Your healthcare provider will give you a prescription for mifepristone/ misoprostol that may also include pain medication. You should call your pharmacy to ensure this medication is available.

1. You will first take mifepristone orally. You may experience some spotting in the 24 hours that follow mifepristone. Some people find they do not experience any symptoms and continue to work during this time. 
2. 24-48 hours later, you will place 4 tablets of misoprostol in your vagina. The miscarriage will usually occur within 4-12 hours from the time you insert the misoprostol tablets. 
3. Your provider should arrange a telephone follow-up with you 1 week after you take the medication to ensure you have had the miscarriage.
   

You are likely to experience cramping and bleeding that lasts several hours. For many, heavy bleeding and severe cramping lasts 2-3 hours while the miscarriage is occuring. You may continue to feel symptoms of pregnancy such as nausea and fatigue until your miscarriage is completed. 

After the passage of pregnancy tissue, you will continue to have some cramping and bleeding for up to 2 weeks. Bleeding after a miscarriage is often similar to a menstrual period. 

It is not necessary for you to have an ultrasound after you have miscarried, unless you continue to have heavy bleeding following the miscarriage (soaking 1 pad per hour for more than 3 hours), or you experience ongoing bleeding or cramping 2 weeks after your miscarriage. 

Side effects are usually mild and can include nausea, vomiting or diarrhea. Please alert your provider if you experience vomiting within 1 hour of taking mifepristone. 

You may continue to breastfeed while taking this two drug combination. 

• Have a family member or friend you can call for emotional support
• Use a hot compress or water bottle on your lower abdomen
• Take acetaminophen (Tylenol) or ibuprofen (Advil) for pain, and dimenhydrinate (Gravol) for nausea, as needed
• We recommend you use pads, not tampons, and avoid swimming and sexual intercourse during this time.
  

You may experience 

• Heavy bleeding which may require a visit to the Emergency Room, a D&C and rarely, a blood transfusion
  
• Fever or severe cramping that requires antibiotics to treat an infection
• Ongoing bleeding or cramping >3 weeks after your miscarriage may be due to pregnancy tissue remaining in your uterus
  
  

Although it is called a D&C, it is generally done with a suction device and is better described as a suction and evacuation procedure. While performing this procedure, a thin tube is inserted into the uterus and connected to a source of suction. This source can either be an electric or handheld pump. 

The procedure generally lasts 10 to 15 minutes. It can be done with oral or intravenous pain medication as an outpatient procedure. 

You may recover for 30-60 mins after the procedure before going home. It is 99% successful in completing your miscarriage. 

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• Have a family member or friend you can call for emotional support
• Use a hot compress or water bottle on your lower abdomen
• Take acetaminophen (Tylenol) or ibuprofen (Advil) for pain, and dimenhydrinate (Gravol) for nausea, as needed
• We recommend you use pads, not tampons, and avoid swimming and sexual intercourse during this time

Possible complications include:

• Heavy bleeding which may require a visit to the emergency room, a second D&C, or rarely, a blood transfusion.
  
• Fever or severe cramping that requires antibiotics to treat an infection
• Ongoing bleeding or cramping >3 weeks after your procedure that may be due to pregnancy tissue remaining in your uterus
  
• Possible injury to the uterus, including cervical tears, perforation (hole in the uterus) or Asherman's Syndrome (scarring inside the uterus). 
• These complications are rare (less than 1%). 
• If you do not menstruate by the 3rd month after D&C, please alert your provider as this could be a sign of scarring. Scarring in your uterus is treatable, but could delay your plans to become pregnant again.