When should I seek medical attention after attempting an abortion at home using mifepristone (anti-progestin) and misoprostol (prostaglandin E1 analogue)?

When to Seek Medical Attention After Home Medication Abortion

You should seek immediate medical care if you experience heavy bleeding (soaking through two or more thick full-size pads per hour for two consecutive hours), signs of infection (fever above 100.4°F lasting more than 24 hours, severe abdominal pain, or foul-smelling discharge), or if you have no bleeding within 24 hours of taking misoprostol. 1

Expected Normal Effects vs. Warning Signs

Normal Expected Effects (Do Not Require Emergency Care)

• Cramping and bleeding are expected effects of the medications, with bleeding typically lasting 9-16 days on average 1
• Approximately 80% of women will begin bleeding within 4 hours of misoprostol use, and 98% within 24 hours 2
• Common side effects of misoprostol include:
  • Low-grade fever (typically resolves within 24 hours) 1
  • Gastrointestinal symptoms: nausea, vomiting, diarrhea 3, 4
  • Warmth or chills 5
  • These can be managed with NSAIDs or antiemetics 1

Emergency Warning Signs Requiring Immediate Medical Attention

Hemorrhage

• Soaking through two or more thick full-size pads per hour for two consecutive hours 1
• This occurs in approximately 0.03% of cases requiring transfusion 6

Infection

• Fever above 100.4°F (38°C) persisting beyond 24 hours after misoprostol 1
• Severe abdominal pain that worsens or doesn't respond to pain medication 1
• Foul-smelling vaginal discharge 1
• Infection requiring hospitalization occurs in only 0.01% of cases 6

Failed Abortion

• No bleeding within 24 hours of taking misoprostol suggests possible ongoing pregnancy 2
• This requires follow-up evaluation as ongoing pregnancy is a rare but important complication 1

Ectopic Pregnancy Symptoms

• Severe one-sided abdominal pain
• Shoulder pain
• Dizziness or fainting
• These indicate possible undiagnosed ectopic pregnancy, which is a rare but serious complication 1

Routine Follow-Up Timeline

• Return for evaluation 7±1 days after initiating treatment for clinical assessment, which may include ultrasound or serial beta-hCG levels 5, 7, 6
• By day 7, approximately 95% of women will have completed the abortion 2
• Additional follow-up at 2 weeks to confirm complete passage of pregnancy tissue 7
• Phone contact or final assessment at approximately 5 weeks after treatment 5, 7

Special Populations Requiring Hospital-Based Care

If you have cardiovascular disease or other high-risk medical conditions, the medication abortion should be performed in a hospital setting rather than at home, where emergency support services are immediately available 8

If you have had a previous cesarean delivery, misoprostol should be avoided due to increased risk of uterine rupture 3, 4

Common Pitfall to Avoid

Do not confuse expected heavy bleeding with hemorrhage. Normal heavy bleeding after misoprostol is common and expected, but true hemorrhage requiring intervention (soaking through two full pads per hour for two consecutive hours) is rare, occurring in less than 1% of cases 6. When in doubt about bleeding severity, seek medical evaluation rather than waiting.