Role of combination of mifepristone and misoprostol versus misoprostol alone in the management of late intrauterine fetal death

Authors

  • Dipannita Dhar Department of Obstetrics and Gynecology, 300 Bedded Hospital, Narayanganj, Bangladesh
  • Bidhan Chandra Podder Department of Pediatrics, Institute of Child and Mother Health, Dhaka, Bangladesh
  • Sharmin Sultana Swarna Department of Obstetrics and Gynecology, Mugda Medical College Hospital, Dhaka, Bangladesh
  • Rubina Bari Department of Obstetrics and Gynecology, 300 Bedded Hospital, Narayanganj, Bangladesh
  • Minara Sikder Department of Obstetrics and Gynecology, 300 Bedded Hospital, Narayanganj, Bangladesh
  • Anjumanara Begum Department of Obstetrics and Gynecology, 300 Bedded Hospital, Narayanganj, Bangladesh
  • Farjana Sarmin Department of Obstetrics and Gynecology, 300 Bedded Hospital, Narayanganj, Bangladesh

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20231908

Keywords:

Misoprostol, Mifepristone, IUD

Abstract

Background: Intrauterine fetal death (IUFD) occurs in 1% of pregnancies and has devastating consequences. Previous methods for inducing labor in IUFD involved oxytocin and prostaglandins. The combination of mifepristone and misoprostol is commonly used for early first-trimester termination. This study aimed to compare the effectiveness of mifepristone and misoprostol combination versus misoprostol alone for labor induction in intrauterine fetal death.

Methods: A randomized controlled clinical trial was conducted at Sir Salimullah Medical College, Mitford Hospital, Dhaka, from January 2017 to June 2017. Sixty-four pregnant women with intrauterine fetal death after 28 weeks of gestation were included. Participants were randomly assigned to either group-I (mifepristone and misoprostol) or group-II (misoprostol alone). Statistical analyses were performed using statistical package for the social sciences (SPSS) version 20.0 for Windows.

Results: The mean age was 27.7±5.6 years in group I and 27.5±4.3 years in group II. Majority of patients in group I were housewives (87.5%), while in group II, it was 78.1%. Most patients in group I (56.3%) came from lower-income families, compared to 65.6% in group II. The gestational age did not significantly differ between the groups. The induction to delivery interval was significantly shorter in group I (8.6±2.0 hours) compared to group II (15.1±3.5 hours). The dose administration pattern of misoprostol differed significantly between the groups.

Conclusions: Both methods are equally safe and effective for managing intrauterine fetal death. However, the combination of mifepristone and misoprostol showed greater efficacy in terms of reducing the induction to delivery interval and requiring a lower dose of misoprostol.

References

Gómez Ponce de León R, Wing D, Fiala C. Misoprostol for intrauterine fetal death. Int J Gynecol Obstet. 2007;99(S2).

Goldstein DP, Reid DE. Circulating Fibrinolytic Activity-A Precursor of Hypofibrinogenemia Following Fetal Death in Utero. Obstet Gynecol. 1963;22(2):174-80.

Pritchard JA. Fetal death in utero. Obstet Gynecol. 1959;14(5):573-80.

Parasnis H, Raje B, Hinduja IN. Relevance of plasma fibrinogen estimation in obstetric complications. J Postgrad Med. 1992;38(4):183.

Mariani NC, Leao EJ, Barreto EM, Kenj G, De Aquino MM, Tuffi VH. Use of misoprostol for labor induction in stillbirth. Revista Paulista de Medicina. 1987;105(6):325.

Robbins A, Spitz IM. Mifepristone: clinical pharmacology. Clin Obstet Gynecol. 1996;39(2):436-50.

El-Refaey H, Templeton A. Pregnancy: Induction of abortion in the second trimester by a combination of misoprostol and mifepristone: a randomized comparison between two misoprostol regimens. Human Reprod. 1995;10(2):475-8.

Tang OS, Chan CC, Kan AS, Ho PC. A prospective randomized comparison of sublingual and oral misoprostol when combined with mifepristone for medical abortion at 12–20 weeks gestation. Human Reprod. 2005;20(11):3062-6.

Newhall EP, Winikoff B. Abortion with mifepristone and misoprostol: regimens, efficacy, acceptability and future directions. Am J Obstet Gynecol. 2000;183(2):S44-53.

Cabrol D, d'Yvoire MB, Mermet E, Cedard L, Sureau C, Baulieu EE. Induction of labour with mifepristone after intrauterine fetal death. The Lancet. 1985;326(8462):1019.

Wagaarachchi PT, Ashok PW, Narvekar NN, Smith NC, Templeton A. Medical management of late intrauterine death using a combination of mifepristone and misoprostol. BJOG. 2002;109(4):443-7.

Chaudhuri P, Datta S. Mifepristone and misoprostol compared with misoprostol alone for induction of labor in intrauterine fetal death: A randomized trial. J Obstet Gynaecol Res. 2015;41(12):1884-90.

Panda S, Jha V, Singh S. Role of combination of mifepristone and misoprostol verses misoprostol alone in induction of labour in late intrauterin fetal death: A prospective study. J Fam Reprod Health. 2013;7(4):177.

Lipika, G. Comparative study of management of intrauterine foetal death by misoprostol versus oxytocin. BCPS Dissertation. 2011.

Sharma D, Singhal SR, Paul A. Comparison of mifepristone combination with misoprostol and misoprostol alone in the management of intrauterine death. Taiwanese J Obstet Gynecol. 2011;50(3):322-5.

Gupta S, Kagathra B, Desai A. Mifepristone and misoprostol versus misoprostol alone in management of late intrauterine fetal death. Int J Reprod Contracept Obstet Gynecol. 2017;5(9):2935-8.

Fairley TE, Mackenzie M, Owen P, Mackenzie F. Management of late intrauterine death using a combination of mifepristone and misoprostol-experience of two regimens. Eur J Obstet Gynecol Reprod Biol. 2005;118(1):28-31.

Praveena G, Shameem VP, Rao AA, Rao B. Mifepristone plus misoprostol versus only-misoprostol in induction of labour in intra uterine fetal death. Int J Pharm Biomed Res. 2013;4(2):108-10.

Väyrynen W, Heikinheimo O, Nuutila M. Misoprostol‐only versus mifepristone plus misoprostol in induction of labor following intrauterine fetal death. Acta Obstetricia et Gynecologica Scandinavica. 2007;86(6):701-5.

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Published

2023-06-28

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Original Research Articles