Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2025 Feb 1;145(2):204-209.
doi: 10.1097/AOG.0000000000005800. Epub 2024 Dec 5.

Treatment of Early Pregnancy Loss With Mifepristone and Misoprostol Compared With Misoprostol Only

Matan Friedman  1 , Liat Mor, Rotem Shazar, Natalie Paul, Ram Kerner, Ran Keidar, Ron Sagiv, Ohad Gluck
Affiliations
Comparative Study

Treatment of Early Pregnancy Loss With Mifepristone and Misoprostol Compared With Misoprostol Only

Matan Friedman et al. Obstet Gynecol. .

Abstract

Objective: To compare the rates of treatment failure in cases of early pregnancy loss between mifepristone-misoprostol and misoprostol only.

Methods: This retrospective cohort study included patients who received medical treatment for early pregnancy loss between 2016 and 2023 at a single medical center. Patients returned for a follow-up ultrasonogram after 1 week and were treated again with misoprostol if needed. Finally, they were instructed to obtain an ultrasonogram after menstruation and to return for evaluation in case retained product of conception was suspected. We defined treatment failure as needing any surgical intervention because of retained product of conception, including cases when retained product of conception was diagnosed and treated after menstruation. In May 2022, we changed our protocol for treating early pregnancy loss from misoprostol to mifepristone and misoprostol. We compared the failure rate between patients who received mifepristone-misoprostol and those treated with misoprostol only.

Results: A total of 999 patients were included: 224 in the mifepristone-misoprostol group and 775 in the misoprostol-only group. The rate of treatment failure was significantly lower in the mifepristone-misoprostol group compared with the misoprostol-only group (17.8% vs 25.1%, P =.002). After multivariant analysis was performed, the use of mifepristone and misoprostol was associated with a reduction of 34% in the odds ratio for treatment failure compared with misoprostol alone (adjusted odds ratio 0.661, 95% CI, 0.44-0.97, P =.038). In addition, prior vaginal delivery was associated with a lower risk for treatment failure, and increasing gestational age (according to ultrasonogram) was correlated with a higher risk for treatment failure.

Conclusion: The addition of mifepristone to misoprostol was associated with a significantly lower rate of treatment failure, including late surgical intervention for early pregnancy loss, compared with misoprostol alone.

PubMed Disclaimer

Conflict of interest statement

Financial Disclosure The authors did not report any potential conflicts of interest.

References

    1. Zhang J, Gilles JM, Barnhart K, Creinin MD, Westhoff C, Frederick MM, et al. A comparison of medical management with misoprostol and surgical management for early pregnancy failure. N Engl J Med 2005;353:761–9. doi: 10.1056/nejmoa044064 - DOI
    1. Jurkovic D, Overton C, Bender-Atik R. Diagnosis and management of first trimester miscarriage. BMJ 2013;346:f3676. doi: 10.1136/bmj.f3676 - DOI
    1. Wang X, Chen C, Wang L, Chen D, Guang W, French J. Conception, early pregnancy loss, and time to clinical pregnancy: a population-based prospective study. Fertil Steril 2003;79:577–84. doi: 10.1016/S0015-0282(02)04694-0 - DOI
    1. Graziosi GCM, Mol BW, Ankum WM, Bruinse HW. Management of early pregnancy loss. Int J Gynaecol 2004;86:337–46. doi: 10.1016/j.ijgo.2004.04.038 - DOI
    1. Jia L, Li W, Liu Y, Wang L. Psychologic sequelae in early pregnancy complications. Int J Womens Health 2023;15:51–7. doi: 10.2147/IJWH.S382677 - DOI

Publication types

MeSH terms