A study our team published last summer found that a combined drug treatment is more effective than current standard medication for miscarriages without symptoms (also known as missed, delayed or silent miscarriage) and now the same researchers have found it's also cheaper for the NHS.
What our scientists are doing
Current hospital restrictions on surgery mean that many people having missed miscarriages face waiting for things to progress, which can take weeks and still might not happen, or being offered medication to speed the process along. National guidelines recommend a treatment called misoprostol, which is successful in most cases – but some women wait anxiously for weeks, repeating the medication and eventually needing an operation anyway.
Our National Centre for Miscarriage Research found that misoprostol is more effective when combined with mifepristone, an anti-progesterone drug used to induce labour. A randomised controlled trial found the new combined drug treatment worked 83% of the time, compared to 76% in the placebo group. Crucially, it also reduced the need for surgery; 1 in 4 women given the placebo later needed an operation, compared with less than 1 in 5 of those who had the new medication.
Now the team has carried out further analysis to see how switching to this more effective treatment could save healthcare providers money. Their findings, published yesterday in the British Journal of Obstetrics and Gynaecology, show that combined drug treatment was on average £182 cheaper for each successfully managed miscarriage than the current standard NHS medication.
Why this research matters
Katy has experienced multiple miscarriages and a range of treatment, initially having surgery that caused internal scarring and later choosing medication in the hope it would cause less damage. Katy said: “The treatment for my third miscarriage was a 4-month long nightmare, with several rounds of medication and hospital staff trying to physically remove the pregnancy while I was awake, ending in painful surgery. It was one of the most horrendous experiences of my life and I remain completely traumatised. The long ordeal of treatment made miscarriage even harder so I hope this new research can help to prevent others from going through what I did.”
I couldn't move on physically or mentally because I was pregnant and not pregnant for months, with tests remaining positive and hormones still racing long after we heard those spine-shivering words of ‘I am so sorry but there is no heartbeat’.
Claire chose surgery when she had a miscarriage last year, as her previous experience when medication failed was so distressing. Claire said: “I was told medication would take a few hours to work, but started bleeding and cramping in minutes, while stuck in hospital waiting for other prescriptions. Despite taking effect so fast, the medication didn’t work, so I was sent for surgery – and when that failed too, I had to take the pills again. The whole process took around 3 months and was extremely traumatic. With my second miscarriage, I chose surgery right away to avoid the risk of repeating such a long and painful treatment.”
Where we go from here
This is the largest ever study into the most effective medical treatment for missed miscarriage, and the results are clear, so now we're calling for guidance from the National Institute for Health and Care Excellence (NICE) to be updated in light of this evidence. In the meantime, we encourage anyone diagnosed with missed miscarriage to ask their doctor about the combined drug treatment.
Tommy’s CEO Jane Brewin explained: “One in four pregnancies ends in loss, and while our researchers work to understand how we can prevent this, it’s vital their latest findings are put into practice so that everyone going through miscarriage has the best possible care. Particularly given Covid-19 pressures on the NHS, our new study could be applied to make better use of precious resources, as well as reducing the toll miscarriage can take on parents.”
Besides the physical harm, miscarriage can have serious psychological consequences, which can be made worse by the trauma of a failed treatment forcing mothers to endure weeks of carrying a baby they know has died.
Senior author Tracy Roberts, Professor of Health Economics at the University of Birmingham, commented: “Pregnancy loss causes heartbreak for millions of families, and it is crucial that we find better ways to care for everyone going through miscarriage. Our findings could have huge benefits if they’re translated into clinical practice, with better outcomes for patients and lower costs for care services.”
First author Dr Duby Okeke Ogwulu, of the University of Birmingham’s Institute of Applied Health Research, added: “We hope the NICE guidance will be updated in light of this new evidence, so that everyone who needs it has access to the most effective treatment.”
Read more about ground-breaking work at Tommy's National Centre for Miscarriage Research