Comparative study of mifepristone and misoprostol versus misoprostol alone in induction of labour in late intrauterine fetal death

Abstract

Background: Intrauterine fetal death is most undesirable consequence of pregnancy and stressful condition for women and family and for health professional. Naturally, majority of women (over 90%) go in for spontaneous labour and deliver within 3 weeks of intrauterine death. Prolonged retention of dead fetus in utero has complications like DIC, psychological stress and infection. Various methods are available to induce labor in intrauterine fetal death. One such regimen is medical management using a combination of Mifepristone and Misoprostol. The objective of this study was to compare efficacy and safety of combination of mifepristone and misoprostol versus misoprostol only in induction of labour in late intrauterine fetal death.Methods: A prospective study was carried out in KIMS, Hubli between Jan 2014 to Dec 2015.Data from 100 women with intrauterine fetal death between gestational age of 24-42 weeks were analysed. They were divided into 2 groups of 50 each. Group I received single oral dose of 200mg mifepristone followed 24 hours later with oral misoprostol (100µg-50µg) every 4 hourly. Group II received only misoprostol. Outcomes were measured in terms of induction to delivery interval and number of misoprostol doses required.Results: Mean induction to delivery interval in Group I was 8.3 hours versus13.4 hours in Group II. Induction delivery interval was shorter in combined regimen. Total dose of misoprostol was also less in Group I.Conclusions: Both regimens are safe for induction of labour in late intrauterine fetal death. However, the induction delivery interval and dose of misoprostol required was decreased in combination regimen.