Mifepristone and misoprostol versus misoprostol alone in management of late intrauterine fetal death


  • Shilpa Gupta Department of Obstetrics and Gynaecology, GMERS Medical College, Sola, Ahmedabad, Gujarat, India
  • Bhumika Kagathra Department of Obstetrics and Gynaecology, GMERS Medical College, Sola, Ahmedabad, Gujarat, India
  • Ajesh Desai Department of Obstetrics and Gynaecology, GMERS Medical College, Sola, Ahmedabad, Gujarat, India




Late intrauterine fetal death, Mifepristone, Misoprostol, Induction of labour


Background: The objective was to assess the efficacy and safety of pretreatment with Mifepristone in induction of late intrauterine fetal death in combination with misoprostol.

Methods: A prospective study was carried out in GMERS Medical College, Sola, Ahmedabad between October 2014 to April 2016. Data from 72 women with intrauterine fetal death between the gestational age of 24 to 42 weeks were analyzed. Group A women received single oral dose of 200 mg Mifepristone followed 36 to 48 hours later with Misoprostol (200-50 microgram) every 4 hour to a maximum of 5 doses. The first dose was kept vaginally in the posterior fornix and the rest were given orally. The dose of Misoprostol depended upon the gestational age and the parity. Group B women received only Misoprostol. If the first cycle failed, then after a break of 24 hour, a second course of Misoprostol was started. Outcomes were measured in terms of induction to delivery interval and number of Misoprostol doses needed.

Results: Maternal age, parity, gestational age and pre-induction bishop score were comparable in both the groups. Induction to delivery interval was shorter in the combination regimen. Total dose of Misoprostol needed was also less in the Group pretreated with Mifepristone. In group A 93.3% women delivered within 24 hours of first dose of misoprostol while in group B it was 80.5%. More women in group B required oxytocin. Regarding the complications during labor and delivery the two groups did not have major differences.

Conclusions: Both regimens are safe for the induction of labour in late IUFD. However, the induction delivery interval and the dose of misoprostol needed was decreased by the pretreatment with Mifepristone.


Ngai SW, Tang OS, Ho PC. Prostaglandins for induction of second-trimester termination and intrauterine death. Best Pract Res Clin Obstet Gynecol. 2003;17(5):765-75.

Fletcher HM, Wharfe G, Simeon D, Mitchell S, Brown D. Induction of labor with intravaginal misoprostol versus dinoprostone in intrauterine death: a retrospective study. J Obstet Gynaecol. 1996;16:155-8.

Bugalho A, Bique C, Machungo F, Faaundes A. Induction of labour with intravaginal misoprostol in intrauterine fetal death. Am J Obstet Gynaecol 1994;171:538-41.

Newhall EP, Winikof B. Abortion with mifepristone and misoprostol: regimens, efficacy, acceptability and future directions. Am J Obstet Gynecol 2000;182:44-53.

Ashok PW, Flett GM, Templeton A. Effective, low-cost regimens for medical termination of pregnancy at all gestations. Contemp Rev Obstet Gynecol. 1999:11:207-12.

Ashok PW, Penney GC, Flett GM, Templeton A. An effective regimen for early medical abortion: a report of 2000 consecutive cases. Hum Reprod. 1998;13(10):2962-5.

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.

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.

Royal College of obstetricians and gynaecologists (RCOG). Late intrauterine fetal death and stillbirth. London (UK): Royal College of Obstetricians and Gynaecologists (RCOG) (Green-top guideline; no. 55); 2010:33.

Bishop EH. Pelvic scoring for elective induction. Obstet Gynecol. 1964:24:266-8.

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

Sharma D, Singhal SR, Poonam Paul A, Tai K. J Obstet Gynaecol. 2011;50:332-5.






Original Research Articles