Mifepristone pretreatment for early pregnancy loss

The results of a new study show that pretreatment with mifepristone followed by treatment with misoprostol led to a greater likelihood of successful management of early pregnancy loss compared with only misoprostol treatment.

The results of a new study show that pretreatment with mifepristone followed by treatment with misoprostol led to a greater likelihood of successful management of early pregnancy loss compared with only misoprostol treatment. Researchers randomized 300 women with an anembryonic gestation or in whom embryonic or fetal death was confirmed to receive pretreatment with mifepristone followed by misoprostol alone, or misoprostol only. The women returned 1–4 days after misoprostol use for evaluation, and those in whom the gestational sac was not expelled were offered expectant management, additional misoprostol, or uterine aspiration. In all, 83.8% of the women in the mifepristone-pretreatment group and 67.1% of women in the misoprostol-alone group had complete expulsion after one dose of misoprostol. Uterine aspiration was performed in 8.8% of the pretreatment group, compared with 23.5% of the misoprostol-alone group. The researchers note that 2.0% of women in the pretreatment group and 0.7% of those in the misoprostol-alone group experienced bleeding that resulted in blood transfusion. Additionally, 89.4% of women in the pretreatment group and 87.4% of those in the misoprostol-alone group said their overall experience was either "good" or "neutral," and most women in each group (69.1% and 64.8%, respectively) said they would use medical management if they experienced another pregnancy loss.