Labor induction in women at term with mifepristone (RU 486): A double-blind, randomized, placebo-controlled study

Frydman, René; Lelaidier, C.; Baton-Saint-Mleux, C.; Fernández, H.; Vial, M; Bourget, P.

doi:10.1016/0020-7292(93)90660-o

Cited by 77 publications

(87 citation statements)

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“…Present study corroborates the finding of Hapangama and Neilson wherein they have recorded high incidences of women going in spontaneous labour and having favourable cervix after 48 h (RR 2.9, 95% CI 1.70-3.42). 2 Similar endorsement has also been made by Frydmann et al and Yelakar et al 3,6 In present study in each group of PGE2 gel application (1 st , 2 nd or 3 rd ) more number of women went in spontaneous labour in the study group without requiring oxytocin for induction. The incidence of cesarean section was not significantly reduced in our study though Hapangama and Neilson and Fathima et al have reported reduced caesarean rate.…”

Section: Resultssupporting

confidence: 83%

Oral mifepristone as adjuvant to prostaglandin E2 (PGE2) gel for preinduction cervical ripening and induction of labour in third trimester

Mane¹,

Singh

Singh³

2017

Int J Reprod Contracept Obstet Gynecol

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INTRODUCTIONWhenever the intrauterine milieu is not conducive for the foetus and continuation of pregnancy may affect adversely to mother and the fetus, termination of the pregnancy is planned. If there is no contraindication for vaginal delivery then the favourability of cervix helps in predicting success of vaginal delivery. With almost 20 % rate of induction of labour there is a rising trend in the incidence of caesarean sections and repeat caesarean ABSTRACT Background: Whenever the intrauterine milieu is not conducive for the foetus and continuation of pregnancy may affect adversely to mother and the fetus, termination of the pregnancy is planned. Objective of this work was to study the safety and efficacy of oral mifepristone as adjuvant to PGE2 gel in pre-induction cervical ripening and induction of labour in third trimester. Methods: 150 patients in third trimester were recruited in this single blind randomized control trial that were planned for delivery with unfavourable cervix. They were randomly allocated into two groups i.e. study group (n = 75) who received Tab. Mifepristone 200 mg orally and control group (n = 75) who received placebo orally. At the end of 48 hours (h), change in the Bishop's Score was assessed and those with unfavourable cervix or not in labour, were administered PGE2 gel intracervically every 6h, for maximum of 3 doses for pre-induction cervical ripening of cervix. Analysis regarding safety and efficacy of the drug was done with regards to maternal and perinatal outcome. Results: Out of 150 patients, 75 received mifepristone and 75 received placebo. Mean Bishop's Score showed significant improvement after 48h in study group (R R 5.135, 95% CI 4.78 to 5.48) compared to control group (RR 3.43, 95% CI 3.21 to 3.65). Significant number of women went in spontaneous labour in study group (39 v/s 20) (p -0.035) in each dose category of PGE2 application. The opportunity to induce labour (with oxytocin) was better in study group in each dose category of intracervical PGE2 gel application. Moreover, lesser number of PGE2 gel was used in study group comparing control group. However, there were no statistical differences in both the groups as far as number of vaginal deliveries and caesearean sections are concerned. Duration of labour in both the groups was same. Neonatal and maternal morbidity was comparable in both the groups. Conclusions: Mifepristone improves Bishops score when given 48 h prior to labour induction along with increased number of spontaneous labour and reduced need for PGE2 gel applications, without increasing maternal or neonatal morbidity.

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Section: Resultssupporting

confidence: 83%

Oral mifepristone as adjuvant to prostaglandin E2 (PGE2) gel for preinduction cervical ripening and induction of labour in third trimester

Mane¹,

Singh

Singh³

2017

Int J Reprod Contracept Obstet Gynecol

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“…Though 1 and 5 minute APGAR scores were better in group 1, there was no statistically significant difference. 6 Many studies have reported that mifepristone is better than a placebo in ripening the cervix and in reducing the incidence of Caesarean section rates. This study was to see if mifepristone was as safe or better than dinoprostone in achieving the same result.…”

Section: Resultsmentioning

confidence: 99%

“…12 Frydman et al reported 3% of women going into labour within 24 hrs of ingestion of mifepristone. 6 Totally 30 women in group1 needed dinoprostone gel in addition to mifepristone to prime the cervix of which 21 women needed 1 gel, 6 needed 2 gels and 3 needed 3 gels to improve the Bishop score. The number of gels needed following mifepristone, when mifepristone alone was not sufficient for cervical priming was significantly lesser (42) than the total number of gels needed in dinoprostone group (92).…”

