A randomized prospective study of misoprostol or mifepristone followed by misoprostol when needed for the treatment of women with early pregnancy failure.
OBJECTIVE
To compare the effectiveness and safety of misoprostol and mifepristone, followed when needed by misoprostol, for the treatment of women with early pregnancy failure.


METHODS
Prospective randomized nonblinded controlled trial.


METHODS
University-affiliated tertiary medical center.


METHODS
One hundred fifteen consecutive women diagnosed as having a blighted ovum or missed abortion of <9 weeks of gestation enrolled.


METHODS
The patients received orally 600 mg mifepristone (group I) or orally 800 microg misoprostol (group II). Most patients in both groups subsequently received 48 hours later orally 800 microg misoprostol.


METHODS
Failure was defined as surgical intervention due to retained gestational sac 48 hours after completion of the drug protocol, severe symptoms, or suspected retained products of conception after the menstrual period.


RESULTS
The success rate was similar in groups I and II: 38 of 58 patients (65.5%) versus 42 of 57 patients (73.6%), respectively. No cases of severe infection or bleeding necessitating blood transfusion occurred.


CONCLUSIONS
Misoprostol is an effective and safe treatment for early pregnancy failure and could replace surgical curettage in over two-thirds of the patients. Mifepristone offers no advantage compared with misoprostol as initial treatment.
Stockheim
David
D
Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Israel. stockheim@013.net.il
Machtinger
Ronit
R
Wiser
Amir
A
Dulitzky
Mordechai
M
Soriano
David
D
Goldenberg
Mordechai
M
Schiff
Eyal
E
Seidman
Daniel S
DS
D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage; D000028:Abortion, Induced / Q000379:methods*; D000030:Abortion, Missed / Q000188:drug therapy*; D000328:Adult; D004338:Drug Combinations; D005260:Female; D006727:Hormone Antagonists / Q000008:administration & dosage; D006801:Humans; D015735:Mifepristone / Q000008:administration & dosage* / Q000009:adverse effects; D016595:Misoprostol / Q000008:administration & dosage* / Q000009:adverse effects; D011247:Pregnancy; D011256:Pregnancy Outcome; D016896:Treatment Outcome
D000020:Abortifacient Agents, Nonsteroidal; D004338:Drug Combinations; D006727:Hormone Antagonists; D016595:Misoprostol; D015735:Mifepristone