Efficacy and Safety of Mifepristone and Misoprostol Compared to Misoprostol Alone for the Resolution of Miscarriage and Intrauterine Fetal Death: A Systematic Review and Meta-Analysis.

This article systematically reviews and meta-analyzes randomized controlled trials to evaluate the efficacy and safety of combining mifepristone and misoprostol versus using misoprostol alone for resolving miscarriage and intrauterine fetal death. The analysis of 12 trials involving 2,310 patients found that the combination therapy resulted in significantly higher overall delivery success rates, shorter delivery times, and increased—but manageable—gastrointestinal adverse effects compared to misoprostol alone, with no significant differences in serious complications such as infection or blood transfusion. Dosage variations and timing between medications differed across studies, highlighting the need for standardized protocols. The findings support the use of mifepristone and misoprostol together as an effective and generally safe medical management option for miscarriage and intrauterine fetal death, while recommending clinicians weigh individual risks and benefits.