To avoid having to use intrauterine suction during an early miscarriage, researchers have successfully tested the combination of two molecules (mifepristone and misoprostol).
In the management of spontaneous miscarriages, the combination of two molecules (mifepristone and misoprostol) makes it possible to avoid intrauterine aspiration, namely the surgical procedure.
A cohort of 300 women
The medical management of an early miscarriage is a known alternative to uterine suctioning. However, the standard medication, taken with misoprostol, usually results in treatment failure. To solve this problem, researchers “compared the effectiveness of pretreatment with mifepristone followed by treatment with misoprostol with the effectiveness of misoprostol alone”. Their essay is published in The New England Journal of Medicine.
Scientists studied a cohort of 300 women who had an anembryonic gestation or in whom embryonic or fetal death had been confirmed. Some were given 200 mg of mifepristone, taken orally, followed by 800 mg of misoprostol, assimilated vaginally, while others only took 800 mg of misoprostol.
Uterine suction
Participants returned one to four days after using misoprostol for evaluation.
Complete expulsion after one dose of misoprostol occurred in 124 of 148 women in the mifepristone pretreatment group and in 100 of 149 women in the misoprostol alone group. Uterine aspiration was performed less frequently in the mifepristone pretreatment group than in the misoprostol alone group (8.8% vs 23.5%).
Bleeds leading to a blood transfusion occurred in 2% of women in the mifepristone pretreatment group and in 0.7% of women in the misoprostol alone group. Pelvic infection was diagnosed in 1.3% of women in each group.
The most common complication of pregnancy
“Pretreatment with mifepristone followed by treatment with misoprostol resulted in better management of first trimester miscarriages than treatment with misoprostol alone,” the scientists conclude.
Miscarriage or spontaneous abortion is the most common complication of pregnancy. It occurs before 24 weeks gestation in about 20% of pregnancies and in 12-15% of all pregnancies. However, many cases of miscarriage go unreported, especially those related to premature fetal loss. In the end, the incidence could be much higher.
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