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Medical management of miscarriage – the MifeMiso trial results

25th August 2020

When an ultrasound scan shows that a pregnancy has ended but the process of miscarriage hasn’t started or completed, women are usually [1] offered a choice about how to manage the situation: natural management (also called expectant or conservative management): letting nature take its course; medical management: using medication to begin or speed up the process of miscarriage; or surgical management (also called SMM): an operation to remove the pregnancy.

The MifeMiso trial focused on medical management of miscarriage, investigating whether a single drug treatment (misoprostol) or a combination of drug treatments (mifepristone plus misoprostol two days later) is best for the medical management of missed or silent miscarriage in the first 14 weeks of pregnancy.

The results, published today in the Lancet [2], showed that the combination of drug treatments was the most effective option.  Treatment with mifepristone two days before misoprostol, led to the miscarriage resolving more quickly than treatment with misoprostol alone.

The combined treatment also reduced the need for surgery following medical management, and was less costly overall.

We hope that these results will lead to more consistent practice across the UK for those women who opt for medical management of missed or silent miscarriage.  We hope too that it will lead to a change in the NICE guidance, which currently recommends use of misoprostol alone.


[1] During the Covid 19 pandemic, fewer women are being offered the option of surgery for missed miscarriage.  We look forward to all options being made available as soon as possible.

[2]  Mifepristone and misoprostol versus misoprostol alone for the management of missed miscarriage (MifeMiso): a randomised, double-blind, placebo-controlled trial: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31788-8/fulltext

[3]  The Miscarriage Association’s National Director served on the MifeMiso trial steering committee.

[4] There is further information about the MifeMiso trial process here.



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