Using oral mifepristone followed two days later by misoprostol is better than using the latter alone for the medical management of missed miscarriage, trial results show.

In the MifeMiso trial, 711 women with missed miscarriage in the first 14 weeks of pregnancy across 28 UK hospitals were randomised to either a 200mg oral dose of the anti-progesterone, mifepristone, or placebo.

Women in both trial arms then had a single 800 microgram dose of a prostaglandin — oral, vaginal or sublingual misoprostol — two days later, the authors reported in the Lancet.

If this failed to produce bleeding during the following 48 hours, participants were asked to contact their doctors for consideration of a further misoprostol dose.