QuestionDear Dr. Joan,
I am 43 years old, and have a missed miscarriage that died at around 9 weeks (today is 10 weeks; I just found out today that there's no heartbeat). The MD gave me misoprostol. My husband and I decided that that is preferable to a hospital procedure. I am not excited about taking the drug, however, as I know it will be quite painful, and there will be a lot of bleeding. Is it possible for the body to pass a 9-week old fetus and all of its accompanying tissue without any help? Is it advisable for me to wait awhile and see if nature takes its course?
I am from the USA, living in London UK, waiting on a visa, not on NHS. I went to a private-pay clinic that specializes in prenatal care. High quality place, but I do not have an long-term relationship with the doctor I visited, nor do I have a general practitioner here in London.
Thank you so very much for your time, Dr. Joan.
Sincerely, A.
AnswerDear Ana,
I'm sorry to hear you have had a miscarriage. Your question is an excellent one. There are few studies about misoprostol for treatment of miscarriage. I have personally given it to quite a few patients with mixed results. Many women do not complete the miscarriage with the first round of misoprostol. You can take repeated doses, 24 hours apart. The difficulty is that many women have strong side effects with misoprostol, including nausea, vomiting, and significant cramping or pain. At our office, we premedicate with pain medicine and anti-nausea medications, and have found that this helps significantly. Women can also experience a wide range of bleeding patterns - it can happen suddenly, or can last for weeks to months. There can be clots, or unexpected gushing of blood. I don't want to discourage you. You may a successful experience with one try, and minimal side effects, but I just want to make you aware that the experience can be difficult and unpredictable.
Unfortunately, the best treatment for miscarriage is probably not available to you. Manual Vacuum Aspiration (Aspiration procedure) is a non-surgical method that only takes a few minutes to complete. It utilizes a small handheld device to gently remove the pregnancy tissue. It is much less invasive than a surgical D&C - there is no scraping, no electric machine, and no general sedation. It can be completed in a regular doctor's office, not a hospital. You may want to do a little research and see if you can find a doctor in the UK who offers it.
I personally would probably opt for misoprostol if the Aspiration procedure was not available. It still carries significantly less risk than a D&C. With misoprostol, there is no risk for future pregnancy, and you can start trying right away.
There is more information on treatment of miscarriage and misoprostol on my website:
http://www.earlyabortionoptions.com
I hope this is helpful, and good luck!
Doctor Joan
New York City
