THE ADDITION of mifepristone to misoprostol for medical management of early pregnancy loss significantly reduces the rate of treatment failure compared with misoprostol alone. Early pregnancy loss affects many women, with medical management often preferred to surgical options. Misoprostol alone has been widely used, but the combination of mifepristone and misoprostol is thought to improve treatment efficacy.
This retrospective cohort study aimed to compare the effectiveness of the two treatment protocols. In May 2022, a protocol change at a single medical centre replaced misoprostol monotherapy with mifepristone–misoprostol for early pregnancy loss. The analysis compared treatment outcomes over a seven-year period, assessing rates of treatment failure requiring surgical intervention for retained products of conception.
A total of 999 patients were included in the study, with 224 receiving mifepristone–misoprostol and 775 treated with misoprostol alone. Treatment failure was significantly lower in the mifepristone–misoprostol group (17.8%) compared with the misoprostol-only group (25.1%), with a statistically significant difference (P=.002). After adjustment for potential confounders, the addition of mifepristone reduced the odds of treatment failure by 34% compared to misoprostol alone (adjusted odds ratio 0.661, 95% CI 0.44–0.97, P=.038). Additional factors influencing outcomes included a lower risk of treatment failure in women with prior vaginal deliveries and an increased risk associated with greater gestational age at diagnosis.
The findings support the clinical adoption of mifepristone–misoprostol as a more effective treatment for early pregnancy loss, reducing the likelihood of surgical intervention and improving patient outcomes. Future considerations should include broader implementation of this protocol, with appropriate training for clinicians and ensuring access to mifepristone, particularly in low-resource settings. Further research could explore patient satisfaction and cost-effectiveness to strengthen the case for protocol standardisation.
Abigail Craig, EMJ
Reference
Friedman M et al. Treatment of Early Pregnancy Loss With Mifepristone and Misoprostol Compared With Misoprostol Only. Obstet Gynecol. 2024. DOI: 10.1097/AOG.0000000000005800.
