, based on the available evidence from previous studies, such as 1, the standard regimen for medical management of miscarriage is well established. The medications work by causing the uterus to contract and expel pregnancy tissue. Side effects may include:
- Cramping
- Bleeding
- Nausea
- Diarrhea
- Fever Pain can be managed with ibuprofen 600-800mg every 6-8 hours and possibly prescription pain medication. It is essential to seek immediate medical attention if you experience:
- Excessive bleeding (soaking more than two pads per hour for two consecutive hours)
- Severe pain unrelieved by medication
- Signs of infection like fever over 100.4°F Follow-up with a healthcare provider is crucial to confirm complete expulsion of pregnancy tissue. In cases where surgical evacuation is not feasible, prostaglandins E1 or E2, or misoprostol, can be administered to evacuate the uterus, as noted in 1. However, the priority is to complete the abortion safely and effectively, while minimizing potential risks and complications, as emphasized in 1.
From the FDA Drug Label
MISOPROSTOL ADMINISTRATION TO WOMEN WHO ARE PREGNANT CAN CAUSE ABORTION, PREMATURE BIRTH, OR BIRTH DEFECTS. Cytotec can cause abortion (sometimes incomplete which could lead to dangerous bleeding and require hospitalization and surgery), premature birth, or birth defects.
The medication for inducing abortion (including spontaneous abortion or miscarriage) is misoprostol.
- Key points:
From the Research
Medication for Spontaneous Abortion (Miscarriage)
The medication for spontaneous abortion (miscarriage) includes:
- Mifepristone and misoprostol combination therapy, which has been shown to improve success rates and reduce the need for surgical intervention 3, 4
- Misoprostol alone, which can be used for medical evacuation of spontaneous miscarriage, with a success rate of 78.4% 5
- The dosage and frequency of misoprostol may vary depending on the gestational age and clinical situation, with vaginal, sublingual, or buccal administration being more efficient and better tolerated than oral ingestion 6
Dosage and Administration
The dosage and administration of misoprostol for spontaneous abortion (miscarriage) are as follows:
- A vaginal dose of 800 μg of misoprostol, possibly repeated 24 to 48 hours later, seems to offer the best efficiency/tolerance ratio for missed miscarriage 6
- For early abortion, a protocol of 200mg of mifepristone followed 24 to 48 hours later by 800 μg of vaginal, sublingual, or buccal misoprostol, plus an additional 400 μg dose every 3-4 hours (until 4-5 doses maximum) seems safe and efficient 6
- The World Health Organization (WHO) recommends specific dosing and frequency for misoprostol use in medical evacuation of spontaneous miscarriage, which may not always be followed in clinical practice 7
Clinical Outcomes
The clinical outcomes of medication for spontaneous abortion (miscarriage) include:
- Successful medical evacuation, which can be achieved in most patients with misoprostol-only regimen or combination therapy with mifepristone and misoprostol 3, 5, 4, 7
- Reduced need for surgical intervention, which can be achieved with combination therapy with mifepristone and misoprostol 3, 4
- Minimal adverse effects, which can be achieved with appropriate dosing and administration of misoprostol 5, 6, 7