Aftercare Instructions: Medication Abortion

This information is a summary of the instructions you will be provided following a medication abortion. Your doctor will discuss these instructions with you in detail during your appointment.

When to go to the emergency room

If you are having a life-threatening emergency, call 911 immediately. If you think you are hemorrhaging – blood is “just pouring out” and you are feeling dizzy, weak, or light-headed, call an ambulance (911) and go immediately to the nearest emergency room.

Day One: The Day of Your Appointment at the Clinic

What you should have when you leave the clinic

• 4 misoprostol tablets
• These instructions and a summary of your procedure (including medications and blood type)
• Information on birth control methods that you are considering
• Antibiotics

What to expect after you go home

After taking Mifeprex (mifepristone): Most patients do not have side effects from mifepristone, although some patients feel nauseated or have vaginal spotting or bleeding. A small percentage of patients (less than 5 percent) have heavy bleeding and pass the pregnancy after mifepristone.

When to call the clinic

• If you vomited shortly after you took the Mifeprex pill, call the clinic and talk to one of the doctors.
• If you start to bleed heavily and you soak more than two maxi-pads in an hour for two hours in a row, please call the clinic or the doctor at any hour of the day or night. This does not mean you will definitely have to come to the hospital.
• If you have strong cramps and heavy bleeding and think you might have passed the pregnancy, you may call the clinic the next clinic day to discuss with a doctor if you should use the misoprostol pills or come in for a check. If you are concerned about the amount of bleeding, call at any time. (See the section below: “How to tell if the abortion is complete.”)

Day One – Three: The Day You Place the Misoprostol in Your Vagina

As the doctor and the clinic staff explained at the clinic, one to three days after you took the Mifeprex (mifepristone) in the clinic, you will place the misoprostol pills in your vagina or cheek at home. The soonest you can use the misoprostol is six hours after the Mifeprex.

Preparing for your misoprostol insertion

• Pick a place to insert the pills that is comfortable and private.
• You should have a phone, a bathroom, and your support person with you for the day.
• If you are hungry, eat a light meal before you start and drink plenty of water during the day.
• Since the process may take five to seven hours (or more), many patients prefer placing the tablets in the morning or early afternoon.

Make sure you have:

• Your misoprostol tablets
• A box of maxi-pads

How to place the misoprostol in your vagina

1. Wash your hands well with soap and water.
2. Lie down on your back and bend your knees.
3. Hold one pill between your first and second fingers (your pointer and your middle fingers) and push the pill as high up into your vagina as you can reach with one of the fingers.
4. Repeat this procedure with all four pills.
5. If one of the pills comes out in your hand, push it back up. If any of the pills fall out within 30 minutes, replace it into your vagina. If a pill falls out more than 30 minutes after you insert them, you do not need to replace it.
6. Wash your hands when you are done and rest for 30 minutes.
7. You may do regular activities around the house after placing the misoprostol.
8. DO NOT PUT ANYTHING IN YOUR VAGINA FROM THE TIME YOU PUT IN THE MISOPROSTOL UNTIL YOU STOP BLEEDING, or for two weeks. This means no sex and no tampons.

What to expect after the misoprostol

Cramping, moderate to heavy bleeding, and moderate pain are normal parts of the abortion process as your uterus passes the pregnancy. Most patients pass blood clots.

• Cramping usually starts one to four hours after you place the misoprostol in your vagina.
• Bleeding usually starts between 30 minutes to four hours after you place the misoprostol in your vagina. However, it can take up to 24 hours for some patients.
• Heavy bleeding and strong cramps usually last between one and four hours. Call the clinic if you soak through more than two large maxi-pads per hour for two hours in a row.

For pain: Resting and using a heating pad or hot water bottle may help. ibuprofen usually helps with the pain. Call if your pain is not manageable with ibuprofen.

• Ibuprofen (Motrin, Advil, etc.): You may take 800mg of ibuprofen (four over-the-counter tablets) every six to eight hours. You may take the first dose of pills as soon as you feel you need something for the pain. Ibuprofen usually does not cause side effects such as sleepiness, nausea, or dizziness.

Other misoprostol side effects:

The following side effects are not dangerous and usually only last one to four hours. If any of these side effects make you very uncomfortable, you may treat your symptoms with over-the-counter medicines. Call if over-the-counter medicines do not relieve your symptoms.

Nausea or vomiting

• Call if you vomit several times and cannot hold down liquids.
• Over the counter treatment: Benadryl 25mg to 50mg every six hours as needed, or Dramamine 25mg to 50mg every six hours as needed.

Diarrhea

• Call if you have several episodes of diarrhea lasting more than four to five hours and you are having trouble drinking liquids (you may be getting dehydrated).
• Over the counter treatment: Imodium 2 tablets (4mg) once.

Fever, chills

• • Misoprostol may cause fever or chills in the first 24 hours. After 24 hours, fever or chills may be a sign of an infection and you should call the clinic. If you already took Tylenol ibuprofen for pain, do not take more of the same medication for fever or chills. Call the clinic if your fever is higher than 101° F (or 39° C).
• Over the counter treatment: Tylenol 500 to 650mg every four hours, Ibuprofen 800mg (four over-the-counter pills) every six to eight hours.

How to tell if the abortion is complete

Most patients have bleeding and painful cramping. As you pass the pregnancy, the bleeding is usually heavy and the cramping very strong. This usually lasts one to four hours. Most patients pass some blood clots in the toilet and the pregnancy is often one of those clots. After the pregnancy passes, the cramps decrease and the bleeding slows down significantly.

Within a few hours after passing the pregnancy, cramps and bleeding should be much improved. YOU CANNOT BE SURE THE ABORTION IS COMPLETE UNTIL YOU HAVE YOUR FOLLOW UP CALL OR ULTRASOUND.

Day Seven to 14: Your Final Examination

The last part of the medication abortion process is to confirm with an ultrasound or a telephone call with a nurse that you passed the pregnancy. This is extremely important because the medicines you took can cause birth defects if the pregnancy continues. At this visit, you will be given a birth control method if desired.