Misoprostol second dose - is it as painful as the first dose?

[DappledOliveGroves]

So we found out at a private scan on Thursday evening that our baby's heartbeat had stopped. I was 10+2 but it looked like the baby had died around 10 days before.

The missed miscarriage was confirmed at the EPU yesterday and I elected to have medical management, since the hospital isn't offering D&Cs owing to Covid and I just wanted to get on with dealing with stuff and couldn't face the thought of waiting possibly weeks to miscarry naturally.

I inserted the first dose of misoprostol at 7am today. Cramps started around 9.30am and escalated massively in a huge space of time. I then started vomiting and threw up most of the pain medication. I was in absolute excruciating pain for around 90 minutes and then managed to keep down some painkillers and the cramping eased off. I started bleeding around 2pm and have been passing a lot of blood and clots but don't think I've passed the pregnancy sac yet.

I was told to take a second dose of misoprostol 48 hours after the first, regardless of what has happening bleeding-wise. But I just cannot face the thought of going through the same level of pain again. It was horrific and on a par with labour.

Does anyone have any experience of how one's body reacts to the second dose? Is it less painful? I really want to avoid having to go back to hospital for retained products but at the same time I can't deal with that level of agony again.

If anyone could share their experiences of the second dose I'd be really grateful. Thank you 🙏

[Isthisfinallyit]

I don't know what will happen but sorry you have to go through this. The first day I took it I was just crampy and uncomfortable, second day the same. Third day I spent a long time having contractions and stayed half a day under the shower till I passed the pregnancy. I was almost 12 weeks though so maybe thats why it took longer for me?

Anyway, keeping it in isn't an option either. Can you call a doctor for stronger painkillers?

[DappledOliveGroves]

Thanks very much for replying. I could try and get some stronger painkillers but it's hard to know if they'd stay down. Maybe I could increase the anti-sickness medication so that the painkillers don't get thrown up.

How many doses did you take?

[Tabby92]

Hi! I'm going through exactly the same thing as you. I went for a private scan on Thursday afternoon and they couldn't find a heartbeat. I went to the hospital and was told I had to have treatment and I opted for the tablets too. I was 9 weeks pregnant.
The doctor inserted them for me and I don't have to go back until next week to see if everything is clear. I was in a lot of pain yesterday afternoon and completely unable to move. I was sick a lot too. After that I started bleeding and bled really heavily for about 5 or 6 hours. I'm not sure if the sac has come out but today I'm in less pain and the bleeding is a lot less.
Please let me know how you get on. I am worried about having to go in again for more tablets too. To try and reduce the pain I've been alternating between ibuprofen and parecetemol every 4 hours and it's not stopped everything but the pain has got a lot better. Use a hot water bottle too.

[DappledOliveGroves]

@Tabby92 I'm so sorry that you're in this awful situation too. What's been helping is realising how many other women have had a missed miscarriage and listening to their stories. A few of my colleagues have been so kind and it's like I'm suddenly a member of a club with so many women, albeit not a club that anyone ever wanted to join.

At my appointment at the EPU they gave me the tablets and said to use then whenever we wanted to, or not at all, whatever we chose to do. In an ideal world I'd have gone for a D&C under a general to avoid the pain, but it's off the table because of Covid.

I've had a hot water bottle clamped to me all day and have been taking ibuprofen, naproxen, codeine and paracetamol. As well as anti-sickness meds, though the latter did absolutely nothing as I was sick as a dog about three hours after I'd inserted the tablets.

I'm hoping now that my cervix is presumably open, that the next set of pessaries won't be as painful. But if there is a way I can avoid taking another lot then I'm keen to do so - the pain was just excruciating. I was begging DP to call an ambulance so I could get better pain relief. Thank God the pain began to lessen and I was able to take naproxen and paracetamol without throwing them up.

