Expert: Doctor Early Options - 12/6/2011

Question
QUESTION: I'm from the Philippines where abortion is illegal.
I was was lucky to get mifepristone/misoprostol through the Women on Web.

I took the mifepristone 200mg yesterday and the misoprosol 200mcg x 4 sublingually today (24 hours after). After 30 minutes, I had abdominal cramps, dizziness, fatigue, chills and vomitted. I bled and I think something came out but I did not clearly see it because I was on the toilet and it was flushed.

My question: The instruction was to take a second dose of misoprostol 200 mcg x2 after four hours. Unfortunately because I needed to go home, I wasn't able to do so. I am now bleeding which I think is expected.

Do I need to take this second dose? If I don't, is there a danger of incomplete abortion? What will be the effect if I took the second dose more than 4 hours after, say 12 or even 24 hours after?

ANSWER: you can go ahead and take the second dose at home.  We often have our patients wait 24-48 hours.  The bleeding will either be heavy or light. It really depends on how much was left. Yes, there is a danger of incomplete abortion especially if you are over 8 weeks.  

---------- FOLLOW-UP ----------

QUESTION: Thank you for the quick answer. I am just about 8 weeks and yes, I will take the second dose as you recommend.

You mentioned 24-48 hours for your patients. Is this the maximum (recommended) time limit? Or is there a particular criteria / reason / basis for this?

What effect will the second dose have in terms of the physical symptoms (i.e. the pain and the amount of bleeding)?

Answer
My patients have the ability to call me and we can discuss their bleeding pattern.  If they are not bleeding enough  have them take it within that time period based on their work schedule.  Also, if they are 8-9 weeks, I have them do the protocol twice to insure that there is no retained issue.  

I tell them the cramping is unusually less unless there is a significant amount of retained tissue.