From the Research
If a patient has taken mifepristone followed by 800 mcg of misoprostol 48 hours later but has not experienced any bleeding, the next step would be to administer a second dose of misoprostol 800 mcg. This recommendation is based on the most recent and highest quality study available, which suggests that a repeat dose of misoprostol can improve the effectiveness of medical abortion 1. The second dose should be given 3-4 hours after the first misoprostol dose if no bleeding has occurred. Key points to consider in the management of this patient include:
- If bleeding still doesn't begin after the second dose, the patient should be evaluated clinically with an ultrasound to determine if the pregnancy is continuing or if there has been an incomplete abortion.
- In some cases, a third dose of misoprostol may be considered, but if medication fails to induce abortion after repeated doses, surgical evacuation may be necessary.
- It's essential for the patient to follow up with their healthcare provider within 1-2 weeks to confirm complete abortion through clinical examination or ultrasound.
- The lack of bleeding after misoprostol could indicate medication failure, which occurs in approximately 2-5% of cases, or it could mean the abortion is occurring but without visible bleeding.
- Patients should be monitored for signs of continuing pregnancy such as persistent pregnancy symptoms or minimal bleeding, as highlighted in studies on the efficacy and safety of medical abortion regimens 2, 3.