2-Drug Combo Could Help Some Women Through Miscarriage

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THURSDAY, June 7, 2018 (HealthDay News) -- A two-drug combination is more effective than a single drug for women suffering miscarriage, a new study finds.

Each year, about one million women in the United States have miscarriages, according to researchers at the University of Pennsylvania. In the final part of a miscarriage, the body should expel the pregnancy tissue. However, sometimes this does not occur and the patient is given the drug misoprostol.

But the drug does not always work, and in these cases a woman must have surgery -- prolonging an already physically and emotionally difficult time.

"Though rarely discussed openly, miscarriage is the most common complication of pregnancy, and the public health burden is both physical and psychological," study lead researcher Dr. Courtney Schreiber said in a university news release.

"For too many women, misoprostol alone just leads to frustration," said Schreiber, who directs family planning and is associate professor of obstetrics and gynecology at the university's School of Medicine. "I have seen my patients suffer from the insult of the treatment failure added to the injury of the initial loss," she said.

Schreiber's study involved 300 women with early pregnancy loss -- miscarriage in the first trimester. The study found that a combination of the drugs mifepristone and misoprostol was more effective than misoprostol alone in helping women who miscarry avoid surgery.

Women who took the drug combination were much less likely to require surgery within 30 days than those who took misoprostol alone -- 8.8 percent versus 23.5 percent, respectively, the findings showed.

There were also no significant differences between the groups in terms of pain, bleeding or other side effects. Serious side effects were rare in both groups, according to the report.

"As physicians, we have to do better for these patients, and our new study shows that by combining mifepristone with misoprostol, we can," Schreiber said.

One ob-gyn said there's one roadblock to using mifepristone, however.

"When mifepristone, also known as RU 486, was brought to the United States, it was known as the 'abortion drug,' " noted Dr. Jennifer Wu, an obstetrician-gynecologist at Lenox Hill Hospital in New York City.

"There were many reservations about patients using the 'abortion drug' at home," she explained, and "for these reasons, the decision was made to require special authorization for dispensing RU 486." Currently, clinics and doctors must undergo a special registration process to be able to dispense mifepristone.

However, "in all these years of use, the safety of the drug has been demonstrated," Wu added. "Removing the authorization requirement would make the drug much more available to patients by many different levels of health care providers."

Schreiber agreed.

"High-quality care for women who suffer miscarriage not only improves physical outcomes, but helps alleviate the psychosocial stress that can accompany the loss of a pregnancy," Schreiber said.

"Given how common miscarriage is and the effectiveness of the drug combination as shown in this new study, any doctor who cares for women who become pregnant, and therefore could have a miscarriage, should be registered to prescribe and dispense mifepristone," she added.

The new study was published June 6 in the New England Journal of Medicine.

More information

The March of Dimes has more on miscarriage.

SOURCES: Jennifer Wu, M.D., obstetrician/gynecologist, Lenox Hill Hospital, New York City; University of Pennsylvania, news release, June 6, 2018
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