Mifepristone and misoprostol: Medical management of missed abortion

 

Early pregnancy loss (EPL)—including missed, incomplete and inevitable abortion—is a common clinical outcome, experienced by approximately 1 million women every year.1 Currently, management of EPL includes expectant, medical and surgical options. Previous literature demonstrated that misoprostol, a prostaglandin E1 analogue, is most effective in patients diagnosed with incomplete or inevitable abortion, and especially in those who present with symptoms such as cramping and bleeding.2 However many women are diagnosed with EPL by ultrasound, prior to onset of symptoms. Among women diagnosed with anembryonic gestation and embryonic or fetal demise, in which symptoms of EPL are less common, a single dose of misoprostol will effectively complete an abortion in only 81% to 88%, respectively. A second dose of misoprostol can increase the rate of expulsion3 but this delay in success is associated with increased costs to both patients and the health care system, including more office visits, ultrasound examinations, and patient anxiety. While medical management with misoprostol is an important alternative option to observation or a surgical procedure, we’ve all had patients for whom medical management resulted in a prolonged and frustrating process during a sensitive time. Wouldn’t it be great if we had a medical option that resulted in a more expeditious and safer resolution of pregnancy loss?