Misoprostol vs. D&C for a missed miscarriage?

Question

Hi Ladies,

I was having early pregnancy problems and my latest ultrasound showed the heart stopped beating at around 7 weeks (it was still beating in the ultrasound one week earlier).  I am now left with the option of taking misoprostol tablets to induce a miscarriage or having a D&C.  My doctor prescribed 800 mcg of misoprostol to take but I am still debating what to do.

Does anyone have any advice on this?  I really don't want to undergo a D&C but the prospect of taking the misoprostol really scares me.  Ideally, I'd like to just let nature take its course but I am leaving on vacation in a little over a week and don't want to have a miscarriage when I am away.

Is a D&C always done under general anaesthetic?

Thanks.  Any advice or personal stories would really help me make a decision....

AO313 · Answer

I read this thread before I made my decision, and thought I would add my experience.

I used 4 Cytotec, inserted vaginally, following my missed abortion miscarriage (found out at 10.5 weeks that baby had died at 6-7 weeks). I was home with my husband and had a backup plan with my doctor to go to the ER if things went badly.  I started cramping an hour after insertion.  The worst pain started 3 hours after insertion and lasted 90 minutes -- during which I vomited and had diarrhea.  After this pain subsided, the bleeding started.  I passed the sac and fetal tissue 10 hours after insertion.  

I used Tylenol 3 for pain management -- and it was not enough for the worst pain BUT I plan to try again and feel like it was early labor preparation.  I liked that I was at home with my husband and got to see the sac after it passed.

I did this on a Saturday night and will be able to go to work Monday. I will also have an ultrasound Monday to confirm everything passed.

mmcarro · Answer

I know this is a really late reply, but I was just reading this as I am researching whether I want to wait, or take the pills, or schedule a D & C. I wanted to say I am so sorry for what you went through. Your post got me emotional and I wish I could hug you. You sound like a strong woman and I hope you are doing well now.

Diru · Answer

Hi Ladies,

I wanted to tell my story to collaborate with the valuable information you are giving by sharing your experiences. This is the second time I have a miscarriage but they are not consecutive. 

My first pregnancy end it up in a miscarriage, at that time I was 7 weeks pregnant when I just started bleeding and had the miscarriage without even having had the time to understand what was happening. It was a really frustrating and depressing experience, but in relation to the pain, it was nothing traumatic. My second pregnancy was perfect, just that the delivery finished in a C-section. We got a beautiful and healthy son.
This time we were expecting our second child. I was 10 weeks and 3 days pregnant when I had my appointment for the ultrasound, it was on a Thursday. In the ultrasound the specialist saw immediately that something was wrong, the heartbeat of the baby was absent, I had a missed miscarriage. The baby (fetus) had two weeks dead and my body didn’t realized that yet. After the ultrasound my big question was: What now??? I had to choose between waiting for maximum 3 weeks for a spontaneous miscarriage, taking misoprostol or going for the curettage. As you know, it can be a pretty difficult decision to make, everybody expect you to know what to do at that bare moment. 

I decided to go for the misoprostol but I really wanted to have a curettage but was at the same time wishing for a spontaneous miscarriage, so complicated was my mind. On Monday, I decided to go for the misoprostol because it seems to be the less invasive, I said I would take it on Thursday to arrange some things and to have the weekend to finish the treatment and go back to work on Monday, BUT the fact that there was a big chance that it would not be a complete miscarriage and end it up in a curettage set me to hesitate. On Sunday I started having brownish bleeding and nobody could tell me if my body was in the process of a recognition. Looking for the answer I came to this blog where I could compare situation or make a premonition of what could happen to me. After reading your stories I decided not to go for the misoprostol but to make an appointment for the curettage. Since I was bleeding I didn’t want to suffer of a bleeding out, but at the end it was not necessary because on Thursday at 5:30 am I had cramps and I knew that the miscarriage had just started. It was 6 hours of intense pain, contractions and cramps. I discharged what I thought was the tissue, then the pain decreased until I was feeling fine, like a delivery. That night I had once more pain and more tissue/clots (I didn’t know anymore). 

