Misoprostol Dosing for Incomplete Miscarriage
For incomplete miscarriage, administer a single dose of 600 mcg oral misoprostol, which achieves complete uterine evacuation in approximately 95% of cases without requiring surgical intervention.
Recommended Dosing Regimen
The evidence-based standard is 600 mcg oral misoprostol as a single dose 1, 2. This regimen:
- Achieves complete evacuation in 94.6% of women 1
- Results in 92.4% of women completing miscarriage without surgery 3
- Is recommended by international guidelines for incomplete abortion with uterine size ≤12 weeks gestation 2
Alternative Dosing Options
If the initial 600 mcg dose fails, consider:
- Repeat dosing: 600 mcg oral misoprostol can be given as a second dose (total 1,200 mcg), with similar effectiveness to single-dose regimen 1
- Vaginal route: 600-800 mcg vaginally every 24 hours for up to 2 days achieves 87.8-90.6% complete evacuation 4, 5
- Lower dose option: 400 mcg oral misoprostol achieves 77.7% success as single dose, though slightly less effective 3
Expected Clinical Course
Patients should be counseled on typical symptoms 1, 3:
- Bleeding duration: Average 4-6 days (range 2-8 days)
- Pain/cramping: Average 1 day, manageable with oral analgesics in 51% of cases
- Most bleeding is mild (31%) to moderate (39%) in severity
Side Effect Profile
Common adverse effects are generally tolerable 1, 3, 5:
- Nausea: 10.9%
- Diarrhea: 2.3-6.8%
- Vomiting: 5.4-7.8%
- Transient hyperthermia: 5.4%
- 96% of women report side effects as tolerable 1
Follow-Up Protocol
Arrange transvaginal ultrasound 7-10 days after treatment 4, 3:
- If incomplete evacuation or gestational sac persists, offer additional misoprostol dose
- Schedule surgical evacuation only if medical management fails after repeat dosing or patient declines further medical treatment
- Emergency surgical evacuation needed in <1% for heavy bleeding 5
Critical Safety Considerations
This dosing applies specifically to incomplete miscarriage/abortion, not labor induction or cervical ripening where different protocols apply 6, 7. The oral route for incomplete miscarriage has distinct dosing from labor induction regimens (20-25 mcg every 2-6 hours) 6.
Patient satisfaction is high: 95% report satisfactory experience with medical management 1.