Efficacy of Mifepristone in Preinduction Cervical Ripening in Term Pregnancy

Abstract

Objective: To study the efficacy of mifepristone in preinduction cervical ripening in term pregnancy. Study design: This is a prospective observational study, done in a tertiary care hospital. Fifty pregnant women in the study group were given oral mifepristone 200 mg for preinduction cervical ripening (second dose after 24 hours if applicable) and another 50 pregnant women who underwent expectant management were included in the expectant group. The primary objective was to assess the effect of mifepristone on the change in Bishop score. The secondary objective was to assess the induction-delivery interval and the mode of delivery. Results: In this study, the mean modified Bishop score 24 hours after oral mifepristone (single dose) was (7.34 ± 1.533) which was statistically significant compared to the expectant group's Bishop score (4.28 ± 1.179) p <0.001. Similarly, the mean modified Bishop score 48 hours after oral mifepristone (two doses) was 7.50 ± 0.57 which was statistically significant when compared to the expectant group (4.28 ± 1.155) p <0.001. The requirement for further inducing agents has also been significantly less in the study group compared to the expectant group (p <0.001). Twenty-four percent went into spontaneous labor within 24 hours of the first dose of oral mifepristone without the requirement of a prostaglandin E2 (PGE2) gel. Augmentation with oxytocin was required in 60% of the study group and 86% of the expectant group in active labor. The mean duration between the initiation of PGE2 gel induction and delivery was 13.45 ± 4.536 hours in the study group and 20.41 ± 3.896 hours (p <0.001). Spontaneous vaginal delivery was 82% in the study group and 80% in the expectant management group. Conclusion: Oral mifepristone given for preinduction cervical ripening was found to be effective and safe with a reduction in the need for additional prostaglandins and oxytocin and also shorter induction-to-delivery interval with no serious maternal or fetal adverse effects.

Comparison of outpatient with inpatient mifepristone usage for cervical ripening: A randomised controlled trial

“…We found that women who underwent outpatient cervical ripening with mifepristone had the same rate of Bishop score improvement as women in the inpatient group at 24 h (1 (1–2) vs. 1 (1–2), P = 0.416) and 48 h (3 (2–4) vs. 3 (1–4), P = 0.527). This Bishop score improvement was the same as or slightly lower than that reported in other studies [25] , [26] , [27] , [30] , [31] , [32] , [33] , [34] , [35] , [36] .…”

“…In a study by Hcini et al [24] , upon the use of 600 mg of mifepristone for cervical ripening at or beyond term, only 2 of 108 (1.9 %) patients reported headache and abdominal pain, and no foetal or neonatal side effects were noted. In another study comparing the outcomes of cervical ripening with mifepristone and dinoprostone in 50 women at term pregnancies, there were no differences in neonatal outcomes, including the incidence of hypoglycaemia [35] .…”

“…A similar frequency of additional preinduction methods was reported by Sharma et al (73.3 % of dinoprostone gel) [27] and Wing et al (67.0 % of misoprostol) [29] . Sujithra et al reported a lower frequency of dinoprostone gel use (32 %); however, in every fifth case, it was reused twice [35] .…”