The MifeMiso Trial: guidelines for management of missed miscarriage updated thanks to Tommy's research

Guidelines to tell healthcare professionals how best to support women and birthing people who have sadly had a missed miscarriage have been updated to reflect research findings from our National Centre for Miscarriage Research

Currently 1 in 5 pregnancies sadly end in miscarriage, and sometimes this can happen without any signs or symptoms. This is called a missed miscarriage, and means that even though the baby has died, the remains of the pregnancy tissue is still in the womb. This can come as a huge shock to couples, as many will find out at an ultrasound scan.

There are 3 treatment options for missed miscarriage: 

  • Expectant management: waiting for the miscarriage to happen by itself
  • Medical management: taking medications to help the miscarriage happen
  • Surgical management: having surgery to remove the baby and pregnancy tissue from the womb

In medical management, a drug called misoprostol is given to help resolve a missed miscarriage. However, it is not always effective and some women and birthing people we need further surgery to remove the pregnancy tissue.

We wish nobody had to experience a missed miscarriage, but when it does happen we want to make sure women and birthing people receive the best care possible. 

The MifeMiso trial

The MifeMiso trial, published in the Lancet, was carried out at Tommy's National Centre for Miscarriage Research and aimed to find out if giving a second drug called mifepristone followed by misoprostol two days later improved the completion rate of missed miscarriage. Over 700 women took part in this randomised controlled trial where they received either 1 or both the drugs following a missed miscarriage. 

The trial showed that 83% of women and birthing people who had both medications completed their miscarriage within 7 days, compared to 76% who only took misoprostol. It also found that significantly less women needed further surgery to resolve their miscarriage after taking both drugs. Avoiding unwanted surgery was very important to the women who took part if the trial.

Driving change on a national level

In August 2023, NICE Guidelines were updated to tell NHS Trust, doctors and nurse to give both drugs to treat missed miscarriage, thanks to this research. We estimate that 2,800 fewer women and birthing people will need surgery as a result of this research and change to guidelines.

This would help couples like India and Josh. At her 12 week scan, she was given the devastating news that there was no heartbeat. 

We didn't know much about miscarriage, and naively thought that it would just happen by itself and be done in a day. We waited but nothing happened. We had to go back to hospital to have medical management. I ended up staying in hospital for two weeks in total because the drugs just didn't work.

Kate Davies, Research and Policy Director at Tommy's said: 

This research is a great example of how we're driving research breakthroughs and translating them into changes in national guidelines. We wish that no one had to have a missed miscarriage, but thanks to this work, we can help make this devastating experience more manageable, and ensure all women and birthing people get the best care. 

Learn more about this research in the animation below.