A Prospective Comparative Study of Mifepristone and Misoprostol vs Misoprostol Alone for Induction of Labor in Intrauterine Fetal Death

Abstract

Introduction: Intrauterine fetal death (IUFD) is an important indicator of maternal and perinatal health of a given population. Aim and objective: The objective of the study was to assess the efficacy of mifepristone and misoprostol vs misoprostol alone for induction of labor in IUFD and to determine risk-benefit ratio. Materials and methods:The present study was a prospective observational analytical study which was conducted in the Department of Obstetrics and Gynecology, JNMCH, Aligarh, from January 2018 to January 2021and includes 110 pregnant women with confirmed IUFD on USG. After taking informed consent, a predesigned pro forma was used to collect relevant sociodemographic profile, detailed logical history, and examination from all those participating in the study. Results: Age (mean ± SD) was 25.98 ± 4.49 vs 25.69 ± 4.78 years, parity was 2.31 ± 1.3 vs 2.44 ± 1.61, and gestational age was 31.04 ± 6.89 vs 32.71 ± 5.17 weeks in group I and group II, respectively. Modified Bishops score was >6 in 35 (63.64%) vs 32 (14.55%) women, mean dose of misoprostol required was 0.95 ± 1.5 vs 2.64 ± 1.89, mean induction labor interval was 2.42 vs 7.53 hours, and mean induction to delivery interval was 6.68 vs 16.61 hours in group I and group II, respectively, and the difference was found to be statistically significant. Mean birth weight was 1431.35 vs 1758.60 g, respectively, in the two groups. Four women (7.27%) in group I and 17 women (30.9%) in group II required augmentation with oxytocin which is statistically significant. Nausea, vomiting, loose stools, and hyperthermia were recorded as adverse effects. Among the identifiable causes, abruption was the most common cause in group II, whereas anemia and preeclampsia in group I. Conclusion:The combination of mifepristone with misoprostol was more effective for the induction of labor in IUFD, in terms of lesser amount of misoprostol dosage, oxytocin augmentation, improvement in modified Bishops score, and shorter induction labor and delivery interval when compared to misoprostol alone. Both the regimens were equally safe and easy to administer.

Efficacy of Mifepristone and Misoprostol Compared to Misoprostol Alone in the Medical Management of the First-trimester Missed Miscarriages

“…Compared to 82 (24%) of the 348 women in the placebo plus misoprostol group, 59 (17%) of the 348 women in the mifepristone plus misoprostol group did not spontaneously pass the gestational sac within 7 days. 12,13 conclusIon In contrast to misoprostol treatment alone, according to our research, pretreatment with mifepristone and misoprostol increased the rate of missed miscarriage resolution by 7 days. To maximize the likelihood of successful miscarriage management and decrease the need for surgical evacuation, like D&E particularly in primigravidas, we advise offering mifepristone pretreatment before misoprostol to women who have had a missed miscarriage.…”

A comparative study of second trimester termination of pregnancy with mifepristone and misoprostol vs misoprostol alone in 50 cases

“…In the present study, the complication rate was significantly less in the mifepristone-primed group compared to the misoprostol alone group, which was comparable to the study done by Akkenapally P. L. In a study done by Nagaria et al [10,11] complication rate was 5 % in mifepristone primed group and 10 % in misoprostol alone group (Table 7). Hoda A et al [20] compared to misoprostol alone, the combination of mifepristone and misoprostol was more effective for the induction of labour in IUFD in terms of less misoprostol dosage, oxytocin augmentation, improvement in Modified Bishops score, and shorter induction labour and the delivery interval.…”