Better drug treatment for miscarriage found, as patients struggle to access surgery in COVID-19 pandemic

Greyscale image of a lone, upset woman with a drip beside her.

A new drug combination is more effective for women having miscarriages without symptoms than current standard NHS treatment, according to an NIHR-funded study from the Tommy’s National Centre for Miscarriage Research, published today in The Lancet.

Missed miscarriage (also known as delayed or silent miscarriage) is when a pregnancy has ended in the womb but the mother may not have had any symptoms (such as pain or bleeding). National guidelines recommend a treatment called misoprostol, which is successful in most cases – but some women wait anxiously for weeks, repeating the medication and eventually having to have surgery. This new research shows that misoprostol is more effective when combined with another medicine called mifepristone, an anti-progesterone drug.

Tommy’s researchers at BHP founder-member the University of Birmingham studied 711 women across 28 UK hospitals with a diagnosis of missed miscarriage in the first 14 weeks of pregnancy, randomly assigning them to receive either mifepristone or a placebo drug followed by misoprostol 2 days later.

The trial showed that the miscarriage resolution rate increased by 7% in the mifepristone plus misoprostol group (resolution rate 83%) compared to the placebo plus misoprostol group (resolution rate 76%). In addition, the need for surgery was reduced, with 25% of women given the placebo plus misoprostol later needing surgery to complete the miscarriage, compared with 17% of those who took mifepristone and misoprostol.

Researchers are doing further analysis to see exactly how much money switching to this combined treatment could save healthcare providers, but these findings suggest it would be more cost-effective for the NHS and better for patients.

As this is the largest ever study into the most effective medical treatment for missed miscarriage, and have given a clear result, researchers and campaigners are calling for guidance from the National Institute for Health and Care Excellence (NICE) to be updated in light of the newly published findings. In the meantime, Tommy’s experts encourage anyone diagnosed with missed miscarriage to ask their doctor about the combined drug treatment.

Dr Justin Chu from Tommy’s National Centre for Miscarriage Research, who led the study at the University of Birmingham’s Clinical Trials Unit, commented: “Particularly given the extra strain on the NHS in the Covid-19 pandemic, our findings could have huge benefits if they’re translated into clinical practice. We could achieve better outcomes for women and lower costs for care services. We hope the NICE guidance will be updated in light of this new evidence, so that everyone who needs it has access to the most effective treatment.”

Professor Andy Shennan, Professor of Obstetrics, and Clinical Director NIHR Clinical Research Network South London, said: “This important NIHR-funded study presents compelling results indicating more effective treatments that can help women have better outcomes after miscarriage. The fact that the need for surgery is reduced using this new combination of drugs is a positive result for both patients and those who plan and provide NHS care services.”

The study was funded by the NIHR HTA Programme and supported by the West Midlands LCRN.

More information about the study is available on the NIHR’s Funding & Awards website.