Efficacy of Ulipristal Acetate in Induction of Second Trimestric Missed Abortion: Randomized Controlled Trial

Abstract

iscarriage is common, affecting one in five pregnancies Miscarriage can cause physical harm, such as excessive bleeding and infection, and substantial psychological harm, including anxiety, depression, and post-traumatic stress disorder. Misoprostol, a prostaglandin analogue, is commonly used for the medical management of miscarriage to induce myometrial contractions to aid the expulsion of pregnancy tissue. However, misoprostol is not always effective, and 15–40% of women require an additional dose of misoprostol, thus prolonging the duration of treatment. Failure of medical management can result in more surgical procedures being done, which can be particularly undesirable to women who have chosen to have medical management. To augment the effect of misoprostol, a steroidal anti-progesterone like mifepristone is sometimes used in combination. Mifepristone is a competitive progesterone receptor antagonist that primes the myometrium before prostaglandin exposure. Due to its anti-progestin activity, Ulipristal is highly effective for use in emergency. It’s primary mechanism of action is delay of ovulation, but endometrial effects that may affect implantation may also contribute to efficacy