Induction of labor with mifepristone, ‐ A randomized, double‐blind study versus placebo

Stenlund, Per Mårten; Ekman, Gunvor; Aedo, A.-R.; Bygdeman, M.

doi:10.1034/j.1600-0412.1999.780910.x

Cited by 39 publications

(38 citation statements)

References 17 publications

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“…The median Bishop Score at the start of induction was similar in both groups which was comparable to stenlund et al 12 and Elliot et al 13 During the first 48 hours after the treatment was started 75% women who were given Mifepristone and 48% who were given placebo went into labour which was comparable to Elliot et al 13 and Giacolone et al 14 In Frydman 11 study, spontaneous onset of labour occurred in 31(54%) patients in study group but only in 10(18%) patients in placebo treated females. The number of patients with onset of labour pains within 48 hours of induction was less than the present study.…”

Section: Discussionsupporting

confidence: 86%

“…The incidence of nulliparity was 58% in study group and 52% in control group in present study. The distribution of pregnancies and deliveries did not differ significantly between the two groups which was comparable to frydman et al 11 and stenlund et al 12 In study by Mc Gill, 72% patients in each group were nulliparous. In all these studies most of the women who received labour induction were nulliparous.…”

Section: Discussionsupporting

confidence: 81%

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Mifepristone for cervical ripening and induction of labour

Nayak¹,

Kumar²

2020

IJOGR

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Objective:To study the efficacy of oral mifepristone in pre induction cervical ripening and induction of labour in term pregnancy. Materials and Methods: This is a single blind randomised control trial. 200 women with term pregnancy and bishop score < 6 were recruited and randomly allocated into two groups. Women who received tablet mifepristone 400 mg were assigned to study group (n=100) and who received placebo orally were assigned to control group (n=100). At the end of 48 hours, change in the bishop was assessed and accordingly induction/ augmentation of labour was done. Analysis regarding safety and efficacy of the drug was done with regards to maternal and perinatal outcome Results: Among 200 women, 100 received mifepristone and 100 received placebo. In mifepristone group, 75% patients entered into labour within 48 hours of induction as compared to 48% in placebo group. The mean time interval between induction to start of labour pains was 28 hours 54 min in group A and 42 hours 18 min in group B. This difference was statistically significant. (p=0.000). In the study group 70% patients delivered within 48 hours of treatment as compared to 38% patients in control group. Mean induction delivery interval was 35 hours 38 min in study group and 49 hours 52 min in control group (p=0.000). There were fewer caesareans in the mifepristone treated group (10%) than placebo group (20%) particularly for failed induction (2 versus 6) and non progress of labour (2 versus 5). There was no statistically significant different in perinatal outcome between two groups. Conclusion: Mifepristone has modest affect on cervical repining when given 48 hour prior to labour induction and appears to reduce need for further induction compared to placebo. Mifepristone is a simple and effective method of inducing labour in women with term pregnancy and unripe cervix. The use of Mifepristone provides an interesting new alternative to classic uterotonic agents when induction of labour is necessary.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 81%

Mifepristone for cervical ripening and induction of labour

Nayak¹,

Kumar²

2020

IJOGR

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“…), genetic syndromes (such as Ehlers-Danlos syndrome) [62], subclinical intra-amniotic infection [63][64][65] or intra-amniotic inflammation [66,67], or the elusive condition referred to as cervical insufficiency [68][69][70]. A decrease in progesterone action has been implicated in untimely cervical ripening [71][72][73][74][75][76][77][78], as this hormone plays a key role in maintaining the cervix as long and closed during pregnancy [77][78][79][80][81][82][83][84][85][86][87][88].…”

Section: Introductionmentioning

confidence: 99%

Sterile intra-amniotic inflammation in asymptomatic patients with a sonographic short cervix: prevalence and clinical significance

