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The following is a summary of “Treatment of Early Pregnancy Loss With Mifepristone and Misoprostol Compared With Misoprostol Only,” published in the February 2025 issue of Obstetrics and Gynecology by Friedman et al.

This study aimed to compare treatment failure rates in cases of early pregnancy loss managed with either a combination of mifepristone and misoprostol or misoprostol alone. A retrospective cohort study was conducted, including patients who received medical treatment for early pregnancy loss between 2016 and 2023 at a single medical center. Patients underwent an initial follow-up ultrasonogram one-week post-treatment, with repeat misoprostol administration as needed. A final ultrasonographic assessment was recommended after menstruation, and surgical intervention was performed if retained products of conception (RPOC) were diagnosed. Treatment failure was defined as any need for surgical intervention due to RPOC, including cases diagnosed after menstruation. 

In May 2022, the treatment protocol was revised to include mifepristone prior to misoprostol administration. The study compared treatment failure rates between patients treated with the mifepristone-misoprostol regimen and those receiving misoprostol alone. A total of 999 patients were analyzed, with 224 in the mifepristone-misoprostol group and 775 in the misoprostol-only group. The rate of treatment failure was significantly lower in the mifepristone-misoprostol group compared to the misoprostol-only group (17.8% vs. 25.1%, P=.002). After adjusting for confounding factors, the addition of mifepristone was associated with a 34% reduction in the odds of treatment failure compared to misoprostol alone (adjusted OR 0.661, 95% CI: 0.44–0.97, P=.038). 

Furthermore, prior vaginal delivery was identified as a protective factor against treatment failure, whereas increasing gestational age, as determined by ultrasonography, correlated with a higher likelihood of treatment failure. These findings suggest that the addition of mifepristone to misoprostol significantly improves treatment efficacy and reduces the likelihood of requiring late surgical intervention for early pregnancy loss.

Source: journals.lww.com/greenjournal/abstract/2025/02000/treatment_of_early_pregnancy_loss_with.14.aspx