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

BACKGROUND: This study aims to assess the efficacy of a combination of mife pristone and misoprostol in the management of missed miscarriage and anembr yonic pregnancy. METHODS: Data of 220 consecutive women with miscarriage, u ndergoing medical evacuation of the uterus were collected prospectively at an early pregnancy assessment unit in a tertiary referral hospital. Each wo man received a single oral dose of mifepristone 200 mg and 36-48 h later va ginal misoprostol 800 mug. Three hours following the first dose, two furthe r doses of misoprostol, 400 mug each, were administered vaginally or orally at 3 h intervals. Women who failed to pass products of conception were off ered repeat medical regime with misoprostol. Success was defined as complet e uterine evacuation within 3 days, without the need for surgical evacuatio n. RESULTS: The overall success rate of medical management was 84.1%. Mifep ristone alone induced natural expulsion of products of conception in 18.1% of women. The median dose of misoprostol required was 1600 mug and the medi an 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 blee ding. CONCLUSIONS: The combination of oral mifepristone 200 mg with vaginal or oral misoprostol is an alternative to surgical management of early feta l demise, although it is not as effective as surgery.