Methodology: 4/5
Usefulness: 3/5

Chu JJ, et al. Lancet. 2020 Sep 12;396(10253):770-778.

Editorial: Medical management of miscarriage with mifepristone

Question and Methods: This multi-centre, randomized, double blind, placebo-controlled trial compares spontaneous passage of gestational sac in patients with US-confirmed missed miscarriage when treated with mifepristone + misoprostol or placebo + misoprostol.

Findings: The primary outcome of failure to pass gestational sac within 7 days was 17% in mifepristone + misoprostol versus 24% in placebo + misoprostol. ARR = 6.6% and NNT = 15.

Limitations: Regulatory burdens in Ontario mean that the treatment is only covered for medical abortions and the use for missed miscarriage is costly to patients at $337 for patients.

Interpretation: This large RCT shows a significant reduction in failure to pass gestational sac when treated with mifepristone + misoprostol for missed miscarriage up to 14 weeks gestation compared to misoprostol alone. It adds to the body of evidence that this is a safe and effective treatment with missed miscarriage.

By: Dr. Emma Ferguson

Hans Rosenberg
Dr. Rosenberg is an emergency physician at the Ottawa Hospital, assistant professor at the University of Ottawa, and Director of the Digital Scholarship and Knowledge Dissemination Program.