Miscarriage Treatment Affected by Controversy


Legal controversy surrounding mifepristone, the so-called “abortion drug,” threatens what is considered the gold standard for treating miscarriage. Miscarriage affects one million American women each year, or at least 15% of known pregnancies. Physicians fear the drug will eventually be pulled from the market due to recent legal challenges, all the while seeing a “chilling effect” that prevents some people from prescribing it now. increase.

Last month, a federal judge in Texas ruled to block the approval of mifepristone by the Food and Drug Administration. Did. A long way to go will follow the debate in the Court of Appeals on May 17th.

Mifepristone was approved for early miscarriage in 2000, but is often used “off-label” to treat early miscarriage and to hasten delivery after fetal death in late pregnancy. These uses are so common that U.S. senators have asked the manufacturer, Danko, to petition the FDA to add abortion to the label of its drug, Mifeplex.

Denise Haar, an attorney for the group, which has filed a lawsuit in Texas on behalf of doctors and medical organizations that oppose abortion, said it has no objections to drug use beyond abortion. experts say that once removed from the market for approved use, it is not available for miscarriage.

Dr. Christine Brandy said the “gold standard in miscarriage management”, a two-drug combination of mifepristone and misoprostol, helps empty the uterus and reduce the chance of infection.

“I provide this drug to every patient I manage for miscarriage,” said Brandi, an OB-GYN in Newark, New Jersey. said.

get over the pain

Brandy said medication speeds up the miscarriage process when a woman is already suffering physically and mentally.

Most women who miscarry naturally pass through pregnancy tissue within two weeks of diagnosis, but pregnancy tissue can take several weeks, according to the American College of Obstetricians and Gynecologists. When a woman takes the drug, the tissue generally clears her within 48 hours. Studies show that the drug is about 80% to 90% effective.

Brandi administers mifepristone to a patient in her office. It blocks the hormone progesterone and prepares the uterus to respond to the contractile-inducing effects of misoprostol, which is taken at home later.

Gillian Phillips, a 41-year-old social worker from Northbrookfield, Massachusetts, says the drug has made a horrible situation a little more bearable.

On her second ultrasound, doctors found no fetal heart activity at 9 weeks’ gestation. Ms. Phillips considered undergoing “dilation and curettage” surgery, but she didn’t like the need for general anesthesia and was unable to take her remains home. Medication seemed like a better option.

She was put on mifepristone and eventually needed two doses of misoprostol. “But the miscarriage itself was less significant than my worst period,” she said. “And I was home with my family.”

Today she finds solace in the Memorial Gardens. There, small angel figurines are lined up near the tree in the front yard.

Myriad Norris, 25, of Lexington, Kentucky, said she was glad mifepristone was available when she miscarried in late March.

About 12 hours after finding out she was pregnant, Norris began having convulsions and then bleeding. Worried she might develop an infection, she asked her doctor about mifepristone. She was just past her fifth week of pregnancy, and her tissue disappeared on its own.

Soon, news broke of a Texas judge’s ruling. Norris, a stay-at-home mom who works with the Kentucky for Reproductive Freedom group, said it brought “another layer of grief.”

“Chilling Effects” and Backup Plans

Mifepristone has long been subject to special restrictions, but experts say it is just as safe as the over-the-counter pain reliever ibuprofen. Requests to be dispensed.

Doctors say the current legal situation has made access even more difficult.

“It produces some kind of chilling effect,” and even though it’s still approved and available, doctors are “too worried about the aftermath to give it.” said Brandy.

Dr. Sarah Prager, an OB-GYN at the University of Washington School of Medicine, said her health system does not restrict mifepristone, but others in her state do.

“Facilities that don’t want to have anything to do with abortion have chosen not to carry mifepristone on site,” she said. This includes Catholic institutions that are

Doctors are waiting to find out about Mifepristone’s fate, so they have a back-up plan for miscarriage treatment.

One is to use misoprostol alone to manage the miscarriage. Although safe, studies show that it’s not very effective at helping the expulsion of pregnancy tissue, and if it remains in the uterus it can lead to dangerous infections. A 2018 study published in the New England Journal of Medicine. The success rate for miscarriage patients who used only misoprostol was 67%, compared with 84% for those who used the two drugs, according to the study.

This means that misoprostol-only patients are likely to require follow-up surgical intervention or additional doses. ,” said Prager.

“I feel like we’re just punishing people for not being able to give them the evidence-based, least-impact regimen,” she said.

Phillips said the patient deserved every option she had.

“You already feel completely traumatized and devastated” during the miscarriage, Phillips said. ”.

Information for this article was provided by Heather Hollingsworth of The Associated Press.

photograph Gillian Phillips and sons Jude and Emmett hold an urn containing part of the ashes of daughter Emilia Phillips on Tuesday, May 2, 2023 in North Brookfield, Massachusetts. with nightly. Phillips, who used the drug mifepristone to manage miscarriages, is concerned that other women who have miscarried may suffer if the pill, which is also used for abortions, is removed from the market. (AP Photo/Reba Saldanha)
photograph The remains of her miscarriage and those of her deceased child are buried in the garden of the Jillian Phillips home in North Brookfield, Massachusetts, Tuesday, May 2, 2023. Anyone could suffer a miscarriage if the pill, which is also used for abortion, is taken off the market. (AP Photo/Reba Saldanha)
photograph Gillian Phillips sits for a portrait at her home’s memorial garden in North Brookfield, Massachusetts, Tuesday, May 2, 2023. The body of her child Emilia, who died five days after her birth in 2015, followed her 2016 miscarriage. Phillips, who used the drug mifepristone to manage her miscarriage, said she fears other women who have miscarried may suffer if the pill, which is also used for abortions, is taken off the market. (AP Photo/Reba Saldanha)
photograph Gillian Phillips poses for a portrait with 10-year-old Macy and 4-year-old twins Jude and Emmett at her home in North Brookfield, Massachusetts, on Tuesday, May 2, 2023. I am concerned that other women who have had miscarriages may suffer if the pill, which is also used to have an abortion, is withdrawn from the market to manage her miscarriage. (AP Photo/Reba Saldanha)
photograph Gillian Phillips poses with 10-year-old Macy and 4-year-old twins Jude and Emmett (right) at the memorial garden of her home in Northbrookfield, Massachusetts, Tuesday, May 2, 2023. She was buried there with the remains of her 2016 miscarriage. Phillips, who used the drug mifepristone to manage her miscarriage, said she feared other women who had miscarried could suffer if the pill, which is also used for abortions, was taken off the market. (AP Photo/Reba Saldanha)
photograph Gillian Phillips sits with 10-year-old Macy and 4-year-old twins Emmett and Jude at their home in North Brookfield, Massachusetts, Tuesday, May 2, 2023. An urn in the shape of her deceased sister Emilia, who died in 2015, five days after her birth. Used for abortion and removed from the market. (AP Photo/Reba Saldanha)



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