Publication:

Combination of mifepristone and misopristol in early fetal demise

Background Generally misopristol alone is used in cases of early fetal demise successfully. However to further enhance the success rate a combination of mifepristone along with misopristol can be used. This results in avoiding anesthesia, surgery and operating theater resources, thus being economically viable and results in an overall greater patient satisfaction levels also. Globally, there is a general trend to grant patient greater autonomy in their treatment plan, minimize intervention levels, shorter hospital stay and quicker return to normal schedule and enhanced patient satisfaction levels.

Methods 100 patients with early fetal demise, who reported to a tertiary care service hospital were prospectively evaluated. An oral dose of mifepristone 200 mg stat and 48 hours later misoprostol 800 μg was inserted vaginally. Three hours following the first dose, two further doses of 400 μg misoprostol, was administered vaginally at 3 hours intervals. Repeat medical regime was offered with misoprostol patients who failed to pass products of conception. Success was defined as complete uterine evacuation within 3 days, without the need for surgical evacuation.

Results The overall success rate of medical management was 84%. Mifepristone alone induced natural expulsion of products of conception in (40%) patients complained of heavy bleeding within 48 hours of mifepristone administration alone and in 29 (29%) patients complete miscarriage was confirmed on ultrasound scan. Of the 68 women who were symptomatic at presentation the medical regime failed in 28 (41%), compared with five (16%) failures of the 32 who were asymptomatic. Of the 25 women who had surgical evacuation, eight required an emergency curettage for bleeding.

Conclusions Combination of oral mifepristone along with vaginal misopristol is a simple, safe and effective means of treating early fetal demise, and is an effective alternative method to expectant and surgical options.