Comparative Analysis of Safety, Efficacy and Fetomaternal Outcome of Induction of Labor With Tablet Mifepristone and Tablet Misoprostol Versus Tablet Misoprostol

Abstract

OBJECTIVES:The present study aims at comparing the efficacy, safety and fetomaternal outcome of Misoprostol as cervical ripening and labor inducing agent versus Mifepristone and Misoprostol. The study also aims to observe the improvement in pre induction Bishop's score, proportion of patients going in labor, to study induction-delivery interval. METHODS: It is randomized prospective studies conducted on 100 women. Women were randomized in group A and in group B of 50 patients in each group. Group A received tab Mifepristone 200 mg orally on day 1 followed by tablet Misoprostol 25 mcg after 48 hours and continued 4 hrly till patient went in active labor with maximum four tablets and group B patients received tablet Misoprostol 25mcg and continued 25mcg 4hrly till patient went in active labor. RESULTS: The study demonstrated significant efficacy of tablet Mifepristone for cervical ripening and induction of labor as pre induction Bishop's score was improved. 32%patients went into labor only with tablet Mifepristone. The mean induction-delivery interval was 9.5 hrs in Group A and 11.78 hrs in Group B, 40% patients delivered by cesarean section in group A but it was not associated with any differences in final neonatal outcome in both the groups. Uterine hyper stimulation was present in 42% patients in group A as compared to only 20% patients in group B. Fetal distress was present in 38% of patients in group A as compared to 18% patients in group B. No any difference in final neonatal outcome was observed in both the groups. CONCLUSION: Mifepristone pretreatment is more efficacious and significantly shortens the induction-delivery interval and it has got dual role as a cervical ripening and labor inducing agent.

Effectiveness of Mifepristone plus Misoprostol and Misoprostol alone in Cervical Ripening and Induction of Labour in Postdated Pregnancy

“…Though there was significant change in Bishops score in both groups after use of each drug but the difference in change in mean Bishop's score in two groups was not statistically significant (p=0.84). This demonstrates that both drugs were equally efficient in bringing change in the Bishops score which is comparable to findings shown by Archana A et al 8 Induction to delivery interval in patient who had vaginal deliveries (n=30) was seen more in mifepristone group as compared to misoprostol group with statistically significant findings ( In the present study, significant difference in the success rate of mifepristone group in comparison to misoprostol group was seen showing mifepristone to be effacious in achieving vaginal delivery (p=0.01).…”

“…This phenomenon could be explained by the propensity of misoprostol which can enter the fetal circulation which lead to increased fetal bowel motility resulting in MSL. 11 Mifepristone is successful in achieving vaginal delivery than misoprostol similar to study done by Gaikwad V et al 12 Contrary to present study, Archana A et al 8 showed more number of vaginal delivery in misoprostol group (90%) than mifepristone group (60%). In mifepristone group more number of caesarean section was done mainly for fetal distress and MSL and it was seen after the use of misoprostol.…”

Cervical Ripening Using Mifepristone before Induction of Labor in Term Pregnancy: Prospective Randomized Comparative Study

“…In the studies by Archana et al, 5 Mandade and Bangal, 6 and Wing et al 10 misoprostol requirement was 68, 54, and 67% in the mifepristone group respectively. In our study, it was 94%, which was higher when compared to other studies.…”

“…The studies conducted by Yelikar et al, 3 Archana et al, 5 Mandade and Bangal, 6 Ramesh et al, 7 Arumugaselvi et al, 8 and Sah and Padhye 9 showed satisfactory improvement in Bishop's score after 24 hours ranging from 3 to 8 in the mifepristone group. However, this change was not significant in our study.…”

Efficacy Study of Mifepristone in Pre-induction Cervical Ripening and Induction of Labour

“…There many studies done where they found that, with the use of mifepristone the operative deliveries were significantly decreased. Ghimire et al 24 25 showed more number of vaginal delivery in misoprostol group (90.0%) than mifepristone group (60.0%).…”