The second round of misoprostol is not necessary for most patients. The second dose is only useful if you have had no bleeding at all (not even spotting) after a full 24 hours. If in doubt, just set it aside and call us during normal business hours to discuss. Only patients who are more than 9 weeks from their last menstrual period are instructed to use the second dose after 4 hours regardless. Use our pregnancy calculator if you aren’t sure how far into your pregnancy you are. If you had an ultrasound, go by the ultrasound instead.