Spontaneous abortion medical management: adding mifepristone boosts success rate

  • Schreiber CA & al.
  • N Engl J Med
  • 7 Jun 2018

  • curated by Elisabeth Aron, MD, MPH, FACOG
  • Clinical Essentials
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Takeaway

  • Adding mifepristone (Mifeprex) to misoprostol (Cytotec) improves success rate for medical treatment of first-trimester miscarriage.

Why this matters

  • Early pregnancy loss is common and is often treated with active medical management. 
  • Using mifepristone plus misoprostol improves the success of medical management of miscarriage without increasing side effects.

Key results

  • Treatment success occurred in 83.8% (95% CI, 76.8-89.3) in the combination groups vs 67.1% (95% CI, 59.0-74.6) is the misoprostol-alone group.
  • Taking misoprostol
  • No differences in reported side effects, including blood transfusion and pelvic infection, between groups.

Study design

  • Randomized trial.
  • Women with a nonviable pregnancy between 5 and 12 completed weeks of gestation were randomly assigned to receive pretreatment with 200 mg of mifepristone orally followed by 800 μg of misoprostol vaginally after 24 hours (n=148) vs misoprostol alone (n=149).
  • The primary outcome was gestational sac expulsion by the first follow-up visit (24 hours to 4 days after misoprostol use).
  • Success assessed by transvaginal ultrasound.
  • Funding: The National Institute of Child Health and Human Development of the National Institutes of Health; Women’s Reproductive Health Research award.

Limitations

  • No placebo group.

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