Oral misoprostol with mifepristone versus misoprostol alone for inducing labor in intrauterine fetal death: A randomized placebo-controlled trial

• Main Authors: Yazhini Arjunan, Kubera Siddappa Nichanahalli, Veena Pampapati, Dilip Kumar Maurya, Soundara Raghavan Subrahmaniyan
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2017-01-01
• Series: International Journal of Advanced Medical and Health Research
• Subjects: Intrauterine fetal death; mifepristone; misoprostol; randomized controlled trial
• Online Access: http://www.ijamhrjournal.org/article.asp?issn=2349-4220;year=2017;volume=4;issue=1;spage=23;epage=26;aulast=Arjunan

Context: Intrauterine fetal death (IUFD) causes emotional distress and could result in intrauterine infection. In view of these complications, medical induction is recommended, if it is safe. Aim: The aim of this study was to compare the efficacy and safety of a combination of mifepristone and misoprostol with oral misoprostol alone for induction of labor in IUFD. Settings and Design: This is a randomized placebo-controlled trial conducted at a tertiary care teaching hospital in southern India. Patients and Methods: We recruited 72 women with IUFD in a singleton pregnancy after 28 weeks with intact membranes. Thirty-six women received oral placebo followed by misoprostol. In other group, 36 women received 200 mg oral mifepristone followed by misoprostol (both groups received 50 μg orally 4th hourly up to 5 doses). The interval between mifepristone/placebo and the first dose of misoprostol was 24 h. Results: Successful delivery occurred within 72 h in 31 of 36 (86%) women who received mifepristone before misoprostol and in 28 of 36 (78%) women who received only misoprostol (P = 0.541). Median (interquartile range) induction to delivery interval was 3.5 (2–5) and 4 (3–5) h in the combination group and misoprostol group, respectively (P = 0.465). Conclusions: Addition of mifepristone to misoprostol appears to be marginally more effective than misoprostol alone for induction of labor in intermediate and late IUFD, although the differences were not statistically significant.