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Al Wattar BH, Murugesu N, Tobias A, Zamora J, Khan KS Management of first-trimester miscarriage: a systematic review and network meta-analysis. Human Reproduction Update.. 2019; 25:(3)362-374 https://doi.org/10.1093/humupd/dmz002

ACOG practice bulletin no. 200: early pregnancy loss. Obstetrics and Gynecology.. 2018; 132:(5)e197-e207 https://doi.org/10.1097/AOG.0000000000002899

Colleselli V, Nell T, Bartosik T, Brunner C, Ciresa-Koenig A, Wildt L, Marth C, Seeber B Marked improvement in the success rate of medical management of early pregnancy failure following the implementation of a novel institutional protocol and treatment guidelines: a follow-up study. Archives of Gynecology and Obstetrics.. 2016; 294:(6)1265-1272 https://doi.org/10.1007/s00404-016-4179-6

Dunford A, Fyfe R Combination therapy with mifepristone and misoprostol for the management of first trimester miscarriage: improved success. Australian and New Zealand College of Obstetricians and Gynaecologists.. 2018; 58:(4)438-442 https://doi.org/10.1111/ajo.12747

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Management of first trimester pregnancy loss: mifepristone plus misoprostol versus misoprostol alone

02 November 2019
Literature Review
02 November 2019
Volume 27 · Issue 11

Abstract

Miscarriage occurs in 20% of all pregnancies. Misoprostol is implemented alone for the medical management of first trimester pregnancy loss in New Zealand and the UK. However, current research reports mifepristone plus misoprostol is significantly more effective than misoprostol alone. Results from current randomised control trials indicate efficacy rates of mifepristone, plus misoprostol range between 73%-89.3% compared to 34.8%-67.1% for misoprostol alone. Further research is recommended to ascertain medication regimes and associated adverse effects. Current guidelines for the medical management of first trimester miscarriage should be reviewed in regards to implementing mifepristone in management pathways.

Miscarriage occurs in 20% of all pregnancies (Fernlund et al, 2018) and medical management using misoprostol is now a popular treatment option as opposed to surgical intervention. Current research indicates the use of mifepristone in combination with misoprostol due to higher efficacy rates with this combination (Tulandi and Al-Fozan, 2018).

Mifepristone is a synthetic steroid which acts as a progesterone antagonist (Im and Appleman, 2010). Progesterone is an important endogenous hormone required for ongoing pregnancy (Dunford and Fyfe, 2018). On a cellular level, mifepristone blocks progesterone uptake leading to decreased levels which initiates uterine contraction, cervical softening, dilation, and sensitising the myometrium to prostaglandins; hormones which support uterine contractility (Im and Appleman, 2010; Medsafe, 2013; Dunford and Fyfe, 2018).

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Miscarriage
Misoprostol
Mifepristone
Pregnancy