Mifepristone Pretreatment for the Medical Management of Early Pregnancy Loss

Abstract

(N Engl J Med. 2018;378:2161–2170) First-trimester miscarriage, or early pregnancy loss, is the most common complication in pregnancy. It can frequently be identified before onset of symptoms, and many women prefer active management, which provides the ability to have some control over the situation. Current guidelines recommend the use of prostaglandin analogues to expedite the expulsion of nonviable pregnancy tissue, with a standard dose of 800 μg misoprostol administered vaginally. However, misoprostol has low efficacy among women with a closed cervical os. Although mifepristone, a 19-nor steroid, can help to prepare the myometrium and cervix for prostaglandin activity, its reported effectiveness ranges from 52% to 95%. The authors of the present study thus compared the efficacy of pretreatment with mifepristone followed by treatment with misoprostol with misoprostol use alone, for the management of early pregnancy loss in women with a closed cervical os.