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Blood test 4 Misoprostol pills Blood Test Skype Follow up

Methotrexate 3 packages 4 – 12 hrs apart 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 pregnancyhormones 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 theMethotrexatetablets 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.