This study aims to compare whether a combination of two drugs (Mifepristone and misoprostol) are superior compared to using only one of these drugs (Misoprostol) as medical treatment for a miscarriage. Women in whom early pregnancy failure, 6-14 weeks postmenstrual, is ultrasonographically confirmed qualify for this study. It is expected that the combination of Mifepristone and Misoprostol is more effective in reaching complete evacuation, and therefore can prevent more invasive treatment such as curettage.
This study will test the hypothesis that, in early pregnancy failure, the sequential combination of mifepristone with misoprostol is superior to the use of misoprostol alone in terms of complete evacuation of products of conception (primary outcome), patient satisfaction, complications, side effects and costs (secondary outcomes). The trial will be performed multi-centred (hospitals), prospectively, two-armed, randomized, double-blinded and placebo-controlled. Women with ultrasonographically confirmed early pregnancy failure (6-14 weeks postmenstrual), managed expectantly for at least one week, can be included. Before medical treatment with misoprostol (two doses 400mcg (four hours apart), repeated after 24 hours if no tissue is lost), patients will be randomized to oral mifepristone (600mg) or oral placebo (identical in appearance). The investigators aim to randomize 460 women in a 1:1 ratio, stratified by centre. After six weeks, the primary endpoint, complete or incomplete evacuation, will be determined
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
342
Adding 600 mg of Mifepristone to the regular treatment with Misoprostol 800 mcg.
Regular treatment with Misoprostol 800 mcg.
Rijnstate
Arnhem, Gelderland, Netherlands
Radboud University Medical Centre
Nijmegen, Gelderland, Netherlands
Canisius Wilhelmina Hospital
Nijmegen, Gelderland, Netherlands
Complete evacuation
Whether or not complete evacuation (total endometrial thickness \<15 mm) has been acquired will be assessed through ultrasonography.
Time frame: six weeks after initial treatment
patient satisfaction
To assess how satisfied patient are with the treatment they underwent. Patient satisfaction with treatment will be measured using The Client Satisfaction Questionnaire (CSQ-8, digital)
Time frame: At baseline, day four, two and six weeks after treatment
complications
How many and which complications have occured?
Time frame: six weeks after treatment
side effects
Which side effects have patients experienced and to what degree?
Time frame: six weeks after treatment
costs
To evaluate which medical treatment strategy is cost-effective, volumes of health care consumed will additionally be measured prospectively alongside the clinical trial together with cost associated with productivity losses. Costs of medical interventions (direct costs) and costs resulting from productivity loss (indirect costs) will be taken into account. Resource uses will be recorded in the case report forms. Standardized unit costs will be calculated using the Dutch manual for costing in economic evaluations and standardised costs.
Time frame: up to six weeks after treatment
Overall quality of health, as experienced by the patient.
To measure the quality of the health status of the patients, a validated so-called health-related quality of life (HRQoL) instrument will be used: the Short Form 36 health survey
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Maasstad Ziekenhuis
Rotterdam, South Holland, Netherlands
OLVG
Amsterdam, Netherlands
Amphia Hospital
Breda, Netherlands
Catharina Hospital
Eindhoven, Netherlands
Martini Hospital
Groningen, Netherlands
Zuyderland Medical Centre
Heerlen, Netherlands
St. Antonius Hospital
Nieuwegein, Netherlands
...and 3 more locations
Time frame: At baseline, day four, and two and six weeks after initial treatment.
Overall quality of health, as experienced by the patient.
To measure the quality of the health status of the patients,a validated so-called health-related quality of life (HRQoL) instrument will be used: the EuroQol-5D.
Time frame: At baseline, day four, and two and six weeks after initial treatment.