The use of mifepristone and misoprostol in the management of late intrauterine fetal death

Nzewi, Chuks; Araklitis, George; Narvekar, Nitish

doi:10.1111/tog.12145

Cited by 6 publications

(4 citation statements)

References 40 publications

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“…Based on the weeks of gestational age of onset (GAO), third trimester is defined as ≥27 weeks [ 10 ]. Term pregnancy is defined as delivery between 37 + 0 and 41 + 6 weeks.…”

Section: Methodsmentioning

confidence: 99%

Intra-abdominal pressure in third trimester pregnancy complicated by acute pancreatitis: an observational study

Sun

et al. 2015

BMC Pregnancy Childbirth

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BackgroundIt is known that intra-abdominal hypertension has high morbidity in acute pancreatitis and has detrimental effects on patients. For third trimester pregnancy complicated by acute pancreatitis, the intra-abdominal pressure may have its own characteristic. This article will discuss this clinical scenario.MethodsThis observational study in a cohort group was performed in the surgical intensive care unit of a tertiary hospital. Medical records were reviewed from each acute pancreatitis exactly in third trimester pregnancy. The main statistical methods were Mann–Whitney U test and bivariate Pearson correlation analysis.ResultsDuring the study interval, there were totally 17 pregnancies complicated by acute pancreatitis in the third trimester. All cases with moderate or severe acute pancreatitis had intra-abdominal hypertension of mean value of 16.7 mm Hg (range, 12.9–22.0 mm Hg). The intra-abdominal pressure had significant correlation with APACHE II score (r = 0.7456, p = 0.0006), while a negative correlation was showed with the umbilical artery pH value and with 1-min Apgar score (r = −0.8232, p = 0.0005; r = −0.7465, p = 0.0034; respectively). The intra-abdominal pressure of those with live infants was lower than that of those with dead ones (13.78 ± 2.554 vs. 19.84 ± 1.695, p = 0.0019).ConclusionsThe incidence of intra-abdominal hypertension seems higher in moderate or severe acute pancreatitis in third trimester pregnancy than the non-pregnant cases but there’s no significance in this study. Acute elevated intra-abdominal pressure accounts for great association with mother’s serious scenario and fetal mortality.

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“…Based on the weeks of gestational age of onset (GAO), third trimester is defined as ≥27 weeks [ 10 ]. Term pregnancy is defined as delivery between 37 + 0 and 41 + 6 weeks.…”

Section: Methodsmentioning

confidence: 99%

Intra-abdominal pressure in third trimester pregnancy complicated by acute pancreatitis: an observational study

Sun

et al. 2015

BMC Pregnancy Childbirth

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“…Mifepristone (RU 486), a progesterone antagonist that increases the sensitivity of the myometrium to prostaglandins, has been used prior to misoprostol for mid‐trimester termination of pregnancy (TOP) in a few randomized trials with proven benefits . However, the evidence related to the use of the such a combination for the induction of labor in second and third trimester IUFD is deficient in the absence of well‐designed randomized controlled trials (RCT) . Of the seven available studies that used mifepristone‐misoprostol in cases of fetal death, four were retrospective and three, although prospective, lacked the quality of randomized trials …”

Section: Introductionmentioning

confidence: 99%

Mifepristone and misoprostol compared with misoprostol alone for induction of labor in intrauterine fetal death: A randomized trial

Chaudhuri

Datta

2015

J of Obstet and Gynaecol

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Aim: To assess whether mifepristone and misoprostol are more beneficial than misoprostol alone for the induction of labor in women with intrauterine fetal death. Methods: A randomized double blind placebo-controlled parallel group superiority trial was conducted. One hundred and ten women who had experienced fetal death at or later than 20 weeks of gestation were randomized by computer-generated random number sequence to receive 200 mg of mifepristone or matched placebo tablets orally. Misoprostol was administered vaginally to women of both groups after 36-48 h. The main outcomes studied were the fetal-placental delivery rate within 24 hours of commencement of the first dose of misoprostol without additional intervention and the induction-delivery interval. Results: Successful delivery occurred significantly more frequently in women who received mifepristone prior to misoprostol than in women who received only misoprostol (92.5 % [49/53] compared with 71.2% [37/52] respectively; P = 0.001). The mean induction-delivery interval was also significantly shorter when using mifepristone plus misoprostol than using misoprostol alone (9.8 h, standard deviation, 4.4 compared with 16.3 h standard deviation, 5.7, respectively; P < 0.001). Conclusion: Use of a combination of mifepristone and misoprostol significantly improved the rate of successful delivery and shortened the induction-delivery interval in women who had experienced fetal death compared with the use of misoprostol alone.

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“…The results of this study are similar to the findings in other reports. 10 In present study, women with IUFD and prior cesarean section, trial of labour following induction with EAS instillation and prostaglandins was found to be effective. 33 women were given trial of labour.…”

Section: Discussionmentioning

confidence: 52%

Management of stillbirths: an observational analysis at a rural tertiary care centre in Kerala, India

Ajini

Reena

Radha

2019

Int J Reprod Contracept Obstet Gynecol

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Background: Stillbirth is a distressing event, both for the expecting mother and the obstetrician. Several maternal, social and circumstantial factors influence its occurrence. These women with intrauterine fetal death need to be treated in a considerate manner. Our aim was to analyse different methods of induction, management of labour and their outcomes in women with antepartum fetal demise.Methods: All women admitted to a tertiary care centre with intrauterine fetal death after 22 weeks during the study period of 24 months were recruited. Maternal sociodemographic characteristics and relevant investigations were studied. Induction of labour was achieved with mechanical and pharmacological methods. Stillborn babies, placentae and umbilical cord were examined after delivery.Results: There were 175 women with IUFD admitted during the study period. The stillbirth rate was 38.6 per1000 live births.148 women (84.57%) required induction of labour while16 women had spontaneous onset of labour. Among the 44 women with previous Cesarean section, 11 underwent elective Cesarean section. 19 women (57.6%) out of 33 cases of trial of labour after Cesarean had a successful vaginal delivery. There were 2 cases of rupture uterus and 10 women required ICU admissions. Intrauterine growth restriction was the leading cause of stillbirth (41.8%) followed by hypertensive disorders (27.7%).Conclusions: Present study has shown that vaginal birth can be achieved in most women with mechanical and pharmacological methods of induction within a reasonable period of time.

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The use of mifepristone and misoprostol in the management of late intrauterine fetal death

Cited by 6 publications

References 40 publications

Intra-abdominal pressure in third trimester pregnancy complicated by acute pancreatitis: an observational study

Intra-abdominal pressure in third trimester pregnancy complicated by acute pancreatitis: an observational study

Mifepristone and misoprostol compared with misoprostol alone for induction of labor in intrauterine fetal death: A randomized trial

Management of stillbirths: an observational analysis at a rural tertiary care centre in Kerala, India

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