It's pretty difficult to know what exactly I've passed. There's so much blood each time I go to the loo that it's impossible to really see what's come out. From what I've read, a lot of people seem to 'know' when they've passed the sac - I've read about people feeling an urge to push and then massive relief and much less bleeding afterwards. So far I can't say I've felt anything like that. I know I've passed some big clots but haven't had any need to 'push'.

This whole experience is just awful, but I am grateful I've been able to be at home and DP has been absolutely wonderful.

Sending hugs.

[Tabby92]

I know. I always thought that if you were having a miscarriage you would just start bleeding naturally which is why the news came as such a shock on Thursday. I didn't even know missed miscarriages existed.

I was offered both treatments but the doctor advised against d+c where possible because he said it can have a lot more complications than the pessaries and there's a stronger chance of a ruptured uterus or infection. He said we would just do that as a last resort if everything isn't expelled.

I'm the same with not knowing whether I have passed the sac or not. I think it would upset me seeing it though and have been trying to just flush as soon as I go to the toilet. I've been looking a lot on the internet and it seems like some people don't realise they've passed it and others don't pass it until 4 or 5 days after they've had the treatment so we will just have to wait and see.

I would contact your doctor to see if you could wait a few more days and avoid having more treatment. I have another scan next Friday and if everything hasn't gone I will have to have more tablets but if everything has then I don't.

Thanks for your post anyway it's nice to know I'm not alone. No one in my family has had a miscarriage and none of my friends have either so I've just been sat all day wondering why it's happening to me. My partner is being lovely and won't leave my side. Sorry I can't be of more help with your question about whether the second dose is as painful but do let me know how you get on. I had to call the doctor yesterday because of the pain and because I couldn't stop being sick and he told me everything was perfectly normal because you have contractions as your uterus opens. Sorry you're going through this too.

[HopefulB]

Sorry for your loss @DappledOliveGroves.

I found out at what should have been my 12 week scan last week. I had medical management too. Pain and Nausea are better managed if you can get them under control before it gets bad. I was fortunately given Codeine & Metclopramide about 20mins before the pessaries & was given a diclofenac suppository to insert at about the same time. Whilst I’d usually not be impressed with a medical team suggesting this route of administration it worked well as the pain relief stays in your system a long time & isn’t affected by vomiting. Might be worth asking for if you do have to have another dose?

I’m not suggesting it wasn’t still awfully painful! But if you can take the anti sicknesses and pain relief as often as you can for the first 2-3days I think it helps.

Best of luck x

[DappledOliveGroves]

@HopefulB thank you for your message and so sorry that you're experiencing this too.

I spoke to the EPU earlier who said I should take the second dose, to try and ensure as far as possible that everything is expelled. I spoke to GP and got a prescription for tramadol and took that, anti sickness and naproxen at the same time as the pessaries. It's now been seven hours since I had the second batch of pessaries and I've barely had any pain. I assume it's because my cervix is still open, but it's a massive relief not to be in agony. I've had no sickness today either.

I've been bleeding more last night and today than yesterday, some clots but still not sure if I've passed the pregnancy sac or not. It may be that I passed it on Saturday - it was so hard to tell with the amount of blood and clots. I guess I'll just see what happens over the next few days. The EPU is calling me again tomorrow so I'll ask and see if they scan to make sure or not and go from there.

[DappledOliveGroves]

Just a further update - nothing has really happened since the second dose - bleeding might have got marginally heavier but nothing of note. The lovely lady from the EPU called today to see how I was and they're going to do a scan on 7 August to hopefully confirm that everything has passed. Fingers crossed there are no retained products.

Feeling really tearful today. Just wish I was still pregnant.

Hope everyone else is going ok @Tabby92 @HopefulB

[HopefulB]

@DappledOliveGroves glad you got some pain relief that worked for you. One step at a time in the tears front....

