Early Pregnancy Loss Medication
- Author: Elizabeth E Puscheck, MD; Chief Editor: Richard Scott Lucidi, MD, FACOG more...
For a complete abortion, no medication is likely to be needed. Usually, the uterus contracts well after expelling the entire contents and the cervix is closed. The risk for infection is minimal.
Used to suppress the immune system when the mother is Rh negative.
Suppresses immune response of mother who is nonsensitized Rh O (D) negative exposed to Rh O (D) positive blood from the fetus as a result of a fetomaternal hemorrhage, abdominal trauma, amniocentesis, abortion, full-term delivery, or transfusion accident.
Ergot alkaloid and derivatives
Occasionally, the uterus does not contract well, and a clot may form in the uterine cavity. If the physician notes a boggy uterus after expulsion of the products of conception, the physician may consider methylergonovine in the appropriate candidate. In most cases in which a clot forms within the uterus, a surgical D&C finally is warranted.
Acts directly on uterine smooth muscle, causing a sustained tetanic uterotonic effect that reduces uterine bleeding and shortens the third stage of labor.
Administer IM after a D&C, during puerperium, after delivery of placenta, or after delivering anterior shoulder. Also may be administered IV over no less than 60 sec, but should not be administered routinely because it may provoke hypertension or a stroke. Monitor blood pressure closely when administering IV.
Antineoplastic Agent, Antimetabolite
These agents inhibit cell growth and proliferation.
Antimetabolite that inhibits dihydrofolate reductase, thereby hindering DNA synthesis and embryonic cell reproduction.
Misoprostol, a prostaglandin agent, has been recently reported as safe and effective medical treatment for missed abortion, inevitable abortion, or incomplete abortion. It is used as off-labeled indication and is not FDA approved for this indication.
Prostaglandin agent also categorized as an anti-ulcer (protective) and endocrine metabolic agent. As a prostaglandin agent, misoprostol will increase uterine smooth muscle contractions and soften the cervix to allow passage of products of conception from missed abortion, inevitable abortion, or incomplete abortion. Not FDA approved for medical treatment of these types of abortions; yet, recent literature suggests is that it is safe and effective. Administered orally or vaginally. Comes in 200 mcg tablets.
Cengiz H, Dagdeviren H, Kanawati A, et al. Ischemia-modified albumin as an oxidative stress biomarker in early pregnancy loss. J Matern Fetal Neonatal Med. 2015 Sep 18. 1-4. [Medline].
Barnhart KT, Katz I, Hummel A, Gracia CR. Presumed diagnosis of ectopic pregnancy. Obstet Gynecol. 2002 Sep. 100(3):505-10. [Medline].
Condous G, Kirk E, Lu C, et al. There is no role for uterine curettage in the contemporary diagnostic workup of women with a pregnancy of unknown location. Hum Reprod. 2006 Oct. 21(10):2706-10. [Medline].
Calleja-Agius J, Jauniaux E, Pizzey AR, Muttukrishna S. Investigation of systemic inflammatory response in first trimester pregnancy failure. Hum Reprod. 2011 Nov 29. [Medline].
Nelson DB, Hanlon AL, Wu G, Liu C, Fredricks DN. First trimester levels of BV-associated bacteria and risk of miscarriage among women early in pregnancy. Matern Child Health J. 2015 Dec. 19 (12):2682-7. [Medline].
Giakoumelou S, Wheelhouse N, Cuschieri K, Entrican G, Howie SE, Horne AW. The role of infection in miscarriage. Hum Reprod Update. 2015 Sep 19. [Medline].
Thangaratinam S, Tan A, Knox E, et al. Association between thyroid autoantibodies and miscarriage and preterm birth: meta-analysis of evidence. BMJ. 2011 May 9. 342:d2616. [Medline]. [Full Text].
Arck PC, Rucke M, Rose M, et al. Early risk factors for miscarriage: a prospective cohort study in pregnant women. Reprod Biomed Online. 2008 Jul. 17(1):101-13. [Medline].
Maconochie N, Doyle P, Prior S, Simmons R. Risk factors for first trimester miscarriage--results from a UK-population-based case-control study. BJOG. 2007 Feb. 114(2):170-86. [Medline].
Gracia CR, Sammel MD, Chittams J, Hummel AC, Shaunik A, Barnhart KT. Risk factors for spontaneous abortion in early symptomatic first-trimester pregnancies. Obstet Gynecol. 2005 Nov. 106(5 Pt 1):993-9. [Medline].
Nakhai-Pour HR, Perrine B, Sheehy O, Berard A. Use of nonaspirin nonsteroidal anti-inflammatory drugs during pregnancy and the risk of spontaneous abortion. CMAJ. September 6, 2011. [Full Text].
Hahn KA, Hatch EE, Rothman KJ, et al. Body Size and Risk of Spontaneous Abortion among Danish Pregnancy Planners. Paediatr Perinat Epidemiol. 2014 Sep. 28(5):412-23. [Medline].
Clifford K, Rai R, Regan L. Future pregnancy outcome in unexplained recurrent first trimester miscarriage. Hum Reprod. 1997 Feb. 12(2):387-9. [Medline].
Liddell HS, Pattison NS, Zanderigo A. Recurrent miscarriage--outcome after supportive care in early pregnancy. Aust N Z J Obstet Gynaecol. 1991 Nov. 31(4):320-2. [Medline].
Stray-Pedersen B, Stray-Pedersen S. Etiologic factors and subsequent reproductive performance in 195 couples with a prior history of habitual abortion. Am J Obstet Gynecol. 1984 Jan 15. 148(2):140-6. [Medline].
Chang J, Elam-Evans LD, Berg CJ, et al. Pregnancy-related mortality surveillance--United States, 1991--1999. MMWR Surveill Summ. 2003 Feb 21. 52(2):1-8. [Medline].