The next day again in the morning and at night. Then, the weekend seemed to be everything going fine, I had a bit of pain and blood but with ibuprofen it was doable. On Monday I decided to stay at home since I was not feeling completely good. It was a good decision because I ended that day at the hospital after having a strong pain in my uterus and start bleeding out really quickly. At the hospital I had another ultrasound, and for our surprise the baby was still inside me, it was a sad moment. I decided then to have a curettage. It was a good decision (they offered also misoprostol) I had a complete anesthesia and when I woke up I felt immediately good. Since that day I am fine. I would recommend the curettage to avoid such a hard time, I don’t see the reason why to go through all this on top of the fact you are having a miscarriage and all you dreams about the pregnancy-baby are gone.

Lynette1975 · Answer

I had a d and c after a missed miscarriage was diagnosed. I didnt feel at all well for two weeks after.A pregnancy  test showed  positive so I went to hospital for a scan which showed stuff left behind and an infection.I was given Misoprostol and felt so ill with labour cramps and headache but got no bleeding!I was told to tak another dose and it still isn't working.Hopefully the antibiotics are on my infection.Will have to ring the hospital today.I have had enough emotionally and physically.I desperately want to try and move on and also try again as I am 38 and it took me over a year to conceive.

prettysiri830 · Answer

Was 9 weeks pregnant by the fetus showed 6 weeks growth with low fetal heart rate. After a week there was no heart rate. Its was missed miscarriage. Recommended for Mifepristone and misoprostol. 
Took one tablet of Mifepristone. After 24 hours one Misoprostol was given vaginally  at 7 pm in the evening. Terrible pain all through the night with no signs of bleeding. Morning 8 AM the bleeding started with a discharge of a sack like thing. It was expelled. prescribed to take one more misoprostol orally and the heavy bleeding slowed after 4 hours. The bleeding was there for the next 5 days like a regular period and with lot of back ache. It stopped on the 7th day and went for a scan on the 10th day after taking the medication. It was all clear.

julia185 · Answer

I have done Misoprostol twice, D & C never. I enjoyed being able to be in the privacy of my home. The experience was more like a natural miscarriage would have been. The cramping hurt, but that's to be expected and nothing compared to the pain of giving birth (which I have also done)!  Also, I got to see the baby and hold him (9 weeks), instead of having some doctor throw him away and not even look at him. It was wonderful (bittersweet) to see my child. It validates that this was a real baby, it validates your pregnancy and experience. You owe it to yourself to not deny what is happening but to live in the moment, to weep if you need to, to love. In some cases, a D &C might be safer but I encountered no problems with misoprostol.

diashi725 · Answer

My pregnancy ended at about 6 weeks but because of the way my appointments were scheduled, my doctors didn't discover it until 12 weeks!  I originally was going to go with a D&C to get it over with as quickly as possible, but my doctor recommended taking the misoprostol tablets because of the risks that come with surgery.  I took them yesterday at about 4:30 PM.  I experienced dizziness and nausea within about 30 minutes of taking the pills, but not enough to make me vomit; just laying down made me feel better.  
At about 9:30 pm, the cramping started. At first it was just annoying, then they got more severe. I took some pain medication and it was tolerable.  I only had light bleeding last night, and only passed little clots.  This morning, I am feeling much better - no cramping and still only very light bleeding, like the beginning or end of a period.  
If I were to take a guess, I'd say no significant tissue has passed.  I'm not worried quite yet. Although lots of women experience heavy bleeding at the very beginning, others can have to wait up to two weeks to miscarry.  And then some need a second dosage or do not miscarry at all, warranting a D&C.  
If you are experiencing something similar, or are worried about your progress with misoprostal, the key is to accept that you have no control over this situation.  It may work, it may not.  This is all part of the process of starting over. Eventually, but some method you will start over and heal.  In the mean time, stay calm and do your best to minimize mental stress on your body.  Pray, meditate, and keep yourself busy.  Let the worry and the wondering go and know that it will all be over sooner than you think.  If you are going through this, I'm sending my love, support, and hugs your way.  You are beautiful, strong, and you will be able to help others cope with this in the future.  <3

