I've been pregnant for more than 12 weeks. Can I still use Misoprostol?
Misoprostol still works after 12 weeks of pregnancy but the chance of complications rapidly increases the more advanced the pregnancy is. 4% to 8% of women with second trimester pregnancies (after 12 weeks of pregnancy), who try to end their pregnancies with Misoprostol as described below, will experience severe bleeding. Therefore it is strongly advised that the pills are taken in the waiting room of a hospital or in a private place very close to a hospital. In that case, should you need urgent medical attention, you will be nearby. The symptoms are exactly the same as a miscarriage. If you need emergency care in a hospital, it is important to tell the doctors you had a miscarriage, as women can be prosecuted for having an abortion. The symptoms and treatment are the same.
You should not be alone when doing this.
Till 12 weeks of pregnancy a woman should put 4 pills of of 200 micrograms (in total 800 mcg) Misoprostol under the tongue. Do not swallow!! After 3 hours she should put another 4 pills of Misoprostol under the tongue. Do not swallow. After 3 hours she should put another 4 pills of Misoprostol under the tongue again for a third time. Do not swallow.
If you are 13-20 weeks pregnant, you can use misoprostol to induce your abortion.
A woman should take 2 tablets of 200 mcg (in total 400 mcg) each under the tongue every 3 hours up to a total of 5 doses (10 tablets). However, if you have used the tablets vaginally, if you go to the doctor you will need to use your finger to remove all traces of the tablets from your vagina, so because of this we always advise to use the tablets under the tongue if you are worried about legal problems.
After 24 hours, this method is effective approximately 80% of the time. There may be very heavy cramping and bleeding, therefore it is strongly advised that the pills are taken in the waiting room of a hospital or in a private place very close to a hospital.
Realize that you will loose a lot of tissue and blood, but also a fetus (the size depends on the duration of the pregnancy), which can be recognized as such. It can be quite distressing to see. You are strongly discouraged to do an abortion after 15 weeks by yourself because of the high complication risk and because it can be very traumatic. It is exxentially an induction procedure of birth at that point (the woman goes through a labor alike experience) so she should be in a hospital!.
Sublingual versus vaginal misoprostol for second trimester termination: a randomized clinical trial. Tanha FD1, Golgachi T, Niroomand N, Ghajarzadeh M, Nasr R., Arch Gynecol Obstet. 2013 Jan;287(1):65-9. doi: 10.1007/s00404-012-2508-y. Epub 2012 Aug 19.
The sublingual route of misoprostol administration has the same efficacy as the vaginal route and can be applied for second trimester pregnancy termination in primigravid women in outpatient settings due to its simple administrations.