Understanding Medical Abortion with Methotrexate and Misoprostol

Question
On April 22 I was given a shot of methotrexate and then on may 2nd place 4 misoprostol in my vaginal and repeated that on may 3rd. I had very severe cramps and did expel some blood clots on the 2nd and have spotted since then. On May 4th went back and got an ultrasound and the doctor told me the pregnancy was terminated however the tissues were not all expelled. I was told to take one misoprotol every hour for four hours on May 9th to get rid of the rest of the tissue. It is now May 11th and I have spotted a little but haven't passed anything. What should I do?

Answer
Dear Shannon,
I am surprised that you were given methotrexate.  It is much less successful and has more side effects than the abortion pill.  Incomplete abortion is a common problem with methotrexate.  I also don't agree with the doctor's prescription to take one misoprostol every hour - it is much more effective to take all four at the same time as you did originally.
You have a few options:
1) Do nothing.  As long as you are no longer pregnant the tissue will pass on its own in the next few weeks.  There is nothing to worry about - it doesn't increase your chance of infection or cause other problems for it to pass naturally.
2) Take the misoprostol again, but take all four pills at once.  This may or may not work in the situation of an incomplete abortion.
I hope this is helpful,
Doctor Joan
EarlyAbortionOptions.com
New York City