chinookmama · Answer

Hi,  I just had a really scary experience with misoprostol.  We found out the baby was dead at 10 weeks 3 days, the fetus had stopped developing at 9 weeks 1 day.  We waited until week 11 to see if I would expel everything on my own, but I had absolutely no bleeding and only mild cramping a couple of days and one night of really bad cramps.  When the 12th week was approaching I decided to go with 800 mg of misoprostol intravaginally because I was afraid of the D & C.  In my case this turned out to be a bad idea.  I hemorraged after the c-section with my first son and ended up with a hemoglobin of 6.7.  The recovery was slow and difficult, but we thought it was just because I had pushed for so long before the surgery.  When I took the miso for this miscarriage of my second pregnancy, I bled out a lot.  I went from a hemoglobin of 12.3 just two days before to less than 6 within 6 hours of taking the medication.  I still had a lot of tissue left over in the uterus and would have continued to bleed if the OB in the ER hadn't urged me strongly to do the D & C.  I didn't understand that the D & C actually will prevent heavy bleeding and that if I had just done it first I would not have become life-threateningly anemic within 6 hours.  So, basically, I took the miso at 12 am, by 3 am started bleeding, by 9 am was in the ER with severe anemia.  By 7 pm we did the D & C and I was not bleeding anymore than a few spots.  I am now almost a week out from the miso administration and I may have to get admitted to the hospital for a transfusion.  This has been an unexpected and really scary experience.  I think a lot of women have no problem with miso, but if you have any reason to think you may be someone who bleeds a lot, really consider taking it during the early morning and make sure you have someone who can rush you to the ER if needed.  I mistakenly took it late at night because we didn't think it was going to be a big deal.  I expected to bleed but not to the point of almost bleeding to death.  Also, the expulsion wasn't complete even after 6 hours of heavy bleeding.  In fact, it was no where near complete, so if I had tried to wait it out at home I would have died.  The D & C was quick and my doc could have done it in his office without general anesthesia.  In the ER it was a long process and I have a post-anesthesia/anemia migraine that has lasted now since Sunday afternoon and normal pain meds have not helped at all.  BE CAREFUL with MISOPROSTOL!!!  I would recommend it, but you really need to make sure that you are under the watchful eye of your physician.  Oh, I also got an infection from the heavy and prolonged bleeding, my cervix was open for a while.  Really harrowing experience.  But it doesn't happen to everyone and I think this drug can be safe for some people, we just didn't know that it wouldn't be safe for me.

minerrive · Answer

my baby was found with no heart beat at 10 weeks and suposedly died at 9 weeks, for two weeks I had no symptoms of miscarriage. Did more than 3 ultrasounds vaginally and on the stomach just to be sure that unfortunatelly my baby was not alive. My Dr prescribe me Misoprostol four pills by mounth and sent me home, I took it at 8:30pm and went to sleep at 9:00pm truoughout the night I had some cramping some strongs ones but not strong enough to wake me up. At 4 :00am I got up to pi and my Maxi night pad was soak, all wet even my pijamas did not take any pain medicine. When I pi a big blood cloth came out, no pain the size of a fist. Then took the big cloth from the toilet to put it in the sink to look for the small embryo, no luck, then keept looking in the toilet and there he was. it was the size of 1 inch and a half with hands and feet formed at 9 weeks. is was very emotional. I keept it to buried in one of my plants. Then I went back to bed after I cleaned myself and at 7:00am went to pi again and another big cloth came out again then throught out the day I jut bled and also had tissue came out, no need to take pain medicine. The next day I just went to the Dr to ask some questions and then he went ahead and check my vagina just like a regular paps mear and then he pulled out the rest of the tissue left, that day also I had some cramping and the cramping has not sopped yet. this is the fourth day since I took the misoprostol my bleeding has been normal. I am now taking just the regular dosis of Advil over the counter every three hours as dont want to take the strongest dosis that Dr prescribe in case it was needed. This is my first misscarriage and the aftermath feels worst than when we have a baby via natural. I just need more rest. I do not know anythhing about  the D&C. I just need this to be over. A unique experience that makes any women stronger.