Romero

Miranda

Chaiworapongsa

et al. 2014

The Journal of Maternal-Fetal & Neonatal Medicine

160

122

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Objective To determine the frequency and clinical significance of sterile- and microbial-associated intra-amniotic inflammation in asymptomatic patients with a sonographic short cervix. Methods Amniotic fluid (AF) samples obtained by transabdominal amniocentesis from 231 asymptomatic women with a sonographic short cervix [cervical length (CL) ≤25 mm] were analyzed using cultivation techniques (for aerobic and anaerobic as well as genital mycoplasmas) and broad-range polymerase chain reaction (PCR) coupled with electrospray ionization mass spectrometry (PCR/ESI-MS). The frequency and magnitude of intra-amniotic inflammation [defined as an AF interleukin (IL)-6 concentration ≥2.6 ng/mL], acute histologic placental inflammation, spontaneous preterm delivery, and the amniocentesis-to-delivery interval were examined according to the results of AF cultures, PCR/ESI-MS and AF IL-6 concentrations. Results Ten percent (24/231) of patients with a sonographic short cervix had sterile intra-amniotic inflammation (an elevated AF IL-6 concentration without evidence of microorganisms using cultivation and molecular methods). Sterile intra-amniotic inflammation was significantly more frequent than microbial-associated intra-amniotic inflammation [10.4% (24/231) vs. 2.2% (5/231); p<0.001]. Patients with sterile intra-amniotic inflammation had a significantly higher rate of spontaneous preterm delivery <34 weeks of gestation [70.8% (17/24) vs. 31.6% (55/174); p<0.001] and a significantly shorter amniocentesis-to-delivery interval than patients without intra-amniotic inflammation [median 35, (IQR: 10 – 70) vs. median 71, (IQR: 47 – 98) days, (p<0.0001)]. Conclusion Sterile intra-amniotic inflammation is more common than microbial-associated intra-amniotic inflammation in asymptomatic women with a sonographic short cervix, and is associated with increased risk of spontaneous preterm delivery (<34 weeks). Further investigation is required to determine the causes of sterile intra-amniotic inflammation and the mechanisms whereby this condition is associated with a short cervix and spontaneous preterm delivery.

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“…Similar regimens have also been used with moderate success in the management of miscarriage 8,9 . However, to our knowledge there are no reports of the combined treatment in cases of intrauterine death despite significant effects of both drugs on the uterus in late pregnancy 10,11 . This study has demonstrated an effective combined regimen for induction of labour in late fetal death.…”

Section: Discussionmentioning

confidence: 99%

Medical management of late intrauterine death using a combination of mifepristone and misoprostol

Wagaarachchi¹

2002

BJOG: An International Journal of Obstetrics and Gynaecology

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Objective To assess the efficacy and safety of mifepristone in combination with misoprostol in the management of late fetal death. Design Observational study.Setting Aberdeen Maternity Hospital, Aberdeen.Methods A consecutive series of 96 women with intrauterine death after 24 weeks of gestation were studied.Each woman received a single dose of 200mg mifepristone orally, following which a 24 -48 hour interval was recommended before administration of misoprostol. For gestations of 24 -34 weeks, 200mg of intravaginal misoprostol was administered, followed by four oral doses of 200mg at three hourly intervals. Gestations over 34 weeks were given a similar regimen but a reduced dose of 100mg misoprostol. Results The average induction to delivery interval was 8.5 hours. Ninety-five women (98.9%) were delivered within 72 hours of administration of first dose of misoprostol, with 66.7%, 87.5%, 92.7% and 95.8% women delivering within 12, 24, 36 and 48 hours, respectively. No significant correlation was found between mean induction to delivery interval and maternal age, parity, Bishop's score, birthweight and mifepristone/ misoprostol interval. The induction to delivery interval was shorter with increasing gestation ( P ¼ 0.04).Mild side effects were noted in eight (8.3%) women. Three (3.1%) women had treatment for presumed or proven pelvic sepsis. No cases of uterine tachysystole, haemorrhage or coagulopathy were recorded. Conclusion The combination of mifepristone and misoprostol for induction of labour following late fetal death is an effective and safe regimen. The induction to delivery interval with this regimen appears shorter than studies using mifepristone or misoprostol. INTRODUCTIONWhen fetal death occurs after 24 weeks of gestation, spontaneous expulsion may take several weeks. Such retention of the fetus can be associated with emotional distress, intrauterine infection if the membranes are ruptured, and a time-related risk of consumptive coagulopathy 1 . Consequently, medical induction to expel the dead fetus is recommended, provided it can be undertaken safely.Prostaglandins have been used for induction of labour in cases of intrauterine death 2,3 . The therapeutic effect of prostaglandins is dose-related and is limited by its side effects. The side effects are also dependent on the type of prostaglandin and route of administration. Misoprostol, a prostaglandin E 1 analogue is probably the most preferred because of its low cost, stability in room temperature and ease of administration. Mifepristone is a steroid compound, which competes with progesterone at the receptor level and is widely used for first and second trimester termination of pregnancy 4,5 . Mifepristone, administered before misoprostol, increases the sensitivity of the uterus to prostaglandins and ripens the cervix, thereby allowing lower doses of misoprostol to induce expulsion of the fetus. However, the optimum combination of mifepristone and misoprostol has not been established for induction of late intrauterine deaths.The Department of Obst...

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Induction of labor with mifepristone, ‐ A randomized, double‐blind study versus placebo

Abstract: The results of the present study show that mifepristone is a simple and effective treatment for inducing labor in post-term women with an unripe cervix.

Cited by 39 publications

References 17 publications

Mifepristone for cervical ripening and induction of labour

Mifepristone for cervical ripening and induction of labour

Sterile intra-amniotic inflammation in asymptomatic patients with a sonographic short cervix: prevalence and clinical significance

Medical management of late intrauterine death using a combination of mifepristone and misoprostol

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