A comparative study of mifepristone with dinoprostone for induction of labor in third trimester

Akshaya Sivadas; Seema Grover; Harpreet Kaur; Lajya Devi Goyal; Khushpreet Kaur

doi:10.18203/2320-6012.ijrms20244112

Authors

Akshaya Sivadas Consultant Gynecologist, Naruvi Hospital, Vellore, Tamil Nadu, India
Seema Grover Department of Obstetrics and Gynaecology, GGSMC and H, Faridkot, Punjab, India
Harpreet Kaur Department of Obstetrics and Gynaecology, GGSMC and H, Faridkot, Punjab, India
Lajya Devi Goyal Department of Obstetrics and Gynaecology, AIIMS, Bathinda, Punjab, India
Khushpreet Kaur Department of Obstetrics and Gynaecology, AIIMS, Bathinda, Punjab, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20244112

Keywords:

Mifepristone, Dinoprostone, Induction of labor, Bishop’s score

Abstract

Background: Success of labor induction depends upon favourability of the cervix at the time of induction. Various methods have been tried for labor induction but the search for ideal induction agent continues. There is a paucity of literature regarding the safety and efficacy of Mifepristone as induction agent in live pregnancies. Our aim was to study the efficacy of tablet Mifepristone as a cervical ripening agent and to compare the feto-maternal outcome with Dinoprostone gel.

Methods: A total of 100 patients who required labor induction were enrolled and randomized to receive mifepristone and dinoprostone. 50 patients were given oral tablet Mifepristone 200mg and 50 patients were instilled with intracervical Dinoprostone 0.5mg gel. The outcome was assessed by improvement in bishop’s score, induction delivery interval, requirement of oxytocin, mode of delivery, and feto-maternal complications.

Results: The improvement in mean Bishop’s score after 24hours was more in Mifepristone group (2.78±1.28 to 7.22±2.02) than in Dinoprostone group (2.64±1.29 to 6.70±1.75) (p=0.173). The incidence of vaginal delivery and LSCS were 86% and 14% in Mifepristone group and 72% and 28% in Dinoprostone group, respectively (p=0.227). The requirement of mean dosage of oxytocin was lesser in Mifepristone group (2.26±0.71) as compared to Dinoprostone group (3.29±1.35) (p=0.001). NICU admission was required in 26% neonates in Dinoprostone group and 16% neonates in Mifepristone group (p=0.220).

Conclusions: Mifepristone is a safe and efficient cervical ripening agent with no significant adverse effects to both mother and fetus.

Metrics

Metrics Loading ...

References

Deshmukh K, Patange RP. Comparative study between mifepristone and dinoprostone gel for cervical ripening and induction of labor. Int. J.Health Sci. 2022;6(S1):4067–77.

Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Gilstrap LC, Wenstrom KD. Induction and augmentation of labor. William’s obstetrics. 24th edition. McGraw Hill Professional; 2014:525.

Mahajan DK, London SN. Mifepristone (RU486): a review. Fertil Steril. 1997;68:967-76.

Fathima S, Nayak SR, Rao B, Praveena G, Shameem VPA. Mifepristone in the induction of labor at term. Int J Pharm Biomed Res. 2013;4:164-6.

Mandade K, Bangal VB. A prospective comparative study to evaluate the efficacy and safety of mifepristone with misoprostol over misoprostol alone in induction of labor. Int J Reprod Contracept Obstet Gynecol. 2016;5:4321-9.

Mozurkewich E, Chilimigras J, Koepke E, Keeton K, King VJ. Indications for induction of labor: a best‐evidence review. BJOG. 2009;116:626-36.

Athawale R, Acharya N, Samal S, Hariharan C. Effect of mifepristone in cervical ripening for induction of labor. Int J Reprod Contracept Obstet Gynecol. 2013;2:35-8.

Arumugaselvi B, Sujathasenthil S, Anandan H. Comparative study of oral mifepristone and endocervical prostaglandins E2 gel as preinduction cervical ripening agent in parturition. Int J Sci Study. 2017;5:129-33.

