Drug cocktail offers better miscarriage care

A combination of mifepristone and misoprostol can help women suffering from miscarriage by decreasing the need for surgical intervention to complete the painful process, a new study has shown.

Findings from a trial show that while the standard drug regimen using misoprostol on its own frequently fails to complete the miscarriage, a combination of misoprostol and the drug mifepristone works better.

During miscarriage, if the body does not expel the pregnancy tissue on its own, which is the final part of a miscarriage, women need to undergo a surgical procedure or take the drug misoprostol.

Though often preferable for its convenience and privacy – patients can take it in the comfort of their own homes – misoprostol does not always work, and many women who use it are still left with no option but to undergo an invasive procedure to complete the process.

The report published in the New England Journal of Medicine evaluated 300 women who had early pregnancy loss in the first trimester.

TREATMENT

They were assigned to receive the standard 800 microgrammes of misoprostol placed in the vagina.

Half were also randomly assigned to receive pre-treatment with a 200 mg pill of mifepristone, which primes the uterus to respond to misoprostol’s contraction-inducing effect.

The researchers found that overall, 91 per cent of women receiving the mifepristone pre-treatment plus misoprostol experienced gestational sac expulsion (completed miscarriage) by their first follow-up visit, which occurred two days after the treatment, on average.

Misoprostol alone was only effective 76 per cent of the time, with 67 per cent of the women who took it having a completed miscarriage by their first follow-up visit. Patients assigned to the drug combination group had a much lower chance (nine per cent) of needing a surgical intervention by day 30, compared to 24 per cent in the misoprostol-only group.

However, there were no significant differences between the groups in terms of pain, bleeding, or other side effects and serious side effects were rare in both groups.

“Though rarely discussed openly, miscarriage is the most common complication of pregnancy, and the public health burden is both physical and psychological. For too many women, misoprostol alone just leads to frustration. I have seen my patients suffer from the insult of treatment failure added to the injury of the initial loss,” said lead author and professor of obstetrics and gynaecology Courtney Schreiber.

“As physicians, we have to do better for these patients, and our study shows that by combining mifepristone with misoprostol, we can,” she added.