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P042Early pregnancy loss medical management in clinical practice after mifepristone-misoprostol clinical trial

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      Objectives

      To review clinical practice outcomes of early pregnancy loss (EPL) medical management at a previous mifepristone-misoprostol clinical trial site after study completion.

      Methods

      We reviewed a de-identified database for patients who received mifepristone-misoprostol for EPL from May 2018 to May 2021 at our academic center–based clinic, which was a study site for the mifepristone-misoprostol EPL trial (completed March 2018). All patients received mifepristone 200 mg and misoprostol 800 mcg with clinic follow-up typically scheduled within one week. We analyzed management and safety outcomes.

      Results

      Ninety-one patients chose medical management with mifepristone followed by misoprostol vaginally (79[87%]) or buccally (5[5%]), with route not documented for seven patients (8%). Median gestational age was 49 days (range 30–80) and median time from mifepristone to misoprostol administration was 24 hours (range 8–66). Follow-up was completed in the clinic for 80 (88%) patients, completed remotely for six (6%), and not completed for five (5%). Most patients (80[88%]) were successfully managed with medications alone. Two patients (2%) required tissue removal from the cervical os with ring forceps and nine (10%) had uterine aspirations. Seventy patients initially had ultrasonography at follow-up showing gestational sac expulsion; three (4%) ultimately required an aspiration for bleeding with pathologic examination demonstrating villi for all. The only safety outcomes were one pelvic infection and one transfusion due to significant bleeding.

      Conclusions

      Outside of a clinical trial setting, medical management of EPL with mifepristone and misoprostol remains effective and safe. While gestational sac expulsion on ultrasonography remains a good indicator of successful medical management of EPL, subsequent aspiration may be required more frequently than after medication abortion.
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