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.
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    Arri Coomarasamy, Siobhan Quenby, Justin Chu, Manjeet Shehmar, Laura Jones, Adam Devall

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.