I went back to work Monday, but WFH so I can change positions, be near loo & don’t have to mask up to go to the loo. Feeling proud of myself for managing someone’s maternity plans without a wobble!
I’m still getting a lot of bloating so finding that makes me sad as before even though it wasn’t a baby bump if was definitely baby bloat!

[Tabby92]

@DappledOliveGroves all okay here. I'm feeling very sad too and really tired. I've just had one dose up until now and I've got a scan on Friday where they will decide whether to do a second dose or not. Glad to hear your second dose hasn't been as painful and as bad as the first. I'm really hoping I don't have to have a second dose on Friday.

[Tabby92]

@DappledOliveGroves how are you getting on? I came into hospital yesterday but not much had gone so they ended up giving me a d+c yesterday afternoon. It's a lot better than the tablets, I am feeling fine today and didn't feel anything while they were doing it. Just waiting to be discharged from the hospital now. Hope you're ok!

[HopefulB]

@Tabby92 Glad you got sorted, and hope you’re home soon, and things start to settle back to normal.

My pain has resolved, bleeding has settled to spotting, and the bloating/boobs are heading back to normal. EPU follow up was on Thursday for me, they seemed satisfied with my description of pain & passing vast quantities of blood/tissue in the first 13 hours, so said to do test 3 weeks from day of treatment and if negative all ok. If positive, or if bleeding doesn’t stop get back in touch.

@DappledOliveGroves Are you still waiting for a scan? Hope you’re ok.

[DappledOliveGroves]

@Tabby92 @HopefulB I'm still bleeding but less each day, in general. I have the scan next Friday to see if everything has passed.

Emotionally I'm a wreck. I'd waited so long to be able to TTC - nearly four years - for a number of reasons and my biggest fear was a missed miscarriage and now I'm living that reality and it's just heartbreaking. I wanted this baby so much and I just don't know why this happened.

I want to start TTC as soon as possible but don't know if that's going to be feasible or not. I'm scared if we do TTC that I won't get pregnant or will miscarry again. I just feel like I have no control over any of this and I'm really bad at going with the flow or relaxing or accepting whatever will happen.

Have spent the morning in tears, arguing with DP, and just wish so badly I was still pregnant.

[HopefulB]

@DappledOliveGroves So sorry to hear that.
Do you have family/friends who may have been through similar who you could talk this through with? Or access to someone to talk to through GP or occupational health?

In my head (which could be seen as bluntly pragmatic), whilst this was a much wanted baby my body recognised there was something wrong, and altered the course. It’s not something any of us have control over and is unrelated to anything we have done. Early miscarriage is nearly always about chromosomal abnormalities.

It’s a huge shock, though, and hard to remain rational when you still have hormones raging. Give yourself time to grieve, and time for hormones to settle.

I feel the same in that I want to TTC again ASAP, but I think it’s really important to take time to adjust and make sure you are strong enough to deal with this if it were to happen again - which I wouldn’t wish on anyone.

Take care of yourself xx

[HopefulB]

Still testing + 😔

[DappledOliveGroves]

Sorry that you're still getting a positive test. I haven't tested yet - really don't want to - hoping Friday's scan gives me a better sense of what's happening.

We've gone away for a few days this week to get away from it all. Walked 12 miles today in beautiful countryside which has been lovely and it's nice to have a change of scene. Seeing some friends tomorrow too which will be nice. Just hope time goes quickly before I can hopefully start TTC again. But at the same time want to find a way to remember the baby we lost.

[Tabby92]

Have you got another scan soon @HopefulB? I hope everything goes well for you on Friday @DappledOliveGroves. I'm trying to keep busy too. Let me know how you both get on

[HopefulB]

No scan booked. EPU said they would do if not negative at 3 weeks. I was ok with that as I lost so much in first 24-48hrs that I was sure it had been successful. However i’m still spotting and occasionally passing clots up to size of 20p, so now not so sure, also had a little cramping. I have a day off tmrw so may give them a call for reassurance!

