Chapter 22: Helping a woman after a pregnancy ends early
Treating incomplete abortion with medicines
Two medicines can help empty the womb after an incomplete abortion — misoprostol
and ergometrine. Misoprostol can be given by mouth or inserted in the rectum — it
makes the womb contract and pushes out any tissue. It is best to use this medicine
when you have access to emergency care, including MVA, because it can cause heavy
bleeding and does not always empty the womb completely. Ergometrine is another
medicine that causes contractions and can be given by mouth or injection.
To empty the womb after an incomplete abortion
• give 600 mcg (micrograms) misoprostol...by mouth
The woman should dissolve tablets against
her cheek or under her tongue and then
swallow any remaining parts. If she cannot
swallow, insert pills in her rectum where
they will dissolve and be absorbed. Wear a
glove. Misoprostol can be given up to
2 times, 24 hours apart.
• give 0.2 mg ergometrine �����������������������������������������by mouth, 1 time only
• inject 0.2 mg ergometrine �������������������������������������in the muscle, 1 time only
When misoprostol is used to end a pregnancy
Misoprostol can be used, usually with another medicine called mifepristone, to end a
pregnancy in the first 3 months (see page 485). Because misoprostol is available at
pharmacies and is not expensive, some women use it by itself to end their pregnancies.
Access to emergency care is very important when ending a pregnancy with
misoprostol because it can cause heavy bleeding, incomplete abortion, or other
dangerous problems. Emptying the womb using misoprostol alone may take
several hours or several days to finish. If it does not empty the womb completely,
the woman must find someone to empty her womb in another way.
WARNING! Do not use misoprostol after 12 weeks of pregnancy.
The womb becomes more sensitive and can split open.
Removing tissue from the cervix
If you cannot do MVA, cannot give medicines, and you cannot find someone else
to empty the womb, do a speculum
exam (see page 377) and look for
tissue or clots of blood coming out
of the cervix. Use a sterilized
forceps or long tweezers to remove
the tissue or clots. This does not
always work, but it is better than
A Book for Midwives (2010)