MIFEMISO: Mifepristone and misoprostol for the medical management of missed miscarriage

Currently NICE recommends the drug misoprostol but without strong evidence. This trial is designed to find the best treatment for missed miscarriage.

Often, when an early miscarriage happens, the fetus does not pass out of the womb naturally. This is often described as a 'missed miscarriage' because the parents only find out when they have a scan that the baby has died.

To complete the miscarriage, there are two types of medication that encourage the body to pass the fetus (this is called 'managing a miscarriage').

Before NICE guideline CG15459 was published in 2012, most clinicians prescribed two medicines: mifepristone and misoprostol (MifeMiso combination). In 2012 recommended misoprostol alone, but without any strong supporting evidence.

Therefore the MifeMiso trial is designed to increase the evidence available and find the best treatment. It looks at three criteria:

  • time taken to resolve the miscarriage
  • healthcare costs
  • patient experience.

Our primary outcome measure is passage of the baby within 7 days of intervention.

Our secondary outcome measures include complications such as any requirement for more misoprostol or unplanned surgery.

Alongside our collection of clinical outcomes, a health economic evaluation will explore cost-effectiveness, and we will undertake a patient experince survey and qualitative interviews with 50 purposively selected study participants from different locations.

We expect to publish our findings in 2020.

Stories of miscarriage

  • Story

    A letter to baby Pumbaa, from your mum, Annabel

    Annabel and her partner have been trying to start a family for 8 years having sadly lost their first baby, Pumbaa conceived through IVF, at 12 weeks. 6 subsequent cycles, 5 miscarriages and 4 years later, Annabel finds herself in what she describes as 'maybehood' – not knowing if she will ever become a mother. Annabel has written a letter to baby Pumbaa, reflecting on how life has been over the past 4 and a half years.

  • Story

    Maybehood - not knowing if I'll ever become a mother

    Annabel is a writer and Bristolian living in South East London with her husband. They've been trying to start a family for 8 years having sadly lost their first baby, conceived through NHS IVF, at 12 weeks. 6 subsequent cycles, 5 miscarriages and 4 years later, Annabel finds herself in what she describes as 'maybehood' – not knowing if she will ever become a mother.

  • Story

    Finding support and mental well-being after baby loss

    In this blog, Rebekah opens up about how pregnancy complications and baby loss affected her mental health, having been diagnosed with PTSD after an early miscarriage and the stillbirth of her son Freddie.

  • Helen and Rick with rainbow baby Parker thanks to Tommy's miscarriage clinic


    The darker the storm, the brighter the rainbow

    Helen and Rick had a long and difficult journey to parenthood, with several rounds of fertility treatment and a heart-breaking late miscarriage before their rainbow baby Parker arrived at Tommy’s Birmingham clinic.

  • James


    I was consumed by guilt that I hadn't undergone the physical pain she had

    James and his wife have sadly lost four babies since they started trying to conceive in 2017. In this blog, James reflects on miscarriage from a partner’s perspective, and the complex emotions that Father’s Day stirs up when grieving your children.

  • Craig


    Our rainbow baby reminds us of our never forgotten son

    Craig, 36, lives in North Wales with his fiancée Kerry and her 6-year-old son Jacob. His job as a radio presenter and station director was difficult after the loss of their baby boy Ellis, having to entertain listeners while battling grief, but he’s now using his talent for public speaking to break the silence on miscarriage by sharing their family’s story.

  • Jonathan


    Conquering grief by sharing it

    Jonathan is 27 and lives in Wigan with his wife Michaela. Jonathan is a father to his son, Zachary, born sleeping, and his daughter, Amelie Autumn, who was born on 16 June 2020.

  • Story

    I wish I’d allowed myself to grieve with my wife, she needed that more than anything

    Priyah and Markus from North London started trying for a baby in 2018. Sadly, in the past 2 years, they have experienced 2 miscarriages. In this blog, Markus reflects on what it feels like to lose a baby from a partner’s perspective.

  • Miscarriage care and support in coronavirus pandemic


    Miscarriage care and support in the coronavirus pandemic

    Nicola sadly experienced a miscarriage just before her 12-week scan. As a doctor, she was not used to being in hospital as a patient - but has been inspired to share her story by the support she received.

  • Jag Ricki and Jayden Ashley


    Attachment builds over time, but love happens in a heartbeat, so there is no one way to grieve

    Jag and her husband coped with the loss of their son in very different ways. In this blog, she reflects on the grieving process and the support that has helped her to manage the pain of her ‘favourite what if’.

  • Story

    I've accepted we won't get our fairytale ending

    Lara and her husband Joseph went through 9 rounds of IVF and experienced 2 miscarriages before making the decision to stop trying to conceive. In this blog, Lara reflects on the journey she has been on to find meaning and happiness in a life without children.

  • Blog

    Being pregnant after loss is lonelier than ever in a pandemic, but Tommy’s has been my lifeline

    I had 3 miscarriages before being referred to Tommy’s National Centre for Miscarriage Research at University Hospital Coventry. Now I’m pregnant again, but the coronavirus pandemic means having to find new ways to get the care and support you so desperately need when pregnant after loss.

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