Misoprostol not worked?

[IShineAShoe]

After finding out I had a MMC on Wednesday when I should have been 9w, I started medical management yesterday morning. I prepared myself for a lot of pain and heavy bleeding, but thought it would be the best option so it would be over quickly. Nothing much has happened. I am bleeding, but it’s much lighter than my normal period would be, and although I had some painful cramps last night today they’ve been very mild.

I went to the loo this morning and I felt something solid plop out, but I don’t think this could have been the sac? I thought maybe it was the start of the blood clots, but I’ve not had anything else like it since then.

I know they said it can take up to 72 hours to work, but I read so many experiences of woman of it all happening within a few hours so that’s what I expected.

Would anyone have any advice? I know it’s likely just a waiting game. I need to phone epu back on Monday and they said if I haven’t had heavy bleeding then I’d be brought in to be given more misoprostol. They didn’t mention whether they would check on a scan first to see if there has been any chance, what if the little solid plop this morning was it passing?

I’m so sorry for your loss

It’s possible for it not to work. Had medical management for a mmc at 12 weeks and took two doses as had severe pain but only clots and a bit of tissue passed and I ended up with surgical manage bf to as the rest of it got stuck. They said it’s rare for it to fail twice but possible. Keep an eye on how you’re feeling. I knew from the pain that something was wrong, had another scan in the EPU and surgery the same day so they definitely should see and scan you if nothing else happens before Monday.

If it was discovered at 9 weeks, did they say when they think it stopped growing? That can help in terms of what to expect to pass.

Such an awful thing to go through, I really am so sorry. Look after yourself. Rest as much as you need, take gentle walks around the house or close to home if you feel like it and try to eat and start hydrated. If you get worse pain take decent pain meds, no prizes for suffering.

Thank you for your reply.
It had stopped growing at 6w4. I had a scan when I thought I was 7w which showed a heartbeat and it measured 6w2. So it passed not long after that.

I’ve got good pain meds from the hospital but I haven’t felt like I’ve needed any today. I took some last night as a precaution, but I probably could have managed the cramps without.

Surgical would have been my first choice to get it over and done with, but they aren’t offering that at all just now due to covid. So hopefully it does work soon.

My reply was full of typos, just realised, sorry! Hope it made enough sense.

I didn’t realise they weren’t offering surgical as an equal option at the moment. See how it goes over the rest of the weekend. A second dose might be worth it if you feel things aren’t moving as expected. I passed something huge two days after I had the first dose and thought it might be the sac, I remember calling DH into look at it and I was all over the place, such a difficult time. But it wasn’t, the bleeding stalled but the cramps and back pain got much worse so I knew it wasn’t resolving and when I had the surgical a day or two later they took some tissue for testing as it was my third mc and there was loads still inside. It’s surprising how much has to come out. Sorry if this is too upsetting. When I was going through it I wanted facts no matter how grim but everyone’s different.

If it does get to the surgical option, you might be offered an MVA under local or an ERPC under a general. I’ve had both and would highly recommend the latter. What you’re going through is hate enough without being awake.

Don’t hesitate to contact the EPU if you’re worried. I’ll check back and see how you’re getting on if that’s of any help.

Thank you for your reply @Annelovesgilbert
I had read up on it all so I was prepared for the worst, so I’m pretty sure my experience just now is proof that it’s not working/not worked yet. Epu are closed over the weekend so it will be Monday before anything else could be recommended. When I was in yesterday they did say that in the case it doesn’t work, I’ll be given two more misoprostol tablets. At my last scan they had said the sac was starting to collapse, so I thought maybe there would be less to come out? From my bleeding at the moment, I’d say it’s still a long way from being over.

If the second dose of misoprostol doesn’t work then I will really try to fight for the surgical options. I don’t know if under the circumstances of failed medical management it would be offered anyway or it’s just a blanket “NO, covid”.

Really sorry to hear that you are going through this, there are no words that will make it any easier, just be kind to yourself and take however long you need to grieve, cry, scream, there are no rules, do whatever you need to do for you.
Just wanted to offer my experience for information really..
I had a miscarriage 3 weeks ago today.
I had two rounds of misoprostol, 2 weeks apart, one oral one vaginal and both of which unfortunately failed. I would bleed and have cramps for a few hours after each but then it tapered off and I didn't pass anything. I was told that the only option I had due to covid was to have surgery under local anasthetic. Unfortunately I couldn't tolerate the pain when they attempted it (The nurse said she thought my cervix was really tender after three rounds of medical management as I had the tablets for a third time by then) and in the end I was admitted into hospital and booked in for surgery under general anasthetic. A comment that the consultant said to me after my failed attempted MVA procedure though really stuck with me.. he said that if I had flat out refused the surgery under local anaesthetic then they would have had no option but to offer surgery under general anaesthetic so just bear that in mind...
I'm sure it won't come to that for you though, the sac was in tact with me, it hadn't started breaking down, so hopefully if this first lot of tablets doesn't pass the pregnancy tissue for you then a second round definitely will.

