BACKGROUND AND PURPOSE:

• Misoprostol is an alternative to uterine aspiration following miscarriage but often with limited results
• Schreiber et al. (NEJM 2018) compared the efficacy and safety of pretreatment with mifepristone versus misoprostol alone for miscarriage management

METHODS:

• Randomized Controlled Trial (RCT)
  • Comparative Effectiveness of Pregnancy Failure Management Regimens (PreFaiR) trial
• Participants
  • Healthy women ≥18 years
  • Nonviable intrauterine pregnancy at 5-12 weeks (ultrasound confirmed)
• Patients randomized to the following
  • 200 mg mifepristone followed by 800 µg misoprostol
  • 800 µg misoprostol alone
• Patients returned for follow-up at 1 to 4 days following misoprostol
• Primary outcome
  • Gestational sac expulsion with one dose of misoprostol by the first follow-up visit and no additional intervention within 30 days after treatment

RESULTS:

• 148 participants in mifepristone pretreatment group and 149 in the misoprostol alone group were available for analysis
• 83.8% of mifepristone-pretreatment group and 67.1% of misoprostol alone group experienced complete expulsion
  • Relative risk (RR) 1.25; 95% CI, 1.09 to 1.43
• Uterine aspiration was performed less frequently in the mifepristone-pretreatment group (8.8%) vs the misoprostol-alone group (23.5%)
  • RR 0.37; 95% CI, 0.21 to 0.68
• Blood transfusion was not statistically different between the two groups
  • 2.0% mifepristone-pretreatment group vs 0.7% in the mifepristone-misoprostol-alone group (P=0.31)
• Benefit of mifepristone-pretreatment was also found at ≤9 weeks
  • 84.8% (117 of 138 women) in the mifepristone-pretreatment group vs 66.7% (94 of 141 women) in the misoprostol-alone group
• There were no significant differences in bleeding intensity and pain

CONCLUSION:

• The addition of mifepristone prior to misoprostol improves treatment of early pregnancy loss

Learn More – Primary Sources:

Mifepristone Pretreatment for the Medical Management of Early Pregnancy Loss

Related ObG Topics:

Managing Early Pregnancy Loss

How Effective are Treatments for Unexplained Recurrent Miscarriage?

Physical Activity and Time-to-Pregnancy in Women with a History of Pregnancy Loss

Conceiving After Pregnancy Loss – Is Waiting Beneficial?