Misoprostol Dosing for Incomplete Miscarriage
For incomplete miscarriage, the recommended dosing of misoprostol is 600 μg administered vaginally, which can be repeated after 24 hours if necessary. 1, 2
Dosing Regimens and Routes of Administration
- 600 μg of vaginal misoprostol is an effective dose for incomplete miscarriage management, with success rates of 87.8% 1
- Alternative dosing includes 800 μg vaginal misoprostol, which shows a slightly higher success rate of 90.6%, but with potentially more side effects 1
- For patients who prefer to avoid repeated vaginal administration, 600 μg of sublingual misoprostol every 3 hours (maximum three doses) can be used with equivalent efficacy (87.5%) 3
- A lower dose of 400 μg sublingual misoprostol has shown comparable effectiveness (94.5%) to 600 μg oral misoprostol (94.6%) in treating incomplete abortion 4
Treatment Protocol
- After initial dose administration, patients should be followed up in 7 days with transvaginal ultrasound to confirm complete evacuation 1
- If incomplete evacuation is found at follow-up, an additional dose of misoprostol can be administered 1
- Most patients (>80%) will have completed abortion within one week of treatment 4
- Surgical evacuation should be considered if medical management fails after repeated doses or if the patient prefers not to continue medical treatment 1, 2
Safety Considerations and Contraindications
- Misoprostol is contraindicated in women with previous cesarean delivery due to the risk of uterine rupture 5, 6, 7
- Medical management should be performed in a healthcare facility where blood transfusion and emergency surgery are available, especially for second-trimester cases 6
- For high-risk patients, dilatation and evacuation is the safest procedure if surgical evacuation is feasible 6
Side Effects and Management
- Common side effects include abdominal pain (94.6%), vaginal bleeding (98.6%), nausea (13.5%), vomiting (5.4%), diarrhea (6.8%), and transient hyperthermia (5.4%) 2
- Diarrhea is more common with sublingual administration (70%) compared to vaginal administration (27.5%) 3
- Fatigue may be more pronounced with sublingual administration (65%) versus vaginal administration (40%) 3
- Pre-medication for symptom relief should be considered before administering misoprostol 8
Monitoring and Follow-up
- Transvaginal ultrasound should be performed at follow-up visits to confirm complete evacuation 1, 2
- Vaginal bleeding typically lasts approximately 16 days after treatment 8
- Monitor for heavy bleeding requiring emergency intervention, though this is rare (reported in only 1 case out of 74 in one study) 2
- A second follow-up visit should be arranged 7 days after the first if incomplete evacuation is still present 1
Patient Acceptability
- Medical management with misoprostol has high acceptability rates, with most women indicating they would choose this method again if needed 3, 4
- Outpatient management is safe and effective, reducing the need for hospitalization 1
- Medical management avoids anesthesia risks and surgical complications such as uterine perforation, cervical trauma, and Asherman syndrome 6