Comprehensive Women's Health Center

Aftercare Instructions: Medical Abortion

This information sheet is a summary of the instructions you will be provided following a medical abortion. Your doctor will discuss these instructions with you, in detail, during your appointment.

Day One: The Day of Your Appointment at the Clinic

What to expect after you go home

Today in the clinic you took Mifeprex (mifepristone). Most women do not have side effects from mifepristone, although some women feel nauseated or have vaginal spotting or bleeding. A small percentage of women (less than 5%) have heavy bleeding and pass the pregnancy after mifepristone.

When to call the clinic

	If you vomited shortly after you took the Mifeprex pill, call the clinic and talk to one of the doctors.
	If you start to bleed heavily and you soak more than 2 maxi-pads in an hour for 2 hours in a row, please call the clinic or the doctor at any hour of the day or night. This does not mean you will definitely have to come to the hospital.
	If you have strong cramps and heavy bleeding and think you might have passed the pregnancy, you may call the clinic the next clinic day to discuss with a doctor if you should use the misoprostol pills or come in for a check. If you are concerned about the amount of bleeding, call at any time. See the section below called "How to tell if the abortion is complete."

Day One - Three: The Day You Place the Misoprostol in Your Vagina

As the doctor and the clinic staff explained at the clinic, 1, 2, or 3 days after you took the Mifeprex (mifepristone) in the clinic, you will place the misoprostol pills in your vagina at home. The soonest you can use the misoprostol is 6 hours after the Mifeprex.

Preparing for your misoprostol insertion

Pick a place to do this that is comfortable and private.
You should have a phone, a bathroom, and your support person with you for the day.
If you are hungry, eat a light meal before you start and drink plenty of water during the day.
Since the process may take 5 to 7 hours (or more), many women prefer placing the tablets in the morning or early afternoon.
Make sure you have:

Your misoprostol tablets

Your pain medication (Vicodin and ibuprofen) handy

A box of maxi-pads

How to place the misoprostol in your vagina

Wash your hands well with soap and water
Lie down on your back and bend your knees
Hold 1 pill between your first and second fingers (your pointer and your middle fingers) and push the pill as high up into your vagina as you can reach with one of the fingers
Repeat this procedure with all 4 pills
If one of the pills comes out in your hand, push it back up. If any of the pills fall out, in less than 30 minutes, replace it into your vagina. If a pill falls out more than 30 minutes after you insert them, you do not need to replace it.
Wash your hands when you are done and rest for 30 minutes
You may then do regular activities around the house after placing the misoprostol
DO NOT PUT ANYTHING IN YOUR VAGINA FROM THE TIME YOU PUT IN THE MISOPROSTOL UNTIL YOU STOP BLEEDING or for 2 weeks. This means no sex and no tampons.

What to expect after the misoprostol

Cramping, moderate to heavy bleeding, and moderate pain are normal parts of the abortion process as your uterus passes the pregnancy. Most women pass blood clots.

	Cramping usually starts between 1 to 4 hours after you place the misoprostol in your vagina.
	Bleeding usually starts between 30 minutes to 4 hours after you place the misoprostol in your vagina. However, it can take up to 24 hours in some women.
	Heavy bleeding and strong cramps usually last between 1 to 4 hours. Call if you soak through more than 2 large maxi-pads per hour for 2 hours in a row.
	For pain: Resting and using a heating pad or hot water bottle may help. Both Vicodin and ibuprofen usually help with the pain. You may use either one or both together. Call if your pain is not manageable with Vicodin and ibuprofen.

Vicodin: You may take one or two tablets of Vicodin every 4 to 6 hours. You may take the first pill as soon as you feel you need something for the pain. Vicodin may make you feel sleepy, nauseated, or dizzy. Do not exceed this dose.

Ibuprofen (Motrin, Advil, etc.): You may take 800mg of ibuprofen (4 over-the-counter tablets) every 6 to 8 hours. You may take the first pills as soon as you feel you need something for the pain. Ibuprofen usually does not cause side effects such as sleepiness, nausea, or dizziness.

Other misoprostol side effects:

These side effects are not dangerous and usually last only 1 to 4 hours. If any of these side effects make you very uncomfortable, you may treat your symptoms with over-the-counter medicines. Call if over-the-counter medicines do not relieve your symptoms.

	Nausea or vomiting: Call if you vomit several times and cannot hold down liquids. Over the counter treatment: Benadryl 25mg to 50mg every 6 hours as needed, or Dramamine 25mg to 50mg every 6 hours as needed
	Diarrhea: Call if you have several episodes of diarrhea lasting more than 4 to 5 hours and you are having trouble drinking liquids (you may be getting dehydrated). Over the counter treatment: Imodium 2 tablets (4mg) once
	Fever, chills: Misoprostol may cause fever or chills in the first 24 hours. After 24 hours, fever or chills may be a sign of an infection and you should call the clinic. If you already took Tylenol, Vicodin (which has 500mg of Tylenol in it), or ibuprofen for pain, do not take more of the same medication for fever or chills. Call the clinic if your fever is higher than 101° F (or 39° C) Over the counter treatment: Tylenol 500 to 650mg every 4 hours Ibuprofen 800mg (4 over-the-counter pills) every 6 to 8 hours

How to tell if the abortion is complete

Most women have bleeding and painful cramping. As you pass the pregnancy, the bleeding is usually heavy and the cramping very strong. This usually lasts 1 to 4 hours. Most women pass some blood clots in the toilet and the pregnancy is often one of those clots. After the pregnancy passes, the cramps decrease and the bleeding slows down quite a bit. Within a few hours after passing the pregnancy, cramps and bleeding should be much improved. YOU CANNOT BE SURE THE ABORTION IS COMPLETE UNTIL YOU HAVE YOUR ULTRASOUND (See below)

Day 7 to 14: Your Final Examination

The last part of the medical abortion process is to confirm with an ultrasound that you passed the pregnancy. This is extremely important, because the medicines you took can cause birth defects if the pregnancy continues. At this visit, you will be given a birth control method if you desire it.