P042Early pregnancy loss medical management in clinical practice after mifepristone-misoprostol clinical trial

Abstract

<h3>Objectives</h3> To review clinical practice outcomes of early pregnancy loss (EPL) medical management at a previous mifepristone-misoprostol clinical trial site after study completion. <h3>Methods</h3> We reviewed a de-identified database for patients who received mifepristone-misoprostol for EPL from May 2018 to May 2021 at our academic center–based clinic, which was a study site for the mifepristone-misoprostol EPL trial (completed March 2018). All patients received mifepristone 200 mg and misoprostol 800 mcg with clinic follow-up typically scheduled within one week. We analyzed management and safety outcomes. <h3>Results</h3> Ninety-one patients chose medical management with mifepristone followed by misoprostol vaginally (79[87%]) or buccally (5[5%]), with route not documented for seven patients (8%). Median gestational age was 49 days (range 30–80) and median time from mifepristone to misoprostol administration was 24 hours (range 8–66). Follow-up was completed in the clinic for 80 (88%) patients, completed remotely for six (6%), and not completed for five (5%). Most patients (80[88%]) were successfully managed with medications alone. Two patients (2%) required tissue removal from the cervical os with ring forceps and nine (10%) had uterine aspirations. Seventy patients initially had ultrasonography at follow-up showing gestational sac expulsion; three (4%) ultimately required an aspiration for bleeding with pathologic examination demonstrating villi for all. The only safety outcomes were one pelvic infection and one transfusion due to significant bleeding. <h3>Conclusions</h3> Outside of a clinical trial setting, medical management of EPL with mifepristone and misoprostol remains effective and safe. While gestational sac expulsion on ultrasonography remains a good indicator of successful medical management of EPL, subsequent aspiration may be required more frequently than after medication abortion.