Efficacy of Mefipristone for induction of labour in late term pregnancy
Keywords:Bishops score, Late term pregnancy, Mifepristone, Vaginal delivery
Background: Late-term pregnancy defined as one that has reached between 41 0/7 weeks and 41 6/7 weeks of gestation is associated with an increased maternal morbidity as well as an increased risk of fetal and neonatal mortality and morbidity. Mifepristone, an anti-glucocorticoid and antiprogesterone, though not an oxytocic increases uterine activity and causes cervical effacement and dilatation and improves the Bishop score without over/hyper stimulation of uterus. Increased maternal and fetal mortality from late term pregnancy could be prevented by induction of labour. The objective of this study was to know the efficacy of single dose of oral mifepristone in induction of labour in late term pregnancy and to assess the induction delivery interval in the study population.
Methods: This was a prospective interventional study conducted in Department of Obstetrics and Gynaecology at BGS Global Institute of Medical Sciences, Bengaluru. 100 Women with late term pregnancy who fulfilled the inclusion and exclusion criteria were considered for the study after an informed written consent.
Results: 73.5% (n=36) of multigravida and 80.4% (n=41) of prim gravida showed improvement in the Bishop score post induction with mifepristone and majority (89.79 % primigravida and 84.31% multigravida) of the study population had vaginal delivery. Multigravida (73.5%) had less induction delivery interval (less than 48hours) compared to primigravida (19.6%).
Conclusions: Mifepristone, a progesterone antagonist causes a significant improvement in the Bishop’s score and is associated with an increased rate of vaginal deliveries.
American College of Obstetricians and Gynaecologists. Practice bulletin no. 146: Management of late-term and post term pregnancies. Obstetric Gynecol. 2014;124(2 Pt 1):390-6.
Aaron B. Caughey, Naomi E. Stotland, A. Eugene Washington, and Gabriel J. scobar. Maternal Complications of Pregnancy Increase Beyond 40 Weeks’ Gestation. Am J Obstet Gynecol. 2007 Feb; 196(2):155.e1-e6.
Olesen AW, Westergaard JG, Olsen J. Perinatal and maternal complications related to postterm delivery: a national register-based study, 1978-1993. Am J Obs Gynecol. 2003;189(1):222-7.
M. Galal, I. Symonds, H. Murray, F. Petraglia, and R. Smith. Postterm pregnancy. Facts Views Vis Obgyn. 2012;4(3):175-87.
Gülmezoglu AM, Crowther CA, Middleton P, Heatley E. Induction of labour for improving birth outcomes for women at or beyond term. Cochrane Database Syst Rev. 2012 Jun 13;(6):CD004945.
Reelkar P, Solunke A, Aher G, Shinde U. Study of Use of Single Dose of Oral Mifepristone in Induction of Labour. Scholars J Applied Med Sci (SJAMS). Apr 2018; 6(4):1796-1800.
Heikinheimo O, Kekkonen R, La¨hteenma¨ki P. The pharmacokinetics of mifepristone in humans reveal insights into differential mechanisms of antiprogestin action. Contraception. 2003;68(6):421-6.
Hapangama D,Neilson JP. Cochrane Database Syst Rev. 2009(3):CD002865.
Clark K, Ji H, Feltovich H, Janowski J, Carroll C, Chien EK. Mifepristone-induced cervical ripening: Structural, biomechanical, and molecular events. Am J Obstet Gynecol. 2006;194(5):1391-8.
Yelikar K, Deshpande S. Safety and Efficacy of Oral Mifepristone in Pre-induction Cervical Ripening and Induction of Labour in Prolonged Pregnancy. J Obs Gynecol India. 2015 July-august;65(4):221-5.
Athawale R, 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.
Stenlund PM, Ekman G, Aedo AR, Bygdeman M. Induction of labor with mifepristone, ‐A randomized, double‐blind study versus placebo. Acta Obstet Gynecol Scand. 1999;78(9):793-8.
Wing DA, Fassett MJ, Mishell Jr DR. Mifepristone for preinduction cervical ripening beyond 41 weeks’ gestation: a randomized controlled trial. Obstet Gynecol. 2000;96(4):543-8.