DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20182914

Intrauterine foetal demise in pre-eclampsia - role of mifepristone: a case series

Kanika Chopra, Suchitra ., Prbha Lal

Abstract


Mifepristone is a steroid, which is a progesterone antagonist and is widely used for termination of pregnancies in all the trimester. It increases the sensitivity of the uterus to prostaglandins and ripens the cervix. Its role in inducing women with intra uterine demise is on the rise with varying dose regimen either alone or in combination with misoprostol. Among the various causes of intrauterine demise, one of the most important is hypertensive disorders of pregnancy complicating around 10% of pregnancies worldwide, Serum uric acid, a marker of oxidative stress is an important parameter in defining poor fetal outcome in women with pre-eclampsia. Induction of labour in women diagnosed with intrauterine demise is again a challenge in such women and mifepristone helps to a larger extent. In present case series, authors present six women presenting with pre-eclampsia with intrauterine demise, their clinical and biochemistry profile and responding to single dose of mifepristone of 200 mg with mean induction to delivery interval being 40 hours. Henceforth, authors conclude that even single dose of mifepristone can work wonders taking into consideration the cost of the drug and thus can be definitely employed in daily clinical practice.


Keywords


Induction of labour, Intrauterine foetal demise, Mifepristone, Preeclampsia, Termination of pregnancy

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References


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

Ahmad AS, Samuelsen SO. Hypertensive disorders in pregnancy and fetal death at different gestational lengths: a population study of 2121371 pregnancies. BJOG. 2012;119:1521-8.

Heikinheimo O. Clinical phatmacokinetics of mifepristone. Clin Pharmacokinet. 1997;33:7-17.

Ponce de Leon RG. Wing DA. Misoprostol for termination of pregnancy with intrauterine featl demise in the second and third trimester of pregnancy: a systematic review. Contraception. 2009;79:259-71.

Royal College of Obsterician and Gynaecologists. Green top guidelines No.55: Late Intrauterine Fetal Death and Stillbirth. London: RCOG; 2011.

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

Chittacharoen A, Herabutaya Y, Punyavachira P. A randomized trial of oral and vaginal misoprostol to manage delivery in cases of fetal death. Obstet Gynecol. 2003;101:70-3.

Draycott T, Hawkes N, Read MD. Induction of labour with vaginal misoprostol after intrauterine deaath from 24 weeks gestation. J Obstet Gynecol. 1996;16:517-8.

Srisomboon J, Singchai S. A comparison between 25 Ig and 50 Ig of intravaginal misoprostol for labour induction. J Med Assoc Thai. 1998;81:779-83.

Dodd JM. Misoprostol for the induction of labour at term. PhD thesis. Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Adelaide, 2005.

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

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;109:443-7.

Shilpa G, Bhumika K, Ajesh D. Mifepristone and misoprostol versus misoprostol alone in management of late intrauterine fetal death. Int J Reprod Contracept Obstet Gynecol. 2016 sep;5(9):2935-38.

Cabrol D, Dubois C, Cronje H, Gonnet JM et al. Induction of labour with mifepristone in intrauterine fetal death. Am J Obstet Gynecol. 1990 Aug;163(2): 540-2.