A Prospective Comparative Study of Mifepristone and Misoprostol vs Misoprostol Alone for Induction of Labor in Intrauterine Fetal Death

Abstract

Introduction: Intrauterine fetal death (IUFD) is an important indicator of maternal and perinatal health of a given population. Aim and objective: The objective of the study was to assess the efficacy of mifepristone and misoprostol vs misoprostol alone for induction of labor in IUFD and to determine risk-benefit ratio. Materials and methods: The present study was a prospective observational analytical study which was conducted in the Department of Obstetrics and Gynecology, JNMCH, Aligarh, from January 2018 to January 2021and includes 110 pregnant women with confirmed IUFD on USG. After taking informed consent, a predesigned pro forma was used to collect relevant sociodemographic profile, detailed logical history, and examination from all those participating in the study. Results: Age (mean ± SD) was 25.98 ± 4.49 vs 25.69 ± 4.78 years, parity was 2.31 ± 1.3 vs 2.44 ± 1.61, and gestational age was 31.04 ± 6.89 vs 32.71 ± 5.17 weeks in group I and group II, respectively. Modified Bishops score was >6 in 35 (63.64%) vs 32 (14.55%) women, mean dose of misoprostol required was 0.95 ± 1.5 vs 2.64 ± 1.89, mean induction labor interval was 2.42 vs 7.53 hours, and mean induction to delivery interval was 6.68 vs 16.61 hours in group I and group II, respectively, and the difference was found to be statistically significant. Mean birth weight was 1431.35 vs 1758.60 g, respectively, in the two groups. Four women (7.27%) in group I and 17 women (30.9%) in group II required augmentation with oxytocin which is statistically significant. Nausea, vomiting, loose stools, and hyperthermia were recorded as adverse effects. Among the identifiable causes, abruption was the most common cause in group II, whereas anemia and preeclampsia in group I. Conclusion: The combination of mifepristone with misoprostol was more effective for the induction of labor in IUFD, in terms of lesser amount of misoprostol dosage, oxytocin augmentation, improvement in modified Bishops score, and shorter induction labor and delivery interval when compared to misoprostol alone. Both the regimens were equally safe and easy to administer.