Efficacy of Mifepristone and Misoprostol Compared to Misoprostol Alone in the Medical Management of the First-trimester Missed Miscarriages

Abstract

Introduction: Misoprostol, a prostaglandin analog, is frequently used to treat miscarriages medically by causing myometrial contractions that help the pregnancy tissue to be expelled. Mifepristone, a competitive progesterone receptor antagonist, primes the myometrium for prostaglandin exposure. Aim: By contrasting mifepristone combined with misoprostol with misoprostol alone in first-trimester missed miscarriage, to evaluate the potential challenges such as the requirement for an operation. Objective: To reduce the chances of surgical intervention in first-trimester missed miscarriage. Study design and participants: This study was done in the Saveetha Medical College and Hospital, Chennai, in two years of duration from September 2020 to August 2022. Materials and methods: In the first 13 weeks + 6 days of pregnancy, 150 women who had first-trimester missed miscarriages confirmed by pelvic ultrasound were recruited. Seventy-five women (group A) were randomly allocated to receive mifepristone 200 mg, 48 hours later 400 μg misoprostol per vaginally at 3 hourly intervals to a maximum of three doses were given. Seventy-five women (group B) were randomly allocated to receive 400 μg misoprostol per vaginally at 3 hourly intervals to a maximum of three doses were given. Results: In total 29.33% of 75 women within the mifepristone plus misoprostol group required surgical intervention to complete the miscarriage, versus 56% of 75 women within the misoprostol alone group. Conclusion: We recommend that women with a first-trimester missed miscarriage should be offered mifepristone pretreatment before misoprostol to increase the chance of successful miscarriage management, while reducing the necessity for surgical evacuation like D&E especially in primigravidas.