Combination therapy shortens time to delivery after induction due to late pregnancy loss
Administering mifepristone before misoprostol, compared with misoprostol alone, shortened induction-to-delivery intervals among women who medically managed the loss of their fetus during the third trimester, a systematic review showed.
“Mifepristone is an anti‐progesterone that has consistently been shown to significantly increase the efficacy and safety of prostaglandins such as misoprostol in the management of first trimester loss and abortion care,” Kaitlyn Mayer, MD, an attending physician at the Naval Medical Center in Portsmouth, Virginia, told Healio Primary Care. “Few high-quality studies have investigated its use for the management of pregnancy loss in the second and third trimesters.”
Mayer and colleagues reviewed three retrospective cohorts, two prospective cohorts and four randomized trials that included 695 women who had a mean gestational age of 32.6 weeks. There was “heterogeneity among the studies,” Mayer said.
The findings, presented at virtual American College of Obstetricians and Gynecologists Annual Clinical and Scientific Meeting, indicated that median induction-to-delivery interval with mifepristone and misoprostol treatment was significantly less than misoprostol alone (10.2 vs. 16.9 hours; 95% CI, –12.3 to –1.2). The researchers reported a trend indicating an increased success rate with the combination therapy by 24 hours.
“Providers caring for patients who choose to manage late pregnancy loss with induction of labor should utilize combination therapy with mifepristone and misoprostol compared with misoprostol alone whenever possible,” Mayer said.