O’Riordan M. Pregnancy loss associated with a later risk of atherosclerosis. March 29, 2013. Available at http://www.medscape.com/viewarticle/781681.
Ranthe MF, Andersen EA, Wohlfarht J, Bundgaard H, Melbye M, Boyd HA. Pregnancy Loss and Later Risk of Atherosclerotic Disease. Circulation. 2013 Mar 27. [Medline].
Practice Committee of American Society for Reproductive Medicine. Medical treatment of ectopic pregnancy. Fertil Steril. 2008 Nov. 90(5 Suppl):S206-12. [Medline].
Lewis R. First Do No Harm: Guidelines Define a Nonviable Pregnancy. Medscape Medical News. Available at http://www.medscape.com/viewarticle/812346. Accessed: October 15, 2013.
Doubilet PM, Benson CB, Bourne T, Blaivas M. Diagnostic Criteria for Nonviable Pregnancy Early in the First Trimester. N Engl J Med. 2013 Oct 10. 369(15):1443-1451. [Medline].
Weeks A, Alia G, Blum J, et al. A randomized trial of misoprostol compared with manual vacuum aspiration for incomplete abortion. Obstet Gynecol. 2005 Sep. 106(3):540-7. [Medline].
Zhang J, Gilles JM, Barnhart K, Creinin MD, Westhoff C, Frederick MM. A comparison of medical management with misoprostol and surgical management for early pregnancy failure. N Engl J Med. 2005 Aug 25. 353(8):761-9. [Medline].
Lee SK, Kim JY, Han AR, et al. Intravenous immunoglobulin G improves pregnancy outcome in women with recurrent pregnancy losses with cellular immune abnormalities. Am J Reprod Immunol. 2015 Oct 29. [Medline].
Luna RL, Nunes AK, Oliveira AG, et al. Sildenafil (Viagra) blocks inflammatory injury in LPS-induced mouse abortion: A potential prophylactic treatment against acute pregnancy loss?. Placenta. 2015 Oct. 36 (10):1122-9. [Medline].
[Guideline] American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 94: Medical management of ectopic pregnancy. Obstet Gynecol. 2008 Jun. 111(6):1479-85. [Medline]. [Full Text].
Wahabi HA, Fayed AA, Esmaeil SA, Al Zeidan RA. Progestogen for treating threatened miscarriage. Cochrane Database Syst Rev. 2011 Dec 7. 12:CD005943. [Medline].
Boyle FM, Mutch AJ, Barber EA, Carroll C, Dean JH. Supporting parents following pregnancy loss: a cross-sectional study of telephone peer supporters. BMC Pregnancy Childbirth. 2015 Nov 9. 15:291. [Medline].
[Guideline] ACOG practice bulletin. ACOG practice bulletin. Medical management of tubal pregnancy. Number 3, December 1998. Clinical management guidelines for obstetrician-gynecologists. American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet. 1999 Apr. 65(1):97-103. [Medline].
Chipchase J, James D. Randomised trial of expectant versus surgical management of spontaneous miscarriage. Br J Obstet Gynaecol. 1997 Jul. 104(7):840-1. [Medline].
Chung TK, Cheung LP, Sahota DS, Haines CJ, Chang AM. Spontaneous abortion: short-term complications following either conservative or surgical management. Aust N Z J Obstet Gynaecol. 1998 Feb. 38(1):61-4. [Medline].
Creinin MD, Schwartz JL, Guido RS, Pymar HC. Early pregnancy failure--current management concepts. Obstet Gynecol Surv. 2001 Feb. 56(2):105-13. [Medline].
Geyman JP, Oliver LM, Sullivan SD. Expectant, medical, or surgical treatment of spontaneous abortion in first trimester of pregnancy? A pooled quantitative literature evaluation. J Am Board Fam Pract. 1999 Jan-Feb. 12(1):55-64. [Medline].
Hurd WW, Whitfield RR, Randolph JF Jr, Kercher ML. Expectant management versus elective curettage for the treatment of spontaneous abortion. Fertil Steril. 1997 Oct. 68(4):601-6. [Medline].
Jurkovic D, Ross JA, Nicolaides KH. Expectant management of missed miscarriage. Br J Obstet Gynaecol. 1998 Jun. 105(6):670-1. [Medline].
Kalousek DK. Clinical significance of morphologic and genetic examination of spontaneously aborted embryos. Am J Reprod Immunol. 1998 Feb. 39(2):108-19. [Medline].
Katz VL, Lentz G, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia: Mosby Elsevier; 2007.
Keith SC, London SN, Weitzman GA, O'Brien TJ, Miller MM. Serial transvaginal ultrasound scans and beta-human chorionic gonadotropin levels in early singleton and multiple pregnancies. Fertil Steril. 1993 May. 59(5):1007-10. [Medline].
Nielsen S, Hahlin M. Expectant management of first-trimester spontaneous abortion. Lancet. 1995 Jan 14. 345(8942):84-6. [Medline].
Scroggins KM, Smucker WD, Krishen AE. Spontaneous pregnancy loss: evaluation, management, and follow-up counseling. Prim Care. 2000 Mar. 27(1):153-67. [Medline].
van Veen TR, Haeri S, Baker AM. Teen pregnancy: are pregnancies following an elective termination associated with increased risk for adverse perinatal outcomes?. J Pediatr Adolesc Gynecol. 2015 Dec. 28 (6):530-2. [Medline].
Marko EK, Buery-Joyner SD, Sheridan MJ, Nieves K, Khoury AN, Dalrymple JL. Structured teaching of early pregnancy loss counseling. Obstet Gynecol. 2015 Oct. 126 suppl 4:1S-6S. [Medline].