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

Current NICE guidelines recommend the drug misoprostol for the treatment of missed miscarriage, but without strong evidence. This trial was designed to find out whether treatment with mifepristone and misoprostol is a better alternative.
  • Authors list

    Professor Arri Coomarasamy, Professor Siobhan Quenby, Justin Chu, Dr Laura Jones, Dr Adam Devall and external collaborators

    Start date: 2016
    End date: 2020

Why do we need this research?

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

Most doctors used to prescribe a combination of two treatments – mifepristone and misoprostol – to encourage a woman’s body to complete the miscarriage (this is called 'managing a miscarriage'). However, in 2012, new NICE guidelines were published that recommended using misoprostol alone, but without any strong supporting evidence. It is therefore important to understand whether women benefit from treatment with both mifepristone and misoprostol, or if they only need to be given misoprostol.

What happened in this project?

Researchers from the Tommy’s National Centre for Miscarriage Research took part in the MifeMiso trial, which was designed to increase the evidence available and find the best treatment for women who have had a missed miscarriage. The study looked at three criteria:

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

In total, 711 women were included in the study from 28 hospitals in the UK; half of these women were given mifepristone plus misoprostol while the other half were given a placebo tablet in addition to misoprostol. The researchers found that 83% of women receiving mifepristone plus misoprostol had miscarriages that had completed within seven days of treatment, while this figure was only 76% for the women who received misoprostol in combination with a placebo. Treatment with mifepristone plus misoprostol also reduced the number of women who needed surgery to manage the miscarriage. Interestingly, combination treatment with mifepristone plus misoprostol was also found to be the most cost-effective option for managing a missed miscarriage.

To support this finding, our researchers also carried out something called a network meta-analysis in order to compare different methods of managing a miscarriage. This complex analysis enabled the team to combine the results of lots of trials into a single result. They found that treatment with either misoprostol alone or mifepristone plus misoprostol was more effective at completing a miscarriage than expectant management – which is where the woman waits for the miscarriage to happen naturally. But importantly, this analysis also confirmed that mifepristone plus misoprostol was more effective than misoprostol alone.

What difference will this project make?

Both the MifeMiso study and the network meta-analysis have shown that combination treatment with mifepristone and misoprostol is better than misoprostol alone at helping women deliver their baby after a missed miscarriage. These findings are being considered by NICE and will be used to update national guidelines so that women can receive the best possible treatment to help them complete their miscarriage.