Induction of Labor Using Misoprostol With or Without Mifepristone in Intrauterine Deat

Authors

  • Ajay Agrawal B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
  • Pritha Basnet B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
  • Achala Thakur B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
  • Pappu Rizal B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
  • Rubina Rai B.P. Koirala Institute of Health Sciences, Dharan, Nepal.

DOI:

https://doi.org/10.31729/jnma.2731

Keywords:

induction of labor; intrauterine fetal death; mifepristone; misoprostol.

Abstract

Introduction: Rapid expulsion of fetus in intrauterine fetal death is usually requested without any medical grounds for it. So an efficient, safe method for induction of labor is required. The objective of this study is to determine if pre-treatment with mifepristone followed by induction of labor with misoprostol in late intrauterine fetal death is more efficacious.

Methods: We conducted a randomized controlled trial in 100 patients in B.P.Koirala Institute of Health Sciences, Nepal from June 2011 to May 2013. Group A women received single oral dose of 200 mg mifepristone, followed by induction with vaginal misoprostol after 24 hours. Group B women were induced only with vaginal misoprostol. In each group, five doses of misoprostol was used four hourly. If first cycle was unsuccessful, after break of 12 hour, second course of misoprostol was started. The primary outcome was a measure of induction to delivery time and vaginal delivery within 24 hours. Secondary outcome was to measure need of oxytocin and complications.

Results: Maternal age, parity and period of gestation were comparable between groups. Number of misoprostol dose needed in group A was significantly less than group B. Mann Whitney U test showed, women in group A had significantly earlier onset of labor, however total induction to delivery interval was not significant. In group A, 85.7% delivered within 24 hours of first dose of misoprostol while in group B 70% delivered within 24 hours (p=0.07). More women in Group B required oxytocin.

Conclusions: Pretreatment with mifepristone before induction of labor following late intrauterine fetal death is an effective and safe regimen. It appears to shorten the duration of induction to onset of labor. 

Keywords:  induction of labor; intrauterine fetal death; mifepristone; misoprostol. 

References

1. Kochenour NK. Management of fetal demise. Clin Obstet Gynecol. 1987 Jun;30(2):322-30.
2. Ngai SW, Tang OS, Ho PC. Prostaglandins for induction of second-trimester termination and intrauterine death. Best Pract Res Clin Obstet Gynaecol. 2003 Oct;17(5):765-75.

3. Ashok PW, Flett GM, Templeton A. Effective, low-cost regimens for medical termination of pregnancy at all gestations. Contemp Rev Obstet Gynaecol. 1999;11:207-12. 4. Ashok PW, Penney GC, Flett GM, Templeton A. An effective regimen for early medical abortion: a report of 2000 consecutive cases. Hum Reprod. 1998 Oct;13(1O):2962-5. 5. Jannet D, Aflak N, Abankwa A, Carbonne B, Marpeau L, Milliez J. Termination of 2nd and 3rd trimester pregnancies with mifepristone and misoprostol. Eur J Obstet Gynecol Reprod Biol. 1996 Dec 27;70(2):159-63. 6. Wagaarachchi PT, Ashok PW, Narvekar NN, Smith NC, Templeton A. Medical management of late intrauterine death using a combination of mifepristone and misoprostol. BJOG. 2002 Apr;109(4):443-7. 7. Fairley TE, Mackenzie M, Owen P, Mackenzie F. Management of late intrauterine death using a combination of mifepristone and misoprostol--experience of two regimens. Eur J Obstet Gynecol Reprod Biol. 2005 Jan 10;118(1):28-31.
8. Royal College of Obstetricians and Gynaecologists (RCOG). Late intrauterine fetal death and stillbirth. London (UK): Royal College of Obstetricians and Gynaecologists (RCOG); 2010 Oct. 33 p. (Green-top guideline; no. 55). 9. Bishop EH. Pelvic scoring for elective induction. Obstet Gynecol. 1964 Aug;24:266-8. 10. Stenlund PM, Ekman G, Aedo AR, Bygdeman M. Induction of labour with mifepristone: a randomised, double blind study versus placebo. Acta Obstet Gynecol Scand. 1999;9:793-8. 11. Vayrynen W, Heikinheimo O, Nuutila M. Misoprostol-only versus mifepristone plus misoprostol in induction of labor following intrauterine fetal death. Acta Obstetricia et Gynecologica Scandinavica. 2007; 86:701-5. 12. Giacalone PL, Daurés JP, Faure JM, Boulot P, Hedon B, Laffargue F. The effects of mifepristone on uterine sensitivity to oxytocin and on fetal heart rate patterns. Eur J Obstet Gynecol Reprod Biol. 2001 Jul;97(1):30-4.

Downloads

Published

2014-06-30

How to Cite

Agrawal, A., Basnet, P., Thakur, A., Rizal, P., & Rai, R. (2014). Induction of Labor Using Misoprostol With or Without Mifepristone in Intrauterine Deat. Journal of Nepal Medical Association, 52(194), 785–790. https://doi.org/10.31729/jnma.2731

Issue

Vol. 52 No. 194 (2014)

Section

Original Article

License

JNMA allow to read, download, copy, distribute, print, search, or link to the full texts of its articles and allow readers to use them for any other lawful purpose. The author(s) are allowed to retain publishing rights without restrictions. The JNMA work is licensed under a Creative Commons Attribution 4.0 International License. More about Copyright Policy.

Most read articles by the same author(s)