What if I do not bleed after the misoprostol?


If after 24 hours the woman has no bleeding, and she is sure that she is pregnant AND that the pregnancy develops in the uterus she can repeat the misoprostol dose of 4 tablets. The first pill mifepristone will work up to 72 hours.  So she can put another 4 misoprostol buccally (between the gum and the cheek, 2 tablets on each side link to image) and let it dissolve for at least 30 minutes.

You can repeat medical abortion or have a surgical abortion, or decide to continue the pregnancy.

Medical abortion is very effective (less than 0,5% have ongoing pregnancies) in the first 9 weeks of pregnancy, but it is still very important that women confirm if the abortion was successful. If after using the medicines the woman continues to have pregnancy symptoms (like nausea, vomiting, feeling tired) she should do an ultrasound as soon as possible to confirm if the pregnancy continues, if the pregnancy develops in the uterus and to check the length of the pregnancy.

The urine pregnancy tests will only be reliable 3-4 weeks after the abortion. Before that time there are pregnancy hormones in the woman’s body, so the test will not be accurate.

If the woman has a continuing pregnancy after using mifepristone and misoprostol or misoprostol alone it is important that she know that there is a small risk of malformation due to the use of misoprostol. Around 1% of exposed fetuses develop fetal abnormalities associated with the use of misoprostol.32   These abnormalities include Moebius syndrome, limb defects, club foot, central nervous system anomalies and anomalies involving the palate. Some research suggests that human fetuses exposed only to mifepristone continue to develop normally.33


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