I think all of us women who have had to experience a miscarriage especially during this pandemic are so brave. Sending you the biggest virtual hugs xxx

I’m so sorry for your loss @Gems7, thank you for sharing your experience. Frankly it sounds like you went through an awful time of it! I’m glad that hopefully you can start to put it behind you now.
The first dose of misoprostol I had was both vaginal and oral, (4 tablets vaginally at the hospital followed by 2 tablets under my tongue 4 hours later at home). If I need another dose on Monday then I was told it will just be another two tablets under the tongue.

The mva would have been my top choice if it was even an option for me. I shall just need to see and I hope the misoprostol gets to work.

I was already suffering mentally with lockdown and not seeing family. I’m worried once I’ve got this behind me it might just hit me what’s happened and I’ll be in an even worse place mentally.

@IShineAShoe Thankyou hun, I'm relieved it's over, it was a little traumatic, the pregnancy tissue just didn't seem to want to leave my body. I'm hoping it's a good thing as I'm really hoping to get pregnant again once I have recovered from this, just waiting for my first period.
I hope things progress quickly for you without the need for anything further (as difficult as it is) I completely understand what you are going through, it was literally me a few weeks ago.
From what I've read on here everybody deals with it differently, I went back to work one week after my surgery (I work in a hospital and had already had 3 weeks off prior to that for my failed medical management treatments so was anxious about having more time) it was good to get back to "normality" but also it wasn't easy as life just moves forward as though nothing has happened but inside Im sad and still grieving. Covid definitely hasn't helped things has it, at least restrictions are being lifted slightly now.
Make sure you have plenty of pads in (a hot water bottle was also a godsend for the cramps) pain relief (which I'm sure EPU will have given you already) and lots of chocolate. Will be thinking of you hun xx

@IShineAShoe I had a MMC confirmed 6th of May and had my first dose on the 11th. It was absolutely brutal, I will never go down this route ever again. Thought there was no way any product could be left behind but when I went in 2 days later for a check up they said there was still tissue to come so I had to take another dose. I went back a week later and they said everything pregnancy wise was gone but my lining was still thick so they wanted me to come back in another 2 weeks to see how it looked then in case I would need another dose. During those 2 weeks I bled lightly for about 11 days before I got up one morning and felt something pass from me. When I got to the bathroom it was a fairly large piece of tissue which EPU have since told me was decidual casting and within an hour of it passing the bleeding finally stopped altogether and I was finally freed from EPU on my last appointment on the 1st. It makes me sad I went through nearly a month of this trauma when I could have had surgery but because of covid they really coaxed me into medical. I wish I had just pushed for surgery but it's my first pregnancy so I didn't know how awful the medical route would be, I'd never heard of it. I'm so sorry for your loss and that you're in this situation and I hope they can offer you help so you can begin to get back to 'normal' again 💕

@IShineAShoe I had a MMC confirmed 6th of May and had my first dose on the 11th. It was absolutely brutal, I will never go down this route ever again. Thought there was no way any product could be left behind but when I went in 2 days later for a check up they said there was still tissue to come so I had to take another dose. I went back a week later and they said everything pregnancy wise was gone but my lining was still thick so they wanted me to come back in another 2 weeks to see how it looked then in case I would need another dose. During those 2 weeks I bled lightly for about 11 days before I got up one morning and felt something pass from me. When I got to the bathroom it was a fairly large piece of tissue which EPU have since told me was decidual casting and within an hour of it passing the bleeding finally stopped altogether and I was finally freed from EPU on my last appointment on the 1st. It makes me sad I went through nearly a month of this trauma when I could have had surgery but because of covid they really coaxed me into medical. I wish I had just pushed for surgery but it's my first pregnancy so I didn't know how awful the medical route would be, I'd never heard of it. I'm so sorry for your loss and that you're in this situation and I hope they can offer you help so you can begin to get back to 'normal' again 💕

Sorry, not sure why that's posted twice!

Hi @Stabal, thank you for sharing your experience. I’m so sorry it was so awful and drawn out. I was so prepared for it being pretty awful. I know they won’t consider any surgical option until after the second dose fails.

I had a natural miscarriage last year which began itself. It was also pretty traumatic and seemed to last for weeks. I wasn’t keen to wait for a natural miscarriage this time, seeing as the baby had already died three weeks before and nothing had happened yet.

Today doesn’t seem to be any better (or should I say worse?) in terms of bleeding. I’m bleeding, but there’s hardly anything on the pad. Pretty sure I’ll need to go back for the second dose.

I went back for more misoprostol (4x vaginally, and I have 2x to take orally in a couple hours). I’m hoping this works. If not then they aren’t doing anything else. Just test again in three weeks and phone them back.

@IShineAShoe fingers crossed that this time takes 🤞 sorry it's been so drawn out for you 💐

My baby stopped at 7weeks 3days. I had the medication on the 28th may but it took a week for it to actually happen. I was bleeding from the 28th. But 11 days later I started getting the most painful contractions and very heavy bleeding. I then had something that felt like the size of my fist fall out.

It looks likely that the second lot haven’t worked either. If it takes up to 72 hours to work then there’s still a chance, although I feel no different to when I had the first round of misoprostol.
So I guess I’m back to waiting for it to happen naturally which I really hope happens sooner rather than later.

