Vaginal misoprostol regimen for early pregnancy loss (11 weeks’ gestation)
Medical management of early pregnancy loss at 11 weeks’ gestation is recommended with misoprostol 800 mcg administered vaginally as the initial dose. [1] A single repeat dose may be administered as needed if no response occurs. [1]
Recommended dose and route
- Misoprostol 800 mcg is administered vaginally as the initial dose. [1]
Repeat dosing interval
- The repeat dose should not be administered earlier than 3 hours after the first dose. [1]
- The repeat dose is typically administered within 7 days if there is no response to the first dose. [1]
Maximum dosing frequency
Only one repeat dose is specified in the ACOG sample protocol. [1]
Expected follow-up after completion
Follow-up to document complete passage of tissue is recommended, typically within 7–14 days. [1] Confirmation is recommended with ultrasound examination or serial serum β-hCG measurements when ultrasound is unavailable. [1]
Safety counseling and urgent evaluation triggers
Patients should be counseled on the need to call for excessive bleeding. [1] A counseled threshold is soaking two maxi pads per hour for 2 consecutive hours for 2 hours. [1]
Rh(D) immune globulin consideration
Rh(D)-negative, unsensitized patients should receive Rh(D)-immune globulin within 72 hours of the first misoprostol administration. [1]