Mifepristone For Induction Of Labour Research Articles

Efficacy and safety of oral mifepristone in induction of labour in prolonged pregnancy

Background: Induction of labour implies, achieving vaginal delivery by stimulating uterine contractions before spontaneous onset of labour. Prolonged pregnancy exceeding duration of expected date of delivery is associated with increased risk to foetus and most common indication for induction of labour. Objectives: To study the safety and efficacy of oral mifepristone in induction of labour in prolonged pregnancy. Methods: This experimental study was carried out in Universal College of Medical Sciences Teaching Hospital, Bhairahawa between June 2016 to June 2017 after ethical clearance. Total 102 women were included in the study with 51 participants in the study group (mifepristone) and 51 in the control group (misoprostol). Data were expressed in frequency and mean ± SD and analysed using Independent “t” test and Chi-square test. A p-value of <0.05 was considered significant. Safety and efficacy of the drug was analysed with regards to maternal and perinatal outcome. Results: Single dose of mifepristone was sufficient enough for successful induction in 40 (78.43%) women in study group. Time interval from induction to delivery had maximum frequency of 6-12 hours in both groups (p-value 0.13). The active phase of labour lasted for 2-6 hours in 38 (74.5%) women of the study group. Around 27 (42.9%) women of study group required augmentation of labour and 49 (96.1%) women had vaginal delivery. There was no significant difference in perinatal outcome between both the groups. Conclusion: Mifepristone combined with or without augmentation is safe, efficient, economical, and convenient induction agent for initiation of labour in prolonged pregnancies.

The effect of mifepristone in induction of labour at term

The effect of mifepristone in induction of labour at term

A Retrospective Case-Control Study Evaluating the Role of Mifepristone for Induction of Labor in Women with Previous Cesarean Section.

To investigate the role of "mifepristone" for induction of labor (IOL) in pregnant women with prior cesarean section (CS). In this retrospective study, all pregnant women with prior CS who received oral mifepristone (400mg) for IOL (as per clear obstetric indications) [group 1] were compared with pregnant women with prior CS who had spontaneous onset of labor (SOL) [group 2], with respect to incidence of vaginal delivery, CS, duration of labor, and various maternal and fetal outcomes. During the study period, 72 women received mifepristone (group 1) for IOL and 346 had SOL (group 2). In group 1 after mifepristone administration, 40 (55.6%) women had labor onset, and 24 (33.3%) women had cervical ripening (Bishop Score≥8) within 48h. There were no statistically significant differences with respect to duration of labor (p value: 0.681), mode of delivery (i.e., normal delivery or CS-p value: 0.076 or 0.120, respectively), or maternal (blood loss or scar dehiscence/rupture uterus), or fetal outcomes (NICU admission) compared to women with previous CS with SOL (group 2). However, the need of oxytocin (p value 0.020) and dose of oxytocin requirement (p value 0.008) were more statistically significant in group 1. Mifepristone may be considered as an agent for IOL in women with prior CS.

