Misoprostol - Not An Abortion Pill

When a fetus dies early in a pregnancy, it is called a miscarriage or spontaneous abortion. If the products of conception are not expelled, there can be uterine bleeding, infection, or death.

Usually with a miscarriage, the uterus will start to contract to expel the fetus and the other products of conception. When this happens, the woman experiences bleeding and cramping. An incomplete expulsion is called an incomplete abortion.

Incomplete abortion can be managed three ways: 1) wait to see if the uterus completes the expulsion, 2) have a health provider remove the retained products of conception or 3) give the woman medication to cause the uterus to contract and expel the products of conception.

This medication is called misoprostol (Cytotec). When the tablets are placed into the vagina, the woman will start to experience cramping within hours. Expulsion is usually accomplished within 24 hr. She usually returns in one week for an ultrasound to confirm that the uterus has emptied.

Diagnosis and management are usually straightforward- a positive pregnancy test, woman with bleeding, cramping, dilated cervix, dropping pregnancy hormone levels and an ultrasound showing a fetus without a heart beat or no fetus at all. In developing countries, diagnosis and management often have to be made in the absence of these things.

Anywhere women don't have the ability to decide if they want to be pregnant or lack access to contraception, botched abortions with retained products of conception are often indistinguishable from incomplete spontaneous abortions. Short term, misoprostol is an effective management option. Long term, women everywhere should have access to contraception and the right to choose when and how many times they want to be pregnant

Sharan Abdul-Rahman, MD

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