[DappledOliveGroves]

I had my scan at the EPU this morning and they confirmed they couldn't see any retained products so that's good. They also gave me a pregnancy test and that's showing negative now, so hopefully my period will come soon and then we can start TTC again.

Emotionally I feel a bit begged. We had a few days away this week and the change of scene was really good. Felt more normal. I've started running again and trying to get fit and hopefully be in better shape if I'm lucky enough to get pregnant again. I had spinal surgery last year and my back was excruciating as soon as I got pregnant as the hormones made the ligaments relax. Hopefully I can try and work on core strength and got back to the gym now it's open.

Hope everyone else is doing ok.

[HopefulB]

That’s good news @DappledOliveGroves!

I started running again this week too. Has made me feel so much better! It’s helped get rid of the bloat and my body feels more ‘mine’ again. I’d love to be fitter too before we conceive again.

Best of luck on your journey. I’ve joined the folks on the TTC after miscarriage thread.

[Furbabymum15]

Hello sorry to read about your loss.

I had a mmc picked up at my 12 wks scan in May.

My baby died at 10 wk and 3 days.

I had 6 tablets in a day but was monitored in hospital.

The whole experience is soul destroying but I know the pain u mean and I found the best pain relief you was dihydrocodeine.

I hope this helps xx

[HopefulB]

Sorry for your loss too @Furbabymum15.

Update from me, still testing +, had scan today, they can see tissue with blood supply, not sure if placenta or molar, so now have hysteroscopy booked for Friday.

Feeling very low again. Without dismissing our loss, I thought we would have closure by now.

[DappledOliveGroves]

Thank you for your message @Furbabymum15. I'm so sorry for your loss.

@HopefulB - hope it all goes well tomorrow. It's so unfair that you have to go through all of this.

[LemonRabbit]

Hi ladies,
Sorry for all your losses it’s all so unfair - physically and emotionally.
I’ve just found this thread and read it with interest.

I had an anembryonic preg (empty sac) - an early miscarriage that still grows a sac. You get all the pregnancy symptoms but your body is tricked as there’s literally nothing there!
I took misoprostal yesterday and had a few very intense hours - cramping, bleeding, vomiting. Awful!!
Anyway, I feel drained today, and still bleeding a little but not cramping up or anything like that.
The trouble is (and sorry for TMI) I haven’t passed any clots. I was warned I’d see the sac (I’m almost 9w but only empty sac that prob stopped growing around 6w - it’s about 2cm)
I know my preg isn’t huge or as far along as some of you, but just so worried it’s incomplete.
Just wondering if any of you ladies went on to “pass the sac/clots” after the first intense day of cramping with misoprostal? Or any advice? I lost a lot of blood but all very runny.
I phoned EPU. They said intense cramping means it’s worked, sac may have been reabsorbed (I’m not convinced) and do a HPT in 3 weeks and phone back if it’s positive. A lot of waiting!!

[DappledOliveGroves]

@LemonRabbit - so sorry for what you've been going through.

Personally, all of my heavy bleeding took place after the first dose of the misoprostal. There was a lot of blood and also clots, though not huge (maybe a few the size of a lychee) - I was never aware that I'd passed the sac or the foetus. The only thing, in retrospect, that may have been a clue that I'd passed the sac, was that I felt a 'pop' just at the point that I began bleeding after the first dose of the misoprostal. It may have been that the 'pop' was the sac going. I don't know. There was too much blood to really be able to tell what was happening.

Do you have a second lot of misoprostal to take 48 hours after the first dose? My bleeding increased slightly after the second dose with a few smaller clots, but nothing noteworthy.

I was so lucky that everyone at the EPU was wonderful and when I said I was concerned that I wasn't sure if I'd passed all of the pregnancy remains, they said to come in for a scan (which I had last week and which was clear). I also had a negative pregnancy test too. Can you call the EPU back to see if they will scan you in a couple of weeks' time?