Mifepristone Pretreatment for the Medical Management of Early Pregnancy Loss
This article was presented during the first site evaluation on the following patient:
HPI: Ms LS is a 29 year-old G2P0020 who had received an elective termination of pregnancy on 2/20/19 at 14 weeks gestation at women’s clinic where she took misoprostol + mifepristone PO; she comes to the ED c/o a constant crampy suprapubic pain which radiated to the LLQ 6/10 and started 2 days ago. Pt reports her LMP of 11/30/18, still has moderate vaginal bleeding. She denies fever, chills, nausea, vomiting, diarrhea, flatulence, headache, dizziness, SOB, chest pain, calf pain, syncope, urinary frequency
DDx:
- Retained products of conception (POC)/incomplete abortion
- Had an elective TOP 4 days ago
- Acute Cystitis (bladder infection)
- Suprapubic pain
- malaise
This patient was considered to be borderline end of first trimester and beginning of second trimester. In our differential we were not sure if she had passed all the product of conception (POC). Then during the bedside transabdominal sonogram, it was confirmed the absent of POC by showing endometrial stripe.
Based on the article, a 2018 randomized controlled trial revealed that the combination of mifepristone-misoprostol is better to misoprostol alone for the management of early pregnancy loss.
- The treatment of mifepristone first followed by misoprostol had a higher rate of complete expulsion, hence less need for D&E (Dilation and evacuation) compared with misoprostol treatment alone.
- medical management during early pregnancy loss is more desirable than surgical management.
One of the feedback received was that this article is intended for early pregnancy loss like miscarriage, but my patient wanted an elective termination of pregnancy. However, I believed the approach should be the same in terms of how to manage a successful termination of pregnancy without complications.
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