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

Currently NICE recommends the drug misoprostol for the treatment of missed miscarriage, but without strong evidence. This trial is designed to find out whether treatment with mifepristone and misoprostol is a better alternative.
  • Author's 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 misoprostol alone 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 have been taking 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 7 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.

What difference will this project make?

The MifeMiso study has shown that combination treatment with mifepristone and misoprostol is the best option to help women deliver their baby after a missed miscarriage. The researchers hope that these findings will be used to update national guidelines so that women can receive the best possible treatment to help them complete their miscarriage.