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 The 300 women in the study had all recently suffered an early
pregnancy loss, but their bodies hadn't expelled the fetus. With the
combination of mifepristone and misoprostol, the need for surgical
removal of the dead fetus using uterine aspiration was two and a
half times lower than with just misoprostol, researchers report in
the New England Journal of Medicine.
About one million women in the U.S. experience a first-trimester
miscarriage each year.
The combination of mifepristone and misoprostol is commonly
characterized as "the abortion pill," which complicates its use in
women who've lost a pregnancy. Doctors have to undergo a special
registration process to prescribe mifepristone even though it is
considered a safe drug. The system is in place because of objections
by anti-abortion activists.
"This is a great opportunity for physicians to improve the care of
women who become pregnant and therefore could have a miscarriage,"
lead study author Dr. Courtney Schreiber of the University of
Pennsylvania said in a telephone interview. She urged doctors to
complete the registration process so they can make the treatment
available to women who need it.
All the women in the study had a nonviable pregnancy between 5 and
12 weeks of gestation. The researchers found that giving 200
milligrams of oral mifepristone about 24 hours before vaginal
administration of 800 micrograms of misoprostol increased the odds
of complete expulsion by 25 percent compared to misoprostol alone.
The success rate was about 84 percent with mifepristone pretreatment
and 67 percent without the combination.
As a result, by the 30-day mark, surgical removal was needed only
about 9 percent of the time when the two drugs were used and 24
percent of the time without the mifepristone.
"The improved efficacy is clear. It seems to apply to all women,"
Schreiber said. "We looked carefully for subgroups that might not
need mifepristone for medical management of miscarriage, but it
looks like it helps all women across the board, and the increased
efficacy was substantial."
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"Early pregnancy loss is an unfortunately common occurrence that
causes a great deal of emotional stress for a woman," said Dr.
Katrina Mark, an assistant professor of obstetrics, gynecology and
reproductive services at the University of Maryland School of
Medicine in Baltimore, who was not involved in the research.
"So any way that we can simplify the process and help alleviate the
physical stress is welcomed," she said in an email.
Asked if they would use the method again if they lost another
pregnancy, 69 percent of the women who got the drug combination said
they would, compared with 65 percent of those who only received
misoprostol.
"Many women desire medical management because they can complete
their miscarriage in the privacy of their home with their partner or
loved ones around them," Schreiber said. "But the concern was the
success rates were low with misoprostol alone and it could take a
long time for the miscarriage to be completed. We showed quick and
relatively high efficacy (with the drug combination) and this should
really improve the care for women who are suffering this very
distressing event."
In addition, Mark said, "this study contributes to the overwhelming
evidence that mifepristone is actually a very safe medication. It is
my belief that these regulations are not due to safety concerns but
rather politically motivated given that this medication is also
approved to induce elective abortions."
"It is my hope," she said, "that this study will shed light on the
fact that this is a very safe and effective medication that can help
to improve the outcomes of women suffering from early pregnancy loss
and should not be withheld or made unnecessarily challenging to
obtain due to a partisan agenda."
SOURCE: https://bit.ly/2J4cXbm The New England Journal of Medicine,
online June 6, 2018.
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