Medical management of early fetal demise using a combination of mifepristone and misoprostol

Prabhath Thanuja Wagaarachchi, Premila Wencesiaus Ashok, N. Narvekar, Norman Smith, Alexander Allan Templeton

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

BACKGROUND: This study aims to assess the efficacy of a combination of mifepristone and misoprostol in the management of missed miscarriage and anembryonic pregnancy. METHODS: Data of 220 consecutive women with miscarriage, undergoing medical evacuation of the uterus were collected prospectively at an early pregnancy assessment unit in a tertiary referral hospital. Each woman received a single oral dose of mifepristone 200 mg and 36-48 h later vaginal misoprostol 800 mug. Three hours following the first dose, two further doses of misoprostol, 400 mug each, were administered vaginally or orally at 3 h intervals. Women who failed to pass products of conception were offered repeat medical regime with misoprostol. Success was defined as complete uterine evacuation within 3 days, without the need for surgical evacuation. RESULTS: The overall success rate of medical management was 84.1%. Mifepristone alone induced natural expulsion of products of conception in 18.1% of women. The median dose of misoprostol required was 1600 mug and the median induction miscarriage interval after first prostaglandin administration was 8.04 h (range: 0.58-50.54 h). Of the 142 women who were symptomatic at presentation the medical regime failed in 30 (21.1%), compared with five (6.4%) failures of the 78 who were asymptomatic (P = 0.007). Of the 35 women who had surgical evacuation, eight required an emergency curettage for bleeding. CONCLUSIONS: The combination of oral mifepristone 200 mg with vaginal or oral misoprostol is an alternative to surgical management of early fetal demise, although it is not as effective as surgery.

Original languageEnglish
Pages (from-to)1849-1853
Number of pages4
JournalHuman Reproduction
Volume16
Issue number9
DOIs
Publication statusPublished - 2001

Keywords

  • anembryonic pregnancy
  • fetal demise
  • mifepristone
  • misoprostol
  • missed miscarriage
  • MISSED ABORTION
  • RANDOMIZED TRIAL
  • MISCARRIAGE
  • EVACUATION
  • PREGNANCY
  • INDUCTION
  • EXPECTANT
  • RU-486

Cite this

Medical management of early fetal demise using a combination of mifepristone and misoprostol. / Wagaarachchi, Prabhath Thanuja; Ashok, Premila Wencesiaus; Narvekar, N.; Smith, Norman; Templeton, Alexander Allan.

In: Human Reproduction, Vol. 16, No. 9, 2001, p. 1849-1853.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND: This study aims to assess the efficacy of a combination of mifepristone and misoprostol in the management of missed miscarriage and anembryonic pregnancy. METHODS: Data of 220 consecutive women with miscarriage, undergoing medical evacuation of the uterus were collected prospectively at an early pregnancy assessment unit in a tertiary referral hospital. Each woman received a single oral dose of mifepristone 200 mg and 36-48 h later vaginal misoprostol 800 mug. Three hours following the first dose, two further doses of misoprostol, 400 mug each, were administered vaginally or orally at 3 h intervals. Women who failed to pass products of conception were offered repeat medical regime with misoprostol. Success was defined as complete uterine evacuation within 3 days, without the need for surgical evacuation. RESULTS: The overall success rate of medical management was 84.1{\%}. Mifepristone alone induced natural expulsion of products of conception in 18.1{\%} of women. The median dose of misoprostol required was 1600 mug and the median induction miscarriage interval after first prostaglandin administration was 8.04 h (range: 0.58-50.54 h). Of the 142 women who were symptomatic at presentation the medical regime failed in 30 (21.1{\%}), compared with five (6.4{\%}) failures of the 78 who were asymptomatic (P = 0.007). Of the 35 women who had surgical evacuation, eight required an emergency curettage for bleeding. CONCLUSIONS: The combination of oral mifepristone 200 mg with vaginal or oral misoprostol is an alternative to surgical management of early fetal demise, although it is not as effective as surgery.",
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T1 - Medical management of early fetal demise using a combination of mifepristone and misoprostol

AU - Wagaarachchi, Prabhath Thanuja

AU - Ashok, Premila Wencesiaus

AU - Narvekar, N.

