Q. Why am I not bleeding even after taking four pills of Misoprostol for abortion?

Answered by
Dr. Jimesh H. Mavani
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Mar 29, 2020

Hello doctor,

I am O negative and my husband is Rh-positive. I have a baby of 1.6 years old, Rh-positive. Now I am pregnant of six weeks and do not want to continue so I take an abortion kit but after taking all four Misoprostol pills bleeding not started yet and it is almost 24 hours gone. What to do now? Do I have life threatening risk? I am worried.



Welcome to

You need to do one ultrasound scan to confirm the pregnancy. If you had done scan before taking pills then wait for 12 days and if no bleeding then repeat ultrasound scan. And if you did not do ultra scan then get it done.

You should bleed. But if not then either you had wrong pills or pills did not work. And will require surgical abortion. You need to consult a nearby gynecologist or abortion center.

One rare chance is to have an ectopic pregnancy if you did not do an ultrasound scan. But if it was there then you should have more pain in the lower abdomen on one side. It will clear in the next ultra scan. In that case, treatment may vary. After bleeding starts you should take Rh anti D 150 ug injection within 72 hours because we do not know the fetus blood group.

Do drink more water. And if you did not do ultrasound scan then you can repeat the urine pregnancy test also. Because sometimes kits also come faulty and give false-positive results. So to compare or confirm you can repeat.

Thank you doctor,

I have done ultrasound and it is not ectopic pregnancy and in ultrasound pregnancy is confirmed of average six weeks. If bleeding not started what should I do?



Welcome back to

Means tablets failed and very less chances it will work if you take again. You need to do surgical abortion means have to do dilatation and curettage procedure to clean the uterus. Better to go directly for the procedure.

Thank you doctor,

In surgical abortion procedure do I need to take anti D because I am Rh negative and my first baby is Rh positive and during my first pregnancy I have given anti-D. Do I need it again?



Welcome back to

Yes, in any type of bleeding. In Surgical abortion also. Anti d injection is to avoid some problems in future pregnancy. Dose is less than what we take while delivery of the baby. Anti D 150 within 72 hours of bleeding or abortion is recommended. Because without it next pregnancy may get major problems during the fifth or sixth month. So better to take it.

Injection is recommended in every pregnancy. It is to avoid your body to form IgG antibodies against positive blood if fetus blood mixed with your blood. Because your antibodies can remain lifelong and can be harmful to the next baby if it has positive blood group. It can create problem during the middle of next pregnancy.

Thank you doctor,

It is almost 24 hours gone after taking the first three Misoprostol tablets at 11 AM and fourth at 9 PM. Do I need to wait further to see bleeding or should I go to a gynecologist in a hurry. One thing I would like to communicate you after taking the first three pills vomiting occur after three hours and slight bleeding occurred.



Welcome back to

If pregnancy is confirmed and slight bleeding occurs. Then as I said already you can wait for 10 to 12 days for abortion to happen. But yes, you should take anti D now.

Actually chances are less that it will clear up on its own. But you can wait. Sometimes it clears up in 10 to 20% time. Chances are less because pills have effects only up to 12 hours after you take it. If vomiting happened after three hours then no need to worry, pills should work because it gets absorbed within 30 minutes.

Many times pregnancy stops growing and your body throws it out on its own in 10 to 20%. So you can wait up to 12 days. But if no bleeding till 12 days or bleeding continues after 12 days then ultra scan will require to confirm. Or you can directly opt for surgical abortion in nearby abortion center if you do not want much tension and wants it to clear up as early as possible.

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