Article Summary: 

Chu J. Mifepristone and misoprostol versus misoprostol alone for the management of missed miscarriage (MifeMiso): a randomized, double-blind, placebo-controlled trial January 24, 2020. Accessed March 2, 2024. https://www.thelancet.com/action/showPdf?pii=S0140-6736%2820%2931788-8 

Summary of article: A missed pregnancy is when an ultrasound shows a nonviable fetus in the first 14 weeks. Patients come in with complaints of vaginal bleeding and cramping but missed pregnancies can also be asymptomatic. Treatments are expectant management, medication or surgical. Misoprostol is usually given as one dose but 15-50% of women require a second dose. Mifepristone can be given with Misoprostol to enhance the effects of Misoprostol. 

Objective: This study researched the effectiveness of administering a combination of Mifepristone and Misoprostol compared to Misoprostol alone for the treatment of missed abortions. One limitation of this article is that the results can be only used for missed pregnancies, not incomplete or any other types of miscarriages. 

Method: This study is a double blind, placebo controlled and randomized trial. Included patients with missed pregnancies in the first 14 weeks in patients aged 16 or older. One group of 354 women were given mifepristone and placebo and the other group of 357 women were given Misoprostol 800 mg and mifepristone 200 mg.

Results: 59 (17%) of 348 women in the mifepristone plus misoprostol group did not pass the gestational sac spontaneously within 7 days, versus 82 (24%) of 348 women in the placebo plus misoprostol group (RR 0·73, 95% CI 0·54–0·99; p=0·043; table 2). 62 (17%) of 355 women in the mifepristone plus misoprostol group of required surgical intervention to complete the miscarriage, versus 87 (25%) of 353 women in the placebo plus misoprostol group (RR 0·71, 95% CI 0·53–0·95; p=0·021)

• The study showed that combination treatment using mifepristone plus misoprostol results in an increased number of completed missed pregnancies within the first 7 days. That group also led to fewer incidences of surgical management to complete the miscarriage. Clinicians need to ensure that medical management is sufficient enough so we can decrease the number of days of symptoms as well as improve outcomes by reducing the need for surgery. Successful treatment with medications is cost effective as well.