Comparison of combination of mifepristone and misoprostol with misoprostol alone in management of intrauterine death

Rajkumar; Mamta Sharma

doi:10.18203/2320-1770.ijrcog20242481

Authors

Rajkumar Department of Obstetrics and Gynecology, Government Medical College, Kota, Rajasthan, India
Mamta Sharma Department of Obstetrics and Gynecology, Government Medical College, Kota, Rajasthan, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20242481

Keywords:

Intrauterine fetal death, Mifepristone, Misoprostol

Abstract

Background: Intrauterine fetal death is one of the most devastating obstetric complications. A clinically accepted definition of IUFD is the death of fetus at or after 20 weeks of pregnancy, but for international comparison WHO has now recommended IUFD as a baby born with no signs of life at or after 28 weeks of gestation.

Methods: The prospective analytical study was be conducted in the department of obstetrics and gynecology at government medical college and J. K. Loan Hospital Kota over a 1 June 2021 to 30 November 2022 year women with intrauterine death after 28 weeks of gestation are studied. 120 pregnant women were divided randomly, alternatively into two groups of 60 each. Group I (combination regimen)- women received 200 mg mifepristone orally and misoprostol after 24 hours. Group II (misoprostol group).

Results: We included 120 patients with late IUD and found that the mean induction to delivery interval was 9.98 hours in combination group where as it was 14.2 hours in misoprostol only group. This provides a good alternate regimen in the management of late intrauterine deaths.

Conclusions: The combination of mifepristone and misoprostol for induction of labour in IUFD has shorter induction to delivery interval and lesser number of misoprostol doses usage when compared to only-misoprostol group. However, conventional regimen with misoprostol alone may be appropriate in settings where cost is a prohibitive factor.

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References

ACOG Practice bulletin No.102: Management of stillbirth. Obstet gynecol. 2009;113:748-61.

WHO. Maternal, newborn, child and adolescent health. Available at: http://www.who.int/maternal_child_adolescent/epidemiology/stillbirth/en/. Accessed on 15 June 2016.

Silver RM. Fetal death. Obstet Gynecol. 2007;109:153-67.

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

WHO recommendation for induction of labor. WHO 2011. Available at: https://www.who.int/publications/ i/item/9789241501156. Accessed on 15 June 2016.

Sharma D, Singhal SR, Poonam, Paul A, Kunika. Comparison of mifepristone combination with misoprostol and misoprostol alone in the management of intrauterine death: condensation - misoprostol and mifepristone combination is more effective than misoprostol alone in the management of intrauterine death. Taiwan 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. 2016;5(9):2935-9.

Maheshwari S, Borgohain D. Methods of induction of labor in intrauterine fetal demise: A comparative study. Int J Reprod Contracept Obstet Gynecol. 2017;6(9):3911-5.

Panda S, Jha V, Singh S. Role of a combination of mifepristone and misoprostol versus misoprostol alone in induction of labor in late intrauterine fetal death. J Fam Reprod Health. 2013;7(4):177-9.

Modak R, Roy S, Biswas DK, Pal A, Mandal TK. Role of combination of mifepristone and misoprostol versus misoprostol alone in induction of labor in late intrauterine fetal death: a randomized trial. Int J Clin Obstet Gynecol. 2018;2(6):78-82.

Väyrynen W, Heikinheimo O, Muutila A. Misoprostol only versus mifepristone plus misoprostol in the induction of labor following intrauterine fetal death. Acta Obstet Gynecol Scand. 2007;86(6):701-5.

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

Operational guidelines for establishing sentinel stillbirth surveillance system, child health division ministry of health and family welfare government of India. 2016. Available at: https://nhm.gov.in/images/pdf/programmes/RBSK/Operational_Guidelines/Operational_Guidelines_for_establishing_Sentinel_Stillbirth_Surveillance_System.pdf. Accessed on 15 March 2020.