Use of mifepristone for termination of intrauterine fetal demise (IUFD) in previously scarred uterus in later half of pregnancy (>20 weeks)

R. Arora, P. B. Patel, A. Dabral, M. Sachdeva, P. Arya


Background: Mifepristone has the potential to be used as an agent for induction of labour by increasing the uterine contractility and increasing the sensitivity of uterus to prostaglandins. The present study is an endeavor to study the effect of mifepristone alone to induce labour in scarred uterus and its risk benefit ratio.

Methods: Total 39 patients with IUFD and previous uterine surgery were included in the study after their informed consent. All women in the study were given Tablet Mifepristone 200 mg orally, thrice a day, maximum 6 doses (Max -1200 mg) over a duration of 48 hours. Patients were monitored for vitals, the uterine contractions and any bleeding per vaginum. Next dose of drug was omitted if sufficient uterine contractions or cervical dilatation ≥2.5 cm achieved. Patients were shifted to the labour room after onset of active labour. Labour was augmented with oxytocin wherever required.

Results: spontaneous labour occurred in 74.3% (29/39) women while operative (cesarean/ hysterotomy) delivery occurred in 17.9% (07/39). Mean induction (first dose of mifepristone) to delivery interval was 51.5 hrs in second trimester while 59.8 hrs in third trimester women. Oxytocin augmentation was done in 8 (20.5 %) women.

Conclusions: The potential advantage of mifepristone over prostaglandins and oxytocin, is mainly in situations where they are contraindicated (i.e., scarred uterus). In this study authors found that with mifepristone only regimen is quite safe and effective, inducing spontaneous labour in 74.3% (29/39) women with IUFD and in reducing the operative (cesarean/ hysterotomy) delivery (17.9%).


Induction of labour, IUFD, Mifepristone, Scarred uterus

Full Text:



Confidential Enquiry into Maternal and Child Health (CEMACH). Perinatal Mortality 2007: United Kingdom. CEMACH: London, 2009. Available at: ment/1d2c0ebc-d2aa-4131-98ed-56bf8269e529/PerinatalMortality-2007.aspx.

Belkin T, Wilder J. Management Options for Women with Midtrimester Fetal Loss: a case report. J Midwifery Women Health. 2007;52(2):164-7.

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

Hapangama D, Neilson JP. Mifepristone for induction of labour. Cochrane Database Syst Rev 2009;(3): CD002865.

Cabrol D, Bouvier D’Yvoire M, Mermet E, Cedard L, Sureau C, Baulieu EE. Induction of labor with mifepristone (RU 486) after intrauterine fetal death. Lancet 1985;2:1019.

Cabrol D, Dubois C, Cronje H, Gonnet J M, Guillot M, Maria B. Induction of labor with mifepristone (RU 486) in intrauterine fetal death. Am J Obstet Gynecol. 1990;163(2):540-2.

Frydman R, Lelaidier C, Baton -Saint-Mleux C, Fernandez H, Vial M, Bourget P. Labor induction in women at term with mifepristone (RU 486): A double-blind, randomized, placebo-controlled study. Obstet Gynecol. 1992;80(6):972-5.

Lelaidier C, Baton C, Benifla JL, Fernandez H, Bourget P, Frydman R. Mifepristone for labour induction after previous caesarean section. Int J Obstet Gynaecol. 1994;101(6):501-3.

Ahuja N, Dahiya P. A comparative study of mifepristone alone versus mifepristone and misoprostol for induction of labor in intrauterine fetal death. Indian J Obstet Gynecol Res. 2016;3(4):348-351

Berkane N, Verstraete L, Uzan S, Boog G, Maria B. Use of mifepristone to ripen the cervix and induce labor in term pregnancies. A J Obstet Gynecol. 2005;192(1):114-20.

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