Efficacy of mifepristone and misoprostol for medical treatment of missed miscarriage in clinical practice—A cohort study

Abstract

Introduction It has been estimated that one out of every four women experience first‐trimester miscarriage. Missed miscarriage is a common form of early miscarriage where the products of conception are not expelled from the uterus. It is diagnosed by ultrasound. The primary objective of this study was to evaluate the success rate of a combination treatment with mifepristone and misoprostol for missed miscarriage in clinical practice. The secondary objective was to identify significant factors influencing the rate of success. Material and methods A cohort of 941 consecutive women with an ICD‐10 diagnosis of missed miscarriage who received treatment with 800 µg vaginal misoprostol and 2 repeat doses of 400 µg oral misoprostol after mifepristone pretreatment between 1 January 2012 and 31 December 2014 was analyzed. Women with a uterine size smaller than 12 weeks who were planned for medical treatment were included in the study. The exclusion criteria were primary surgical management or planned follow up outside the Stockholm County Council area. Results The success rate of medical treatment, defined as no need for surgical treatment, was 85.5% (805/941) in women with a uterine size of less than 12 weeks. However, for women with uterine size below 9 weeks the success rate was 88.9% (586/659). Indeed, uterine size of 9 gestational weeks or larger at time of treatment was identified as the only significant risk factor for surgical intervention. Conclusions The medical regimen for missed miscarriage offered in this study appears to be safe and with high rates of success. Conclusions about which women to exclude from medical treatment could not be made. Medical treatment may therefore benefit all women with missed miscarriage who wish to avoid primary surgery.

To operate or to wait? Doppler indices as predictors for medical termination for first trimester missed abortion

“…Prior studies by Kim et al portrayed such association, which is contrary to that of Reeves et al and Ehrnstén et al, who stated that the possibility of a successful outcome decreases as gestational age and parity advance since the stretching of uterine muscles and loss of muscle integrity lead to poor response to medical termination. This relationship was most striking in ≥ para 5 patients; this may explain the apparent contradiction with the current study as the mean parity was 4 in our patients [8][9][10]. This study shows there is a strong relationship between predicting good responder and vaginal delivery.…”

Bleeding pattern after medical management of early pregnancy loss with mifepristone–misoprostol and its prognostic value: a prospective observational cohort study

“…Therefore, it is possible that some cases with documented histologically proven RPOC and early D&C might have resolved spontaneously if they had chosen a more expectative approach. The overall success rate in this study (83.1%—defined as no histologically confirmed RPOC in a D&C within three months) was comparable to success rates in other recent prospective studies (83–85%—defined as no surgical intervention to complete the miscarriage up to discharge) [ 9 , 16 ]. However, it is mentionable that the overall D&C-rate was 24.7%, which shows on the one hand the known difficulties in interpreting sonographic results after incomplete expulsion [ 17 ], but on the other hand maybe as well that persistent decidual tissue can cause bleeding disorders and pain [ 18 ].…”

Management of pregnancy after radical trachelectomy

“…Therefore, it was suggested that expectant management may be useful and appropriate for first-trimester miscarriages after RT [12]. Although the use of mifepristone and/or misoprostol for the treatment of an early miscarriage has been reported to have a high success rate in patients without a history of RT [13,14], there are no data evaluating the efficacy of any medication to treat miscarriage in patients after RT.…”