Efficacy and safety of oral mifepristone for cervical priming and induction of labor in term pregnancy

Abhilasha Gupta, Aruna Verma, Iti Madan, Monika Kashyap


Background: The objectives of the study was to assess the efficacy of mifepristone in priming the cervix/inducing labor over next 96 hrs in term pregnancy.

Methods: In this single blind randomized controlled trial 200 women with term pregnancy beyond 39 weeks and Bishop’ score <6 were randomly allocated into two groups. Tab Mifepristone 400 mg orally was given to women in study group (n=100) and no intervention in control group (n=100). On follow up one case was lost in control group. All women were observed for change in the bishop’s score or onset of labor in next 96 hrs. If Bishop’s score was <6, the choice of induction was left on the clinician/patient.

Results: Mean induction to delivery interval, duration of active phase and improved Bishop score were 79.35±53.43 hr, 2.47±1.23 hr, 6.68±1.69 for study group versus 148±65.66 hr, 3.09±1.45 hr, 5.8±2.15  for control group (p value is <0.001) respectively.  Seventy one (71%) women in study group and 39 (39.3%) women in control group delivered vaginally within 96 hrs without any need of augmentation. There were 9 (9%) caesareans in study group and 24 (24.2%) caesareans in control group but no instrumental delivery in both groups. There was no statistically difference in perinatal outcomes between two groups.

Conclusions: Mifepristone is an effective drug for cervical ripening and initiation of labor when given in term pregnancy beyond 39 weeks with poor Bishop’s score (<6) and appearing to reduce need for other agent for augmentation of labor.


Bishop's score, Cervical priming, Induction of labor, Mifepristone

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Chervenak FA. Current progress in obstretics and gynaecology. 2015

Spong CY. Defining Term pregnancy: recommendations from the Defining "term" pregnancy Workgroup. JAMA. 2013;309:2445-6.

Reddy UM, Ko CM, Raju TN, Willinger M. Delivery indications at late preterm gestations and infant mortality rates in The United States. Pediatrics. 2009;124:234-40.

ACOG Committee Opinion. Nonmedically indicated early-term deliveries. Committee opinion. Number 561. Obstet Gynecol. 2013; 121.

Cole RA, Howie PW, Macnaughton MC. Elective induction of labour. A randomized 265 prospective trial. Lancet. 1975;1:767-70.

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

Heikinheimo O, Kekkonen R, Lähteenmäki P. The pharmacokinetics of mifepristone in humans reveal insights into differential mechanisms of antiprogestin action. Contraception. 2003;68(6):421-6.

Frydman R, Lelaidier C, Baton-Saint-Mleux C, Fernandez H, Vial M, Bourget P et al. Labour induction in women at term with mifepristone: a double blind controlled trial. Obstet Gynecol. 1992;80:972-5.

Gemzell-Danielsson K, Lalitkumar S. Second trimester medical abortion with mifepristone-misoprostol and misoprostol alone: a review of methods and management. Reproductive Health Matters. 2008;16(31):162-1726.

Byrne JD. Term pregnancy. J Perinatol. 2004;24:416-20.

ACOG Committee Opinion no.579: Definition of term pregnancy. Obset Gynecol. 2013;122:1139-40.

Dharani H, James PN. Mifepristone for induction of labour (review). Chochrane Database Syst Rev. 2009; 3, Art. No. CD002865.

Wing DA, Fassett Michael J, Mishell Daniel R. Mifepristone for preinduction cervical ripening beyond 41 weeks’ gestation: a randomized controlled trial. Obstet Gynecol. 2000;96:543-8.

Athawale R, Acharya N, Samal S. Effect of mifepristone in cervical ripening for induction of labour. Int J Reprod Contracept Obstet Gynecol. 2013;2(1):35-8.

Fathima S, Nayak SR, Rao B. Mifepristone in induction of labour at term. Int J of Pham Biomed Res. 2013;4(3):164-6.

Wing D, Guberman C, Fassett M. A comparison of oral mifepristone to intravenous oxytocin for pre-induction cervical ripening and labour induction in women with pre-labour rupture of membranes beyond 36 weeks gestation. American J Obstetrics Gynecol. 2003;189(6):204.

Wing D, Guberman C, Fassett M. A Randomized comparison of oral mifepristone to intravenous oxytocin for labor induction in women with prelabor rupture of membranes beyond 36 weeks’ gestation. American J Obstetricians Gynaecologists. 2005;192:445-51.