Section: Resultsmentioning

confidence: 99%

Mifepristone: an alternate to dinoprostone in induction of labour

Sailatha

Famida

Chellaiyan

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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Background: To assess and compare the efficacy, safety and fetomaternal outcome of mifepristone versus dinoprostone in priming the cervix and in inducing labour in pregnant women at term.Methods: This is a prospective comparative study done in Chettinad health and research institute, over a period of one year from October 2015 to October 2016. 50 pregnant women (Group 1) in 3rd trimester with unfavorable cervix were given 200mcg of mifepristone orally. If labour did not start or if the Bishop score remained poor at the end of 24hrs, induction was continued with 0.5mg of dinoprostone gel at a maximum of 3 gels at 6th hourly interval. Another 50 pregnant women (Group2) in 3rd trimester underwent induction according to the routine dinoprostone gel regimen of maximum 3 gels at intervals of 6hrs.Results: Improvement in Bishop score was significant with mifepristone by the end of 24hrs.But, in comparison, there was statistically significant improvement in Bishop score in favour of dinoprostone (Mean 4.7) than mifepristone (Mean 4.0). Also, the induction delivery interval was significantly less (Mean 11.5 hrs) with dinoprostone than mifepristone (Mean 20.3 hrs). Number of cases undergoing LSCS for failed induction was less in mifepristone group (4%). The rate of vaginal delivery, Caesarean sections, instrumental delivery and overall fetal outcome was comparable in both groups.Conclusions: Mifepristone is a safe, effective and suitable alternate agent for cervical ripening and initiation of labour when given 24 h before onset of labour.

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“…This was a bit much earlier than the women who were not induced (38 ± 1 week). In general terms, 70% of women with twin gestations will deliver between 35 and 37 weeks [33][34][35]. This differs from our findings where 93, 7% (n = 148) of the women had gestational ages that ranged between 37 -40 weeks at induction or spontaneous labor, 76 (51.35%) of them in the group that was induced versus 72 (48.65%) in the group that was not induced but this did not show any significant statistical difference (OR 1, 44; 95% IC 0.44-4.75; P ≤ 0.90).…”

Section: Discussionmentioning

confidence: 99%

Twin gestation: Is induction of labor possible in highly selected cases?

Mbu¹,

Fouedjio²,

Fouelifack³

et al. 2012

OJOG

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Induction of labor has been in practice for several decades but the decision to induce labor in multifetal gestations has not been accepted by many practitioners in contemporary obstetrics. The aim of this study was to compare maternal and fetal outcomes among women with uncomplicated twin gestations who were induced at term and those who were not. It was a cross-sectional analytic study that lasted ten years, (1 st January 2000 to 31 st December 2009 inclusive) at the maternity of the central hospital, Yaounde, Cameroon. 158 women were enrolled, 79 were induced and 79 went into labor spontaneously. Maternal and fetal outcomes, duration of labor, the prevalence of caesarean section were compared in the two groups. The average age of the women in the groups was 26, 75 ± 3.65 years (range 15 -41 years). For those who were induced, indication was premature rupture of membranes in 44 (56%) of cases. The characteristics of induced and none induced women were similar, except for the number of antenatal consultations (P ≤ 0.001). There was a significant difference in the duration of labor in the two groups (6 hrs versus 9, 75 hrs; P ≤ 0.001). The overall rate of vaginal delivery in the two groups was 87, 97% (n = 139), 88.87% in the group that was induced versus 86.07% in the group that labor was spontaneous (OR 1, 22; 95% IC 0, 51-2, 92; P ≤ 0.90). With respect to primary outcomes, there were no statistically significant differences between the group that labor was induced and that which labor was spontaneous. The prevalence of caesarean delivery was similar in the two groups (10%, 12% vs 13%, 92%; OR 0%, 7%; 95% IC 0, 27-1, 85; P ≤ 0.50). The main indications for caesarean section were acute fetal distress and failed induction. The first and fifth minute APGAR scores less than 7 in the first twins delivered in the two groups were similar. The 312 children delivered in both arms did not show any complications at birth. However, there were 3 neonatal deaths (1 vs 2). There were no cases of uterine rupture or maternal deaths among the 156 women. Induction of labor may be proposed to women with uncomplicated term twin gestations with specific indications. Induction in these highly selected cases does not impute any additional risks but close monitoring of labor is very necessary.

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Labor induction in women at term with mifepristone (RU 486): A double-blind, randomized, placebo-controlled study

Cited by 77 publications

References 0 publications

Oral mifepristone as adjuvant to prostaglandin E2 (PGE2) gel for preinduction cervical ripening and induction of labour in third trimester

Oral mifepristone as adjuvant to prostaglandin E2 (PGE2) gel for preinduction cervical ripening and induction of labour in third trimester

Mifepristone: an alternate to dinoprostone in induction of labour

Twin gestation: Is induction of labor possible in highly selected cases?

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