1.
Blood test
& Methotrexate
2.
4 Misoprostol pills
3 packages 4 – 12 hrs apart
3.
Blood Test
4.
Skype Follow up
Visit with Doctor
Month
Date
MEDICATION Misoprostol (M,) Gravol
(G), etc.
BLEEDING: (H, B, or S)
PAIN : Worst level of
pain experienced( 0-10)
OTHER SYMPTOMS :
Nausea (N),
Vomiting (V),
Diarrhea (D),
Fever (F),
Chills (C),
Headache (H),
Tiredness (T)
etc.
INSTRUCTIONS: Please assist us by filling in this diary every day during your treatment.
If you use a medication, put the initial, for example, "M" for Misoprostol, “G” for Gravol in the column under the appropriate day.
For bleeding, put an “H” for bleeding Heavier than your normal period, “B” for any red Bleeding, and “S” for spotting.
Where it says “worst level of pain experienced”, ask yourself this question: On a scale of 0 to 10, with 0 being no pain and 10 being pain
as bad as it can be, what is the worst level of pain you experienced today?
For other symptoms put an “N” for nausea, “V” for vomiting, “D” for diarrhea, etc
INSTRUCTIONS:
Do not take any folic acid supplements (in most
vitamin pills).
To prevent infection, take the 4 Metronidazole
(antibiotics) on the night before you take the
Misoprostol. Swallow all pills in one dose
(or insert the metronidazole suppository into your
rectum). It is best to eat first, and you will need to
avoid alcohol for 24 hours.
You can take Gravol for nausea. For cramping, take
Ibuprofen, Tylenol #3, and/or Percocet. Remember
that Tylenol #3, Percocet, and Gravol can make you
drowsy, so don’t drive after you have taken them.
You may eat or drink as usual, and go back to your
normal activities (including wearing tampons and
sexual activities) as soon as you feel ready. Most
women need to rest for 1-2 days after using the
misoprostol tablets.
Mood swings or emotional upset often accompany the
drop in pregnancy hormones and may last for a few
days or even weeks. Nausea from the pregnancy
should disappear within two days and breast changes
usually go down by then end of the first week but
both may still persist if you are on the birth control
pill. Your regular cycle will return in 4-6 weeks.
CALL US:
If you soak more than 2 pads per hour for more
than 4 hours
(8 pads in 4 hours maximum).
If you have a fever over 38∘C (100.4∘F) for more
than 4 hours, or feel sick (nausea, vomiting) for
MORE THAN 24 HOURS AFTER YOUR
LASTMISOPROSTOL DOSE. (It is normal to have
those side effects on the same day you take
misoprostol.)
EMERGENCY NUMBER:
Call Willow Women’s Clinic
604-709-5611 24 Hours
Please do not call the emergency number if you are
concerned that you are not bleeding enough. Call the
office during regular hours to discuss with staff.
PROTOCAL
1st
Skype Visit: You will meet with the doctor who will go
over your medical history, ultrasound and blood tests. The
counsellor will explain the procedure to you.
Once you have received the package: Call us to let us know
and we will answer any more questions you may have.
You will take the Methotrexate tablets to stop the pregnancy.
Most women feel nothing after taking them but some get more
nauseous or tired.
You may decide to use the misoprostol anytime within 7 days
after taking the Methotrexate. The counsellor will discuss the
best timing for you.
Within 24 hours of taking the Misoprostol:
You will take Metronidazole (antibiotics) with food. Avoid
alcohol for at least 24 hours.
The next day: You will use the first set of 4 Misoprostol pills.
Wash your hands and put one drop of water on each pill before
putting them into your vagina as far as you can with your
finger. Follow with the next package of 4 misoprostol at least
4 hours, but no more than 12 hours, later. Again, wait at least 4
hours, but no more than 12 hours, and insert the last package of
4 misoprostol pills in the same way. You can expect to have
cramps, bleeding, and to pass blood clots within the next 24
hours. The bleeding is likely to be heavier than a period and
stay at least as heavy as a period for a few days.
Most women will have strong cramping. You may use a hot
water bottle and take the Ibuprofen, Tylenol #3 and/or the
Percocet you were given. It is normal to have side effects from
the medication such as a brief fever, nausea, vomiting or chills.
If the nausea is quite strong take a gravol before taking the pain
medications. If you are actually vomiting, use the gravol
suppository.
If you are one of the women who have a delayed reaction to the
medication you may have little or no bleeding. This does not
mean the procedure is not working, and we will discuss your
options at your follow up appointment.
One week after taking Methotrexate: You will go for
another blood test.
The next day: You will have another Skype visit with the
doctor who will review your blood tests. You should have your
diary with you so you can let us know how things went. If the
blood test shows that the hormone level has dropped >80% you
are done and do not require any further treatment.
If the blood test does not show an adequate drop in level you
may be asked to have another blood test in a few days or
arrange for an ultrasound. We will book a further Skype
appointment for after these tests are done.
You can expect to have more bleeding which may be heavy at
times and you may pass more clots. You may have some
spotting up to four weeks after but this should stop after your
first normal period.
The pregnancy usually stops when you take the medication,
but if you are in the small percentage of women who still
have a growing pregnancy at the time of your follow up,
you will require surgery. This can be arranged at our clinic
or you can go to a clinic closer to you.