MIFEMISO - patient survey (updated)

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1. Welcome page
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We are seeking your views about a possible research study into the medical management of ‘missed’ or incomplete miscarriage in the first 12 weeks of pregnancy. 

‘Missed’ (or silent) miscarriage is when a scan shows that the pregnancy has ended, but the physical process of bleeding has not yet happened.

Incomplete miscarriage is when the physical process of miscarriage has begun but a scan shows that there is still pregnancy tissue remaining in the uterus (womb).

The aim of the trial is to compare different medicines that complete the process of miscarriage.  It will be funded by the National Institute of Health Research (NIHR), which is the research section of the NHS.   

Current national guidance for medical management in the first 12 weeks of pregnancy is to use the medicine misoprostol to bring on womb contractions.  However there is evidence that in approximately one third of women treated with misoprostol, the pregnancy tissue remains and these patients then require surgery to remove any remaining tissue.   

An alternative method of medical management is a two-stage approach, using a medicine called mifepristone as well as misoprostol.  Mifepristone makes the womb more sensitive to misoprostol and helps to open up the neck of the womb (cervix).  If mifepristone is used, it is taken by mouth and then 36-48 hours later misoprostol is either taken by mouth or inserted into the vagina.  This combination of mifepristone and misoprostol is used as standard in the treatment of miscarriages that happen later in pregnancy.

We want to find out which of these methods is best for women who have medical management of early pregnancy loss, before 13 weeks.  The best way to do this is with a randomised trial.  Women in the trial will have either mifepristone or an identical placebo (dummy) tablet in the first instance, and then 48 hours later they will start misoprostol treatment. 

Women in the trial won’t be able to choose whether they have had the mifepristone or the placebo medicine (a computer will make that choice) and neither they nor their doctors will know which medicine they have had.  However all women will go on to have the misoprostol treatment 48 hours later, unless they miscarry before then.

We would really like to know what you think about this trial and how you might feel if you chose medical management of miscarriage and were asked to take part.  Most of the questions are tick-boxes but there are also spaces for you to comment if you’d like to.  All your answers will remain anonymous.

Thank you,

Professor Arri Coomarasamy,
Dr. Justin Chu,
Dr. Adam Devall

Reproductive Physiology Research Team
Birmingham Women’s NHS Foundation Trust.