Medical Management of Miscarriage (Outpatient) at Less Than 9 weeks Gestation
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We are sorry we have had to tell you that sadly, your pregnancy has ended. We would like to offer you our condolences. We are aware that this is a distressing time for you; the aim of this leaflet is
to give you information about what may happen next if you chose medical management of your miscarriage.
Please note this is one of three options open to you. You will also receive information about the other options available.
Medical management to treat an early miscarriage involves the use of medication to expel any remaining pregnancy tissue from your womb. Before this can commence you will be assessed by nursing and medical staff and routine blood samples will be taken to ensure you are fit enough to commence treatment. You have been offered this treatment as an outpatient as you have miscarried at less than nine weeks by scan or have tissue remaining from the pregnancy inside your womb. This is a safe treatment while being in your own environment at home.
It is important to note you must not smoke or drink alcoholic drinks for at least 4 days once the treatment starts. On the day the treatment starts, you will be asked to attend the Early Pregnancy Assessment Unit (EPAU) and we anticipate your appointment with us may last for 2 hours. You must bring another adult with you that can escort you home in a car or taxi and stay with you for the following 24 hours. You should also have a supply of maternity sanitary towels ready at home as tampons should not be used as they can increase the risk of infection when on this treatment.
You will be given an 800 microgram dose of misoprostol which is a tablet that will relax the neck of the womb and cause the miscarriage to take place or, with an incomplete miscarriage, to be
finished. The misoprostol can either be taken orally or inserted vaginally, depending on your preference. The misoprostol dose will be four 200microgram tablets, initially which will be administered in hospital. Nursing staff can administer vaginally misoprostol if you wish, but if you have used tampons in the past it is very similar.
Using the misoprostol vaginally has a quicker and slightly more effective result. At the same time you will be given a supply of selected painkillers and some anti-sickness medication. You must stay with us for 1 hour after receiving the medication to ensure it is tolerated, after which you must be escorted home by an adult. Please be prepared to stay at home the whole day as it is
anticipated the medication will work over the following 6 to 8 hours. You should expect a vaginal bleed that is much heavier than a period with large blood clots and tissue; this will be accompanied by contraction-like pains. After this the bleeding and pain will subside, but a period-like loss should be expected for up to a week afterwards.
You will be sent home with a supply of:
1. Codeine 30mg tablets – 1-2 tablets up to four times a day. Tablets to assist with the pain. Please purchase some paracetamol tablets over the counter and take as instructed in the drug patient information leaflet enclosed in the packet. It is important you do NOT take ibuprofen, aspirin or diclofenac as these may reduce the effect of the misoprostol tablets you have been given.
2. Anti-sickness medication – Cyclizine 50mg, ONE tablet to be taken three times a day, (as misoprostol can cause nausea and vomiting).
3. A further dose of 400 micrograms of misoprostol (2 tablets). EPAU nursing staff will telephone you 4 to 6 hours after the administration of the first dose, to check how you are. If no bleeding has commenced you will be instructed to take this second dose of misoprostol at home orally and then a nurse will then contact you the following day. However if the bleeding or pain becomes unmanageable or you feel very unwell, dizzy, or faint do not hesitate to telephone us for advice. If necessary EPAU staff will arrange to admit you to the hospital, however if no bed is immediately available we may ask you attend the Accident and Emergency department.
Diarrhoea, abdominal pain, nausea, vomiting, fever, rashes, dizziness are side effects of misoprostol.
• You will have some crampy abdominal pain and vaginal bleeding after taking the misoprostol. Please follow the advice above if you bleed heavily and pass clots after taking the misoprostol. Please take painkillers as needed for your pain and contact the Early Pregnancy Assessment Unit if your pain is not controlled by the painkillers.
• Chills are a common side effect of misoprostol but this should not last long. Fever is a less common side effect and does not mean you have an infection. If the fever or chills last longer than 24 hours after taking the misoprostol please contact the Early Pregnancy Assessment Unit.
• Nausea and vomiting may occur after using misoprostol but should get better within two to six hours.
• Diarrhoea may occur after using misoprostol but should get better within a day. Skin rash may occasionally occur after using misoprostol.
4. If bleeding has not started 24 hours after treatment, please contact (EPAU). If treatment is successful a further appointment will be made for you in 3 weeks to carry out a pregnancy test and assess any bleeding or pain.
– You should bring an early morning urine sample with you for this purpose. You will be given a urine sample bottle for this purpose.
– If the pregnancy test is negative you will be discharged, if positive a further ultrasound scan will be arranged for you. If during this time you experience any offensive (smelly) vaginal discharge, have flu-like symptoms or a high temperature you should contact EPAU as you may have developed an infection. You should also refrain from sexual intercourse whilst bleeding and for 2 weeks after the bleeding has stopped.
Miscarriage can be a sad and difficult time, and you and your partner may experience many emotions following it. This is normal and you should allow yourself time to recover both emotionally and physically. The miscarriage association offer emotional support to women going through a miscarriage. A lot of women are keen to try for a pregnancy again as soon as possible. We advise you to wait until you have a negative pregnancy test and you have seen your next period. Then you will be ready to try again if you wish.
Early Pregnancy Assessment Unit: 01908 996434 (Internals Calls Ext: 86434) (08:30 -17:00 weekdays and 08:00 to 13:00 weekends)
Out of hours emergency 01908 660033 ask the switch board operator to bleep 1629
The Miscarriage Association – 01924 200799 www.miscarriageassociation.org.uk