Better Medical Miscarriage Treatment

Written by Clay Smith

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In women with confirmed first trimester pregnancy loss, the combination of mifepristone 200mg orally and misoprostol 800μg vaginally at 24 hours vs misoprostol 800μg alone resulted in improved complete expulsion at day 8 (NNT = 6) and decreased need for surgery: 9% vs 24%.

Why does this matter?
About 1 million women have a miscarriage each year in the US.  Up to 20% of these may need surgical evacuation.  This trial looked for a way to optimize medical management of miscarriage.

Two drugs were better
This was a randomized trial of 300 women with confirmed first trimester miscarriage to receive either mifepristone 200mg orally and misoprostol 800μg vaginally in 24 hours (aka 2-drug) vs misoprostol 800μg alone (aka 1-drug).  They found complete expulsion at 8 days in 84% of the 2-drug group and 67% of the 1-drug group, NNT = 6.  Uterine aspiration was required for the 2-drug group in 8.8% vs. 23.5% of the 1-drug patients.  Once non-viability has been confirmed, it is worth discussing this with OB as an option for our patients suffering first trimester pregnancy loss.

Source
Mifepristone Pretreatment for the Medical Management of Early Pregnancy Loss.  N Engl J Med. 2018 Jun 7;378(23):2161-2170. doi: 10.1056/NEJMoa1715726.
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Reviewed by Thomas Davis

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