Therapeutic effect of mifepristone combined with misoprostol in early missed miscarriage and prediction of incomplete abortion

Objective: To compare the clinical efficacy of mifepristonemisoprostol medical management versus surgical curettage for first-trimester missed miscarriage, and to establish evidence-based sonographic cutoff values predictive of incomplete abortion requiring surgical intervention. Methods: We retrospectively analyzed a cohort of 702 women diagnosed with first-trimester missed miscarriage between January 2020 and May 2023. Demographic characteristics and ultrasound parameters were systematically recorded. Receiver operating characteristic (ROC) curve analysis was performed to establish optimal sonographic cutoff values for predicting incomplete abortion requiring surgical intervention. Results: 146 patients received medical treatment (mifepristone and misoprostol) and 556 underwent surgical curettage. At the 1-month follow-up, the medical group showed significantly greater endometrial thickness and longer postoperative bleeding duration than the surgical group (P<0.05). The menstrual volume reduction rate (23.56%) was significantly lower in the medical group than in the surgical group. The incomplete abortion rate was higher in the medical group (17.12%, 25/146) than in the surgical group (2.88%, 16/556). Among the medical group, 14 patients (9.59%) required curettage due to incomplete abortion, while 11 cases resolved spontaneously after prolonged medication. ROC curve analysis identified two cut-off values indicating the need for surgical intervention: endometrial thickness >1.21 cm at 24 h post-medical abortion, and residual mass diameter >0.95 cm at 7 days post-medical abortion. Conclusions: Medical management of first-trimester missed miscarriage using mifepristone-misoprostol demonstrates comparable efficacy to surgical curettage. An endometrial thickness >1.21 cm at 24 h or residual tissue diameter >0.95 cm at 7 days post-medical abortion should prompt consideration of incomplete abortion.