Dayan-Schwartz Adi, Vinitski Revital, Hassan Haya, Izhaki Ido, Abd Elgani Suzan, Kogan Liron, Baram Shira, Zbidat Firas, Seh Khadeje, Zafran Noah, Reiss Ari, Beck-Fruchter Ronit
Department of Obstetrics and Gynecology, Emek Medical Center, Afula 1834111, Israel.
Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel.
J Clin Med. 2025 Sep 8;14(17):6340. doi: 10.3390/jcm14176340.
: Missed miscarriage (MM) is a common first-trimester complication. Misoprostol alone achieves moderate success, while combination therapy with mifepristone improves outcomes in spontaneous pregnancies. Evidence in assisted reproductive technology (ART) pregnancies is scarce. We evaluated whether combined mifepristone-misoprostol improves outcomes in ART pregnancies compared with misoprostol alone and compared results with spontaneously conceived (SC) pregnancies. : This retrospective matched cohort study was conducted at a single center (2017-2024). ART pregnancies were matched 1:2 with SC pregnancies by maternal age. Patients received misoprostol alone or 200 mg mifepristone followed 48 h later by misoprostol. The primary outcome was treatment success, defined as complete uterine evacuation without repeat misoprostol or surgery. Secondary outcomes included emergency visits, surgical procedures, and ART-related predictors. Subgroup analyses were performed by ART protocol. : Among 307 patients (94 ART, 213 SC), combined therapy yielded higher success than misoprostol alone in SC (84% vs. 71%, = 0.023) and ART pregnancies (95% vs. 80%, = 0.035). In hormonally supported frozen embryo transfer (HRT-FET) cycles, success was 100% with combined therapy versus 80% with misoprostol alone. : Combined mifepristone-misoprostol is more effective than misoprostol alone, with particularly high success in HRT-FET cycles.
稽留流产（MM）是常见的孕早期并发症。单独使用米索前列醇成功率中等，而米非司酮联合治疗可改善自然妊娠的结局。辅助生殖技术（ART）妊娠方面的证据较少。我们评估了米非司酮联合米索前列醇与单独使用米索前列醇相比，是否能改善ART妊娠的结局，并将结果与自然受孕（SC）妊娠进行比较。
本回顾性匹配队列研究在单一中心进行（2017 - 2024年）。ART妊娠按产妇年龄与SC妊娠以1:2进行匹配。患者单独接受米索前列醇治疗，或先服用200毫克米非司酮，48小时后再服用米索前列醇。主要结局为治疗成功，定义为子宫完全排空，无需重复使用米索前列醇或手术。次要结局包括急诊就诊、手术操作及ART相关预测因素。按ART方案进行亚组分析。
在307例患者（94例ART妊娠，213例SC妊娠）中，联合治疗在SC妊娠（84% vs. 71%，P = 0.023）和ART妊娠（95% vs. 80%，P = 0.035）中的成功率均高于单独使用米索前列醇。在激素支持的冻融胚胎移植（HRT - FET）周期中，联合治疗的成功率为100%，而单独使用米索前列醇为80%。
米非司酮联合米索前列醇比单独使用米索前列醇更有效，在HRT - FET周期中成功率尤其高。
