Early Pregnancy Loss in Emergency Medicine Medication

Updated: Jan 03, 2017
  • Author: Slava V Gaufberg, MD; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Medication

Medication Summary

The goals of pharmacotherapy are to prevent complications and to reduce morbidity.

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Immune globulins

Class Summary

This agent suppresses immune response and antibody formation.

Rho(D) Immune Globulin (RhoGAM)

In nonsensitized Rho(D)-negative mothers who are exposed to Rho(D) prevents antibody formation to Rh-positive red blood cells of the fetus caused by abortion, fetomaternal hemorrhage, abdominal trauma, amniocentesis, full-term delivery, or transfusion accident.

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Oxytocic Agent

Class Summary

This agent has vasopressive effects and prevents postpartum bleeding.

Oxytocin (Pitocin, Syntocinon)

Produces rhythmic uterine contractions and can control postpartum bleeding or hemorrhage.

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Prostaglandin

Class Summary

These agents induce uterine contractions.

Misoprostol (Cytotec)

Not approved for use in pregnancy, yet is an invaluable medication widely used for cervical preparation for miscarriage, labor induction, and as a medical abortifacient. Provides safe, passive method of cervical dilatation and should be considered for facilitation of passage of products of conception in the setting of inevitable or incomplete miscarriage, preabortion ripening when prior uterine surgery (ie, LEEP, cesarean delivery) are known risk factors for uterine perforation during surgical abortion. Can be administered orally or vaginally. Some studies show premoistened tablets placed vaginally help absorption. Patients can be instructed in self-administration to help time the dose in synchrony with their abortion procedure.

In a study by Singh of primigravid women (6-11 wk gestation), 93.3% achieved dilatation of the cervix of 8 mm or greater after 3 h postintravaginal misoprostol 400 mcg, whereas only 16.7% of women achieved this after 2 h of 600 mcg. The 600-mcg group had slightly greater adverse effects (eg, bleeding, abdominal pain, fever >38ºC).

Dosage intended for cervical ripening can induce abortion in some patients. Oral doses of 100-400 mcg can be combined with vaginal insertion of prostaglandins to enhance cervical dilatation.

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