Research suggests better treatment for missed miscarriage patients

A new drug combination may be more effective for women having miscarriages without symptoms than current standard NHS treatment, new research suggests.

Missed miscarriage – also known as delayed or silent miscarriage – is when a baby has died in the womb but the mother has not had symptoms, such as bleeding or pain.

According to charity Tommy’s National Centre for Miscarriage Research, current hospital restrictions on surgery mean many women face waiting for the miscarriage to happen by itself, which can take weeks, or being offered medication to speed the process along.

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 needing surgery.

However, research published in the Lancet indicates misoprostol is more effective when combined with mifepristone which is an anti-progesterone drug used to induce labour.

Tommy’s researchers at the University of Birmingham studied 711 women across 28 UK hospitals with a diagnosis of missed miscarriage in the first 14 weeks of pregnancy.

The women were randomly assigned either mifepristone or a placebo drug followed by misoprostol two days later.

Researchers found that the combined drug treatment worked in 83% of cases, compared to 76% in the placebo group.

They say that it crucially reduced the need for surgery.

A quarter of the women given the placebo later needed an operation to complete the miscarriage, compared with less than one in five (18%) of those who had the new medication.

Dr Justin Chu, from Tommy’s National Centre for Miscarriage Research, who led the study at the University of Birmingham’s Clinical Trials Unit, explained: “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, with better outcomes for patients and lower costs for care services.

“We hope the Nice (National Institute for Health and Care Excellence) guidance will be updated in light of this new evidence, so that everyone who needs it has access to the most effective treatment.”

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.

Claire Bromley, 32, from Kent, chose surgery when she miscarried this year as her previous experience when medication failed was so distressing.

She said: “The whole process took around three months and was extremely traumatic, so I hope this new drug will mean others don’t suffer like I did.

“I was told the medication would take a few hours to work, but started bleeding and cramping in minutes, while stuck in hospital waiting for other prescriptions.

“Despite taking effect so fast, it didn’t work, so I was sent for surgery – and when that failed too, I had to take the pills again.

“With my second miscarriage, I chose surgery right away to avoid the risk of repeating such a long and painful treatment.”

Researchers and campaigners are calling for guidance from 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.

Professor Andrew Shennan, clinical director of NIHR Clinical Research Network South London and professor of obstetrics at Kings College London, added: “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.”

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