Sorry to bother you @IShineAShoe but I wondered if you could bring yourself update this thread with what happened next? I’m so sorry for your loss.

I find myself in a similar position. I found out yesterday at an early scan I’d had a mmc, the baby stopped developing at 7+5 when it should have been more like 10 weeka. I was expecting the worst yesterday as I have had mmc before (3 years ago) and this time I had very few pregnancy symptoms, so it wasn’t a total shock. I had an EPRC last time but this time I opted for medical as we are going away next week and I wanted it to be done ASAP and not have to wait for surgery next week, but nothing much has happened :( at least with the surgery when it’s done, it’s really done. I had the misoprostol vaginally yesterday morning and had some bleeding last night with a few clots, but I’m certain it’s not enough and today it has pretty much stopped. I called the EPU this morning and they promised to talk to a consultant and ring me back but no news yet. I want another oral dose today but I know they are going to ask me to come back next week. We are meant to be heading to a cottage by the sea on Sunday (in the UK but few hours away) and we have been looking forward to it so much and so are my children. I can’t stand the thought that we might not be able to go - on top of the news yesterday it’s just so rubbish.

@DaisyBank82
I’m so sorry you’re going through this. My second dose of misoprostol appeared to not work either. After that I was advised they weren’t able to do anything else, I had to wait three weeks and retest. My light bleeding had fully stopped by the next week. The tests I took over the following weeks were getting fainter but after 3.5 weeks I still had a faint line. I went for a follow up scan which showed a little remaining product but not enough for them to do anything. I started having some more spotting and some tiny clots a couple days later and by the next week my tests were negative.

Looking back, I’m sure the first lot had worked, and the hard “marble” I passed the next morning was the sac. I was lucky that perhaps my body just absorbed most of the other tissue and that’s why I did have the heavy bleeding or big clots.

It’s a horrible waiting game. When was the soonest they could get you in for surgical options? If I was unlucky to go through this again I’d really prefer a surgical option so I wouldn’t have the wait thinking it hadn’t worked.

Thank you so much for your reply @IShineAShoe. I hope you’re doing ok now? It’s a horrible thing to go through. Unfortunately I’m no stranger to baby loss so I was always aware this was a possible outcome. I am very lucky to have two lovely living children to distract me.

I did talk to the hospital this afternoon eventually and because I’ve had what I would describe as “moderate” bleeding yesterday (rather than no bleeding at all) they think I might have passed what I need to and ask me to retest in 3 weeks but be prepared that things could start up again this week. I felt like what happened yesterday couldn’t have been everything but there were some clots and maybe the rest could get reabsorbed? I’m pleased as it means they don’t want to see me next week (I don’t want to go back in next week as we are away) and instead I can go away and try to relax and move on a bit.

@DaisyBank82 hi, sorry to jump in but got the notification because I've commented before. There's a big chance you've reabsorbed some tissue meaning the bleed wasn't as bad. However don't be surprised if your tests don't come back negative when you test and if that's the case please please get back to EPU. Try and enjoy your time away, I'm really sorry you've been through this too 💕

@DaisyBank82
Everything crossed that it’s smooth sailing from here now. I hope you enjoy your break away but I wouldn’t hesitate in getting checked out when you’re back in case you think there’s anything still there.

@Stabal and @IShineAShoethank you so much for your replies. I do feel relieved the nurse I spoke to said I can go away as I was worried they’d tell me I had to go back in to the EPU next week. She said if there was no bleeding that’s what they would say but as I had some, and it was more than light (though not really heavy either I can go. I hope I’m not doing the wrong thing by going... We won’t do much to be honest whilst we are there but there are some elderly relatives who live locally who I’d like to see (outside and socially distanced!) and I really hope I don’t suddenly miscarry properly when we are out and about and pass huge clots / haemorrhage like some poor women do. If I’d have more time to research yesterday I probably wouldn’t have gone for medical management as so many women seem to have such a traumatic ordeal (and I didn’t chose it last time as the ERPC felt like a better option then - the pregnancy had developed a bit more then though). The uncertainty is very hard. But this time it felt like the best worst option - I hope I don’t live to regret it.

@DaisyBank82
Keep us updated but I hope you manage to get a good break away.

Hi, I had a confirmed missed miscarriage at 9 weeks this morning. I had a nurse give me 5 tablets internally. I had to stay laying down for an hour before being let home with codeine.

It’s 13 hours later, & whilst I’ve had pain, I’ve had no bleeding at all.

I’m quite scared as they said if there was none by the morning I’d have to ring them, & it would probably lead to surgical intervention, but only with local anaesthetic.

I really don’t want to go through that with a local. She made it sound traumatic.

I don’t know what to do to make it start. I can feel slight pain, even with the codeine but I don’t even have any cm or discharge, let alone bleeding. 😩

@Sansa87 sorry to hear about your MMC 😔 if you've not started to bleed yet you probably won't. They will usually give you a second dose before thinking about the surgical option so I'd give them a ring 🤞

@Stabal Thankyou for replying. Nothing happened over night, have to ring epau between 11 & 12