Mifepristone Followed by Misoprostol for Managing Early Pregnancy Loss

Women with diagnoses of miscarriage (i.e., early pregnancy loss) who have not expelled the pregnancy have three treatment options: expectant management, the prostaglandin misoprostol, or uterine aspiration. Misoprostol leads to uterine expulsion in about two thirds of miscarriages. To determine if this success rate would be improved by pretreatment with the progesterone antagonist mifepristone, investigators randomized 300 women with miscarriage diagnosed between 5 and 12 weeks' gestation to 200 mg oral mifepristone followed 24 hours later by 800 µg self-administered vaginal misoprostol, or to misoprostol alone. Women returned within 4 days for ultrasound assessment of uterine gestational sac expulsion (if the sac was not expelled, surgical…