Mifepristone for induction of labour

The steroid hormone, progesterone, inhibits contractions of the pregnant uterus at all gestations. Antiprogestins (including mifepristone) have been developed to antagonise the action of progesterone, and have a recognised role in medical termination of early or mid-trimester pregnancy. Animal studies have suggested that mifepristone may also have a role in inducing labour in late pregnancy. To determine the effects of mifepristone for third trimester cervical ripening or induction of labour. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register and reference lists of relevant papers (May 2009). Clinical trials comparing mifepristone used for third trimester cervical ripening or labour induction with placebo/no treatment or other labour induction methods. A strategy was developed to deal with the large volume and complexity of trial data relating to labour induction. This involved a two-stage method of data extraction. For this update, two review authors independently assessed trial quality and extracted data. Ten trials (1108 women) are included. Compared to placebo, mifepristone treated women were more likely to be in labour or to have a favourable cervix at 48 hours (risk ratio (RR) 2.41, 95% confidence intervals (CI) 1.70 to 3.42) and this effect persisted at 96 hours (RR 3.40, 95% CI 1.96 to 5.92). They were less likely to need augmentation with oxytocin (RR 0.80, 95% CI 0.66 to 0.97). Mifepristone treated women were less likely to undergo caesarean section (RR 0.74, 95% CI 0.60 to 0.92) but more likely to have an instrumental delivery (RR 1.43, 95% CI 1.04 to 1.96). Women receiving mifepristone were less likely to undergo a caesarean section as a result of failure to induce labour (RR 0.40, 95% CI 0.20 to 0.80). There is insufficient evidence to support a particular dose but a single dose of 200 mg mifepristone appears to be the lowest effective dose for cervical ripening (increased likelihood of cervical ripening at 72 hours (RR 2.13, 95% CI 1.15 to 3.97). Abnormal fetal heart rate patterns were more common after mifepristone treatment (RR 1.85, 95% CI 1.17 to 2.93), but there was no evidence of differences in other neonatal outcomes. There is insufficient information on the occurrence of uterine rupture/dehiscence in the reviewed studies. There is insufficient information available from clinical trials to support the use of mifepristone to induce labour. However, the studies suggest that mifepristone is better than placebo in reducing the likelihood of caesarean sections being performed for failed induction of labour; therefore, this may justify future trials comparing mifepristone with the routine cervical ripening agents currently in use. There is little information on effects on the baby.

Mifepristone for induction of labour.

The steroid hormone, progesterone, inhibits contractions of the uterus. Antiprogestins (including mifepristone) have been developed to antagonise the action of progesterone, and these have a recognised role in medical termination of early or mid-pregnancy. Animal studies have suggested that mifepristone may also have a role in inducing labour in late pregnancy. To determine the effects of mifepristone for third trimester cervical ripening or induction of labour. We searched the Cochrane Pregnancy and Childbirth Group trials register, the Cochrane Controlled Trials Register, and reference lists of relevant papers. Selection criteria included: (1) clinical trials comparing mifepristone used for third trimester cervical ripening or labour induction with placebo/no treatment or other labour induction methods; (2) random allocation to the treatment or control group; (3) adequate allocation concealment; (4) violations of allocated management not sufficient to materially affect conclusions; (5) clinically meaningful outcome measures reported; (6) data available for analysis according to the random allocation; (7) missing data insufficient to materially affect the conclusions. This is one of a series of reviews of methods of cervical ripening and labour induction using standardised methodology. Data were extracted by the reviewer and, independently, by a colleague. Seven trials, that recruited 594 women, are included. All trials compared mifepristone with placebo, except for one that compared mifepristone with no treatment. Compared to placebo, mifepristone treated women were less likely to have an unfavourable cervix at 48 hours (relative risk [RR] 0.36, 95% confidence intervals [CI] 0.2-0.63) or 96 hours (RR 0.39, 95% CI 0.23-0.66). Mifepristone treated women were more likely to have delivered within 48 and 96 hours of treatment than were placebo treated/no treatment women - 48 hours: RR 2.82, 95% CI 1.82-4.36; 96 hours: RR 3.40, 95% CI 1.96-5.92. Mifepristone treated women were less likely to undergo caesarean section (RR 0.71, 95% CI 0.53-0.95). There is little information about fetal outcome, although there was no evidence that neonatal hypoglycaemia might be more common after exposure to mifepristone. Similarly, there is little information about maternal side-effects although some nausea and vomiting was reported in one trial. There is insufficient information available from clinical trials to support the use of mifepristone to induce labour. However, available data do show that mifepristone is better than placebo at ripening the cervix, and inducing labour. There is evidence of a possible reduction in the incidence of caesarean section following mifepristone treatment (compared to placebo) that would justify further trials. We found no trials that compared mifepristone with alternative methods of inducing labour e.g. prostaglandins.