Add-on mifepristone for early pregnancy loss lowers chances of treatment failure

In the treatment of women with early pregnancy loss, adding mifepristone to misoprostol helps reduce the incidence of treatment failure as compared with misoprostol alone, according to a retrospective study.

The study included 999 patients who received medical treatment for early pregnancy loss at a single medical centre, including 224 who received treatment with mifepristone plus misoprostol and 775 who received misoprostol only.

A week after treatment, the patients returned for a follow-up ultrasonogram and were treated again with misoprostol if needed. The patients were instructed to undergo an ultrasonogram after their menstrual period to assess for any remaining pregnancy tissue. Treatment failure was defined as the need for any surgical intervention due to retained product of conception.

Treatment failure occurred less frequently in the mifepristone–misoprostol group than in the misoprostol-only group (17.8 percent vs 25.1 percent; p=0.002). Multivariable analysis confirmed that the use of mifepristone and misoprostol was associated with a 34-percent reduction in the odds of treatment failure compared with misoprostol alone (adjusted odds ratio, 0.661, 95 percent confidence interval, 0.44–0.97; p=0.038).

Of note, patients who had prior vaginal delivery had lower odds of treatment failure. Meanwhile, increasing gestational age, as assessed using ultrasonogram, correlated with a higher risk of treatment failure.