title: Sequential use of mifepristone and misoprostol in treatment of early pregnancy failure appears more effective than misoprostol alone: a retrospective study.
abstract: OBJECTIVE
  Is treatment of early pregnancy failure (EPF) with sequential use of mifepristone and misoprostol more effective than treatment with misoprostol alone?
  
  
  METHODS
  In a retrospective cohort study at the Department of Obstetrics and Gynaecology of the Radboud University Medical Centre, 301 women with early pregnancy failure receiving medical treatment between January 2008 and March 2013 were included. Of these, 199 women were pre-treated with 200mg mifepristone (orally) followed by 2 consecutive doses of 800mcg misoprostol (vaginally) and 102 women were treated with 2 consecutive doses of 800mcg misoprostol (vaginally) alone.
  
  
  RESULTS
  Complete expulsion was achieved in 66.8% of the women treated with a sequential combination of mifepristone and misoprostol versus 54.9% of the women treated with misoprostol alone. The difference in rates of complete expulsion was 11.9% (P<0.05; 95% CI 0.3-23.6%).
  
  
  CONCLUSIONS
  Medical treatment of early pregnancy failure with a sequential combination of mifepristone and misoprostol was more effective than treatment with misoprostol alone. Our findings will have to be confirmed by a large prospective multicentre double blinded-randomized trial.
authors.affiliation: Department of Obstetrics and Gynaecology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands. Electronic address: j.vandenberg@cwz.nl.
authors.forename: Joyce
authors.initials: J
authors.lastname: van den Berg
authors.affiliation: Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Johan M
authors.initials: JM
authors.lastname: van den Bent
authors.affiliation: Department of Obstetrics and Gynaecology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands.
authors.forename: Marcus P
authors.initials: MP
authors.lastname: Snijders
authors.affiliation: Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: Roel
authors.initials: R
authors.lastname: de Heus
authors.affiliation: Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Sjors F
authors.initials: SF
authors.lastname: Coppus
authors.affiliation: Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Frank P
authors.initials: FP
authors.lastname: Vandenbussche
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage* / Q000627:therapeutic use; D000021:Abortifacient Agents, Steroidal / Q000008:administration & dosage* / Q000627:therapeutic use; D000022:Abortion, Spontaneous / Q000188:drug therapy*; D000282:Administration, Intravaginal; D000284:Administration, Oral; D000328:Adult; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D015735:Mifepristone / Q000008:administration & dosage* / Q000627:therapeutic use; D016595:Misoprostol / Q000008:administration & dosage* / Q000627:therapeutic use; D011247:Pregnancy; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D000021:Abortifacient Agents, Steroidal; D016595:Misoprostol; D015735:Mifepristone
keywords: Early pregnancy failure; Mifepristone; Misoprostol