Sailatha R, Famida AM, Vinoth Gnana Chellaiyan D, Vijayalakshmi K, Sathiya S, Renuka S. Mifepristone: an alternate to dinoprostone in induction of labor. Int J Reprod Contracept Obstet Gynecol. 2017;6:1880-4.

Berkane N, Verstraete L, Uzan S, Boog G, Maria B. Use of mifepristone to ripen the cervix and induce labor in term pregnancies. Am J Obstet Gynecol. 2005;192:114-20.

Sharma P, Pathania K, Rana UB. Study of effects of mifepristone on full term pregnancies. J Obstet Gynaecol. 2020;40:188-9.

Yelikar K, Deshpande S, Deshpande R, Lone D. Safety and Efficacy of Oral Mifepristone in Pre-induction Cervical Ripening and Induction of Labour in Prolonged Pregnancy. J Obstet Gynaecol India. 2015;65:221-5.

Chourasia UH, Jain MK, Fidvi JI. The role of oral mifepristone in pre-induction cervical ripening at term. Int J Reprod Contracept Obstet Gynecol 2019;8:4338-40.

Gaikwad V, Mittal B, Puri M. Comparative analysis of safety, efficacy and fetomaternal outcome of induction of labor with Mifepristone versus intracervical dinoprostone gel. Res J Pharm Biol Chem Sci. 2014;5:611-6.

Dhillon P, Biswas M, Tripathi P, Nair VG. Comparative study of oral mifepristone and endocervical prostaglandin-E2 gel as preinduction cervical ripening agents in parturition. Int J Reprod Contracept Obstet Gynecol. 2020;9:3825-9.

Ankitha CR, Chiniwar MA, Menasinkai SB. Comparative study of induction of labor with oral mifepristone and intracervical dinoprostone in primigravida. Int J Clin Obstet Gynaecol 2023;7(1):113-6.

Sah MK, Padhye SM. Mifepristone versus intracervical prostaglandin E2 gel for cervical ripening in primigravid patients at term. Int J Reprod Contracept Obstet Gynecol. 2018;7:824-8.

Frydman R, Lelaidier C, Baton-Saint-Mleux C, Fernandez H, Vial M, Bourget P. Labour induction in women at term with mifepristone (RU 486): a double-blind, randomized, placebo-controlled study. Obstet Gynecol 1992;80:972-5.

Hapangama D, Neilson JP. Mifepristone for induction of labor. Cochrane Database Syst Rev. 2009;3:CD002865.

Priyanka, Shukla S Shetty. The effect of mifepristone in induction of labor at term. MedPulse Int J Gynaecol. February. 2021;17(2):32-5.

Kumari S, Solanki V, Singh U, Mehrotra S. Comparative Study of Mifepristone with Dinoprostone Gel in Induction of Labor in Full-term Pregnancy: An Open-label Randomized Controlled Trial. Journal of South Asian Federation of Obstetrics and Gynaecology. 2021;13(3):98-102.

Baev OR, Rumyantseva VP, Tysyachnyu OV, Kozlova OA, Sukhikh GT. Outcomes of Mifepristone usage for cervical ripening and induction of labour in full-term pregnancy. Randomized controlled trial. Eur J Obstet Gynecol Reprod Biol. 2017;217:144-9.

Lelaider C, Baton C, Benifla JL, Fernandez H, Bourget PH, Frydman R. Mifepristone for labour induction after previous caesarian section. Br J Obstet Gynaecol. 1994;101:501-3.

Giacalone PL, Targosz V, Laffargue F, Boog G, Faure JM. Cervical ripening with mifepristone before labour induction: a randomized study. Obstet Gynecol. 1998;92:487-92.

Mohapatra S, Samarpita. A comparative study on the role of oral mifepristone and endocervical prostaglandin as preinduction cervical ripening agent. Int J Reprod Contracept Obstet Gynecol. 2021;10:215-21.