Mifepristone and misoprostol for early pregnancy failure: a cohort analysis

Kollitz, Kathleen M.; Meyn, Leslie A.; Lohr, Patricia A.; Creinin, Mitchell D.

doi:10.1016/j.ajog.2010.12.026

Cited by 31 publications

(22 citation statements)

References 18 publications

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“…This decrease in exigent presentations has led to an interest in pursuing nonsurgical treatment options for pregnancy loss. 6,7 Although some women pursue expectant management, women generally prefer active management 6,[8][9][10][11][12] ; the ability to have control over the management of miscarriage may relieve some of the emotional burden that accompanies firsttrimester pregnancy loss. [12][13][14] Medical management of early pregnancy loss with prostaglandin analogues allows for planned, expedited expulsion of the nonviable pregnancy tissue, with the goal of avoiding a surgical procedure.…”

Section: Resultsmentioning

confidence: 99%

“…15,19,20 The reported effectiveness of combination treatment with mifepristone and misoprostol for early pregnancy loss has ranged from 52 to 95%. 3,10,11,21,22 This wide range is due in part to heterogeneity in study designs and outcome definitions. 3 To date, the usefulness of mifepristone in the treatment of early pregnancy loss has remained unclear.…”

Section: Resultsmentioning

confidence: 99%

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Mifepristone Pretreatment for the Medical Management of Early Pregnancy Loss

Schreiber¹,

Creinin²,

Atrio³

et al. 2018

Obstetric Anesthesia Digest

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BACKGROUNDMedical management of early pregnancy loss is an alternative to uterine aspira-tion, but standard medical treatment with misoprostol commonly results in treat-ment failure. We compared the efficacy and safety of pretreatment with mifepris-tone followed by treatment with misoprostol with the efficacy and safety of misoprostol use alone for the management of early pregnancy loss. METHODSWe randomly assigned 300 women who had an anembryonic gestation or in whom embryonic or fetal death was confirmed to receive pretreatment with 200 mg of mifepristone, administered orally, followed by 800 µg of misoprostol, adminis-tered vaginally (mifepristone-pretreatment group), or 800 µg of misoprostol alone, administered vaginally (misoprostol-alone group). Participants returned 1 to 4 days after misoprostol use for evaluation, including ultrasound examination, by an in-vestigator who was unaware of the treatment-group assignments. Women in whom the gestational sac was not expelled were offered expectant management, a second dose of misoprostol, or uterine aspiration. We followed all participants for 30 days after randomization. Our primary outcome was gestational sac expulsion with one dose of misoprostol by the first follow-up visit and no additional intervention within 30 days after treatment. RESULTSComplete expulsion after one dose of misoprostol occurred in 124 of 148 women (83.8%; 95% confidence interval [CI], 76.8 to 89.3) in the mifepristone-pretreat-ment group and in 100 of 149 women (67.1%; 95% CI, 59.0 to 74.6) in the miso-prostol-alone group (relative risk, 1.25; 95% CI, 1.09 to 1.43). Uterine aspiration was performed less frequently in the mifepristone-pretreatment group than in the misoprostol-alone group (8.8% vs. 23.5%; relative risk, 0.37; 95% CI, 0.21 to 0.68). Bleeding that resulted in blood transfusion occurred in 2.0% of the women in the mifepristone-pretreatment group and in 0.7% of the women in the misoprostol-alone group (P = 0.31); pelvic infection was diagnosed in 1.3% of the women in each group. CONCLUSIONSPretreatment with mifepristone followed by treatment with misoprostol resulted in a higher likelihood of successful management of first-trimester pregnancy loss than treatment with misoprostol alone. (Funded by the National Institute of Child Health and Human Development; PreFaiR ClinicalTrials.gov number, NCT02012491.) Disciplines Medicine and Health Sciences

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Mifepristone Pretreatment for the Medical Management of Early Pregnancy Loss

