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Explain to your clients that after taking Misoclear it is normal to experience moderate to heavy vaginal bleeding and abdominal cramps that decrease after the pregnancy is expelled.
Women using Misoclear should expect to experience strong cramps one to three hours after taking Misoclear. This will diminish as the abortion happens. Pain killers should be provided.
Possible side effects and their management include:
Low grade fever - provide paracetamol and observe
Headache - provide pain killers and observe
Dizziness - recommend rest and an increase in fluid intake
Nausea/vomiting - provide an anti-emetic and recommend rest
Diarrhoea - provide an anti-diarrhoeal
Pain and cramping - provide an NSAID such as ibuprofen or paracetamol, suggest heat pack
Most women will experience some stomach cramps and abdominal pain during a medical abortion because uterine contractions are needed to expel or push out the pregnancy.
Most of the time this pain can be managed at home. You can get painkillers from your local clinic or over the counter from your local pharmacy to help manage your pain.
Some options they may suggest include:
Paracetamol 500mg tablets - take 1 or 2 tablets every four to six hours when required. Do not take more than 8 tablets in a 24hour period
Ibuprofen 200mg tablets - take 1 or 2 tablets every six to eight hours with food when required
Applying a heat pack or hot water bottle to below the stomach may help to ease the pain. As much as possible, you should make sure you are in a relaxed environment with supportive people there to assist you.
If you experience severe or persistent pain, you should go to your medical clinic immediately.
Complications are rare with Misoclear but it is important that your clients understand that if they experience any of the following, they need to quickly seek medical help.
It is important that women know that they should seek medical help immediately if they have any of these symptoms:
| Warning sign | Management |
|---|---|
| Heavy vaginal bleeding | 1. Assess for signs of low blood volume/hypovolemic. 2. If no hypervolemia, assure client, advise her to take ibuprofen, plenty of oral fluids, rest and check back if symptoms worsen. 3. If client is showing signs of hypovolemia, replace fluids and perform surgical evacuation of uterus. 4. Blood transfusion may be required in rare cases. |
| High fever (>100.4°F or 38°C) or more after taking misoprostol or fever that lasts more than a day | This suggests infection.Treat infection with broad-spectrum antibiotic treatment and perform surgical aspiration. In the extremely rare case of severe infection or sepsis, the woman should be hospitalised for treatment. |
| Foul smelling vaginal discharge | This suggests infection. Treat infection with broad-spectrum antibiotic treatment and perform surgical aspiration. In the extremely rare case of severe infection or sepsis, the woman should be hospitalised for treatment. |
| NO bleeding after 24 hours of taking misoprostol | Examine clinically to rule out ectopic pregnancy and decide: a. to wait for a few more days; OR b. to give additional misoprostol; OR c. to perform vacuum aspiration. |