AU - Smith, Norman

AU - Templeton, Alexander Allan

PY - 2001

Y1 - 2001

N2 - BACKGROUND: This study aims to assess the efficacy of a combination of mifepristone and misoprostol in the management of missed miscarriage and anembryonic pregnancy. METHODS: Data of 220 consecutive women with miscarriage, undergoing medical evacuation of the uterus were collected prospectively at an early pregnancy assessment unit in a tertiary referral hospital. Each woman received a single oral dose of mifepristone 200 mg and 36-48 h later vaginal misoprostol 800 mug. Three hours following the first dose, two further doses of misoprostol, 400 mug each, were administered vaginally or orally at 3 h intervals. Women who failed to pass products of conception were offered repeat medical regime with misoprostol. Success was defined as complete uterine evacuation within 3 days, without the need for surgical evacuation. RESULTS: The overall success rate of medical management was 84.1%. Mifepristone alone induced natural expulsion of products of conception in 18.1% of women. The median dose of misoprostol required was 1600 mug and the median induction miscarriage interval after first prostaglandin administration was 8.04 h (range: 0.58-50.54 h). Of the 142 women who were symptomatic at presentation the medical regime failed in 30 (21.1%), compared with five (6.4%) failures of the 78 who were asymptomatic (P = 0.007). Of the 35 women who had surgical evacuation, eight required an emergency curettage for bleeding. CONCLUSIONS: The combination of oral mifepristone 200 mg with vaginal or oral misoprostol is an alternative to surgical management of early fetal demise, although it is not as effective as surgery.

AB - BACKGROUND: This study aims to assess the efficacy of a combination of mifepristone and misoprostol in the management of missed miscarriage and anembryonic pregnancy. METHODS: Data of 220 consecutive women with miscarriage, undergoing medical evacuation of the uterus were collected prospectively at an early pregnancy assessment unit in a tertiary referral hospital. Each woman received a single oral dose of mifepristone 200 mg and 36-48 h later vaginal misoprostol 800 mug. Three hours following the first dose, two further doses of misoprostol, 400 mug each, were administered vaginally or orally at 3 h intervals. Women who failed to pass products of conception were offered repeat medical regime with misoprostol. Success was defined as complete uterine evacuation within 3 days, without the need for surgical evacuation. RESULTS: The overall success rate of medical management was 84.1%. Mifepristone alone induced natural expulsion of products of conception in 18.1% of women. The median dose of misoprostol required was 1600 mug and the median induction miscarriage interval after first prostaglandin administration was 8.04 h (range: 0.58-50.54 h). Of the 142 women who were symptomatic at presentation the medical regime failed in 30 (21.1%), compared with five (6.4%) failures of the 78 who were asymptomatic (P = 0.007). Of the 35 women who had surgical evacuation, eight required an emergency curettage for bleeding. CONCLUSIONS: The combination of oral mifepristone 200 mg with vaginal or oral misoprostol is an alternative to surgical management of early fetal demise, although it is not as effective as surgery.

KW - anembryonic pregnancy

KW - fetal demise

KW - mifepristone

KW - misoprostol

KW - missed miscarriage

KW - MISSED ABORTION

KW - RANDOMIZED TRIAL

KW - MISCARRIAGE

KW - EVACUATION

KW - PREGNANCY

KW - INDUCTION

KW - EXPECTANT

KW - RU-486

U2 - 10.1093/humrep/16.9.1849

DO - 10.1093/humrep/16.9.1849

M3 - Article

VL - 16

SP - 1849

EP - 1853

JO - Human Reproduction

JF - Human Reproduction

SN - 0268-1161

IS - 9

ER -