leighanne143 · Answer

i have heard the meds often do not work and people end up needing a d and c either way.

i opted for the d and c with both of my miscarriages because i emotionally could not handle waiting for a medication.

i am so sorry for your loss and know the pain you are feeling right now.

TTT777 · Answer

I also bled for only one day after inserting this medicine, with passing tissue as big as my fist and lots of clots.  The next day---no more bleeding which scares me that it is not enought bleeding for everything to come out.

HMC2009 · Answer

I know this posted a long time ago but wanted to post anyway for anyone looking for info on this matter. I took 4 misoprostol vaginally after a missed miscarriage. Bled heavily for one day no cramps. One week later had a HORRIBLE smell went to my doc and found there was left over tissue and had to have a D&C. If I had to do it over again I would have the D&C because misoprostol is a watch and see sort of approach and you go through enough of that with the pregnancy/miscarriage process. I wanted it to be over with quick to be able to start trying again. D&C is quick and painless I went completely under. Had mild spotting for a few days and no pain.

PB77 · Answer

Thanks for info, I really appreciate it.  I'm still on the fence and am not sure what I am going to do.  The miso that my doctor prescribed is oral, which I'm finding out isn't supposed to work as well as the vaginal ones.  I have also read about the chance of uterine rupture through the vaginal insertion.....of course, it's a very, very small chance but I always get paranoid when I hear these things.

mlb1234 · Answer

I have had both done (I just posted about this a day or two ago but I can't remember who I posted to) and I guess I am one of the few who prefer the misoprostol.  With the miso you do induce the m/c to occur but you by no means created it!!!!  I liked it because you could do it when you are ready in the privacy of your own home.  Not with a ton of doctors and nurses around and general anesthetic (my D&C wasn't under general tho - they give you something to calm your nerves and give you amnesia similar to if you had your wisdom teeth pulled and you have no recollection afterwards).  If you take the miso, just wet the pills slightly before inserting them.  Insert as far as possible and lie down for about an hour or two to make sure they dissolve by the cervix and are not dislodged.  It took about 4 hours before anything started happening and by the evening I passed the big clot.    I had another smaller clot the next morning and some spotting for a couple days.  No big deal.  Just take  ibuprofen prior to or after taking the miso and you won't even feel too much cramping.  Best of luck - whatever you decide will be fine.

mel382738 · Answer

The problem with misoprostol is that it can be very emotionally hard and it may not work. I had an experince with this drug myself, and these pills were placed in the vagina-not taken orally. Very hard b.c YOUR the one giving yourself the miscarriage when you do it that way, (Even though it's not your fault what happend to baby) so like I said- it is VERY emotional. 
There is a 4-5% failure rate-which means you will have the cramping and bleeding-just not expell all the tissue, and then you'll have to have a D&C anyway to get all the tissue out.(I was in the lucky %)

I know how hard this is-especially since your body is still going thru the pregnancy symptoms. If you decide to wait for the m/c to occur naturally be aware that you WILL continue to have the pregnancy symptoms until your body recognizes the pregnancy is no longer viable-which can take weeks :(

If I were you, I would opt for the D&C. It will help bring a bit of closer-and you can begin to heal faster. Also-you will then be sooner able to start trying again :)

Misoprostol vs. D&C for a missed miscarriage?

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