Medical management of retained products of conception

Medical management of retained products of conception is an option if bleeding is moderate and the individual prefers active to expectant management. It involves repeat dosing of misoprostol as a single drug along with premedication and analgesia. A suitable regimen is¹

misoprostol 400 micrograms buccally. Moisten the mouth, then place one tablet (200 micrograms) between the teeth and the gums on each side of the mouth and hold them in place for 30 minutes. Remaining tablet fragments may be swallowed with a glass of water. Repeat the 400 microgram dose after 4 hours if no significant bleeding has occurred. medical abortion, retained products of conception misoprostol

Ensure the individual has a support person and access to emergency services. Organise a follow-up phone or in-person assessment 24 to 48 hours after the last dose of misoprostol. Ensure they have written instructions on symptoms requiring medical attention; see Advice after a medical abortion: patient information.

If medical management is unsuccessful, options are expectant management by an experienced provider or surgical evacuation.

¹ Misoprostol is available as a single-ingredient formulation; combination with mifepristone is not required or advised for this situation.Return