Management of Incomplete Miscarriage in the 1st Trimester, at Primary Health Care Level

General measures

Medicine treatment

Referral

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O02.1/O03.4

Both Manual Vacuum Aspiration (MVA) and medical evacuation are equally effective for miscarriage.

GENERAL MEASURES

• Counselling.
• Evacuation of the uterus. 

MEDICINE TREATMENT

Medical evacuation:

•  Misoprostol, SL/PV/buccal, 800 mcg immediately as a single dose.
  •  Repeat after 24 hours if necessary.

LoE:IIIb¹

Manual vacuum aspiration:

Routine analgesia for vacuum aspiration:

• Morphine, IM, 0.1 mg/kg 30 minutes before aspiration procedure, to a maximum of 10 mg (Doctor prescribed).

LoE:IVb²

Alternatively, consider paracervical block if trained in technique. See TOP: Management of pregnancies up to the Twelfth week of gestation (12 weeks and 0 days)

Oral analgesia as required for 48 hours:

• Paracetamol, oral, 500 mg - 1 g, 4–6 hourly as required (to a maximum of 4 g in 24 hours).
  • Maximum dose: 15 mg/kg/dose.

AND

• Ibuprofen, oral, 400 mg 8 hourly with or after a meal, for 2–3 days.

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Follow up after one week to ensure that bleeding has stopped, or sooner if worsening symptoms. Perform a pregnancy test three weeks after medical management.

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LoE:IIIb³

REFERRAL

• Unsafe miscarriage
• Miscarriage ≥ 13 weeks' gestation
• Anaemia
• Haemodynamic instability
• Failed medical evacuation
• Positive pregnancy test 3 weeks after medical management

Click here to access the pdf.

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2025-9_Version 1.0_26 March 2026

Chapter 6: Obstetrics and Gynaecology_6.2.1 Management of Incomplete Miscarriage in the 1st Trimester, at Primary Health Care Level