Schreiber¹,

Creinin²,

Atrio³

et al. 2018

Obstetric Anesthesia Digest

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show abstract

“…(Avoiding premature surgical intervention because of patient or provider nonadherence is critical in estimating the success rates of nonsurgical treatment approaches. 23 ) Our analytical approach accounted for a range of considerations that often contribute to treatment decisions, including patient and provider preferences, and urgent clinical circumstances within a large health system. Furthermore, our findings argue that limiting access to the most expensive option, OR surgical evacuation, is not needed to reduce costs.…”

Section: Commentmentioning

confidence: 99%

“…22 A good example of this problem is the observation that treatment of EPL with misoprostol is significantly less effective in clinical practice than in clinical trials because of an unwillingness of many women to adhere to the treatment protocol. 23 Perhaps a better approach is to consider what would happen to medical expenditures if we enabled more women (and providers) to choose alternatives to surgical evacuation in an OR by simply adding other treatment options. The objective of this study was to estimate the economic consequences of expanding office-based EPL treatment options (medical and surgical) to women experiencing EPL beyond OR uterine evacuations and expectant management alone.…”

mentioning

confidence: 99%

Beyond usual care: the economic consequences of expanding treatment options in early pregnancy loss

Dalton¹,

Liang²,

Hutton³

et al. 2015

American Journal of Obstetrics and Gynecology

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“…10 Kathleen et al, in 2011 performed a similar research with misoprstol administered vaginally, and the success rate was 80 %. 11 Recently, sublingual administration of Misoprostol has been studied for medical abortion and cervical priming. The Misoprostol tablet is very soluble and can be dissolved in 20 minutes when it is put under the tongue.…”

Section: Success Rate Of the Combination (Mifepristone And Misoprostomentioning

confidence: 99%

Use of Mifepristone and Misoprostol Combination on Abortion in First Trimester Pregnancy at Government Hospital in Chitwan District in Nepal

Thapaliya¹,

Thapa²

2015

Int. Res. J. Pharm.

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The present study is a prospective study and was aimed to identify the type and pattern of side effects during and after a medical abortion using a combination therapy of Mifepristone and Misoprostol, association between gestational age and success rate, and its efficacy. Assessment on acceptability, women's perceptions towards medical abortion, and reasons for abortion were also performed. The study was carried out in 500 beded government hospital in Chitwan district in Nepal. The women (n=85) with a gestational history of less than 59 days were enrolled. The regimen used was oral Mifepristone 200 mg followed by sublingual Misoprostol 800 mcg after 24 hours of Mifepristone administration. The women's profile form was used as a major data collection tool. Side effect sheet (typed in Nepali language for convenience) to be filled by the women undergoing medical termination of pregnancy (MTP) was issued, which was later submitted to us at the time of their follow-up visit. On follow-up, a pre-tested questionnaire was administered to determine perception and acceptability of MTP. The success rate was found to be 97.6%. Side effects recorded were vaginal bleeding, uterine cramping, abdominal pain, nausea, vomiting, headache, loss of appetite, and sleeplessness. There was a significant association between gestational age and success rate with P value of 0.003. The women provided different reasons for abortion and had a positive attitude towards MTP. In conclusion; the combination of oral Mifepristone and sublingual Misoprostol for medical abortion was found to be efficacious and sublingual administration of Misoprostol has a number of benefits over other routes (vaginal and oral) which could be further studied over a large population in future.

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Mifepristone and misoprostol for early pregnancy failure: a cohort analysis

Cited by 31 publications

References 18 publications

Mifepristone Pretreatment for the Medical Management of Early Pregnancy Loss

Mifepristone Pretreatment for the Medical Management of Early Pregnancy Loss

Beyond usual care: the economic consequences of expanding treatment options in early pregnancy loss

Use of Mifepristone and Misoprostol Combination on Abortion in First Trimester Pregnancy at Government Hospital in Chitwan District in Nepal

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