The role of oral mifepristone in pre-induction cervical ripening at term


  • Uma H. Chourasia Department of Obstetrics and Gynecology, College of Medicine, Jazan University, Saudi Arabia
  • Mudita Kamlesh Jain Department of Obstetrics and Gynecology, RKDF Medical College, Bhopal, Madhya Pradesh, India
  • Juzar I. Fidvi Department of Obstetrics and Gynecology, Government Medical College, Nagpur, Maharashtra, India



Bishop score, Cervical ripening, Labor induction, Mifepristone


Background: Planned induction of labor is an established part of modern obstetrics and is used as a definite form of treatment where continuation of pregnancy would be detrimental to the health of mother or fetus. The objective of this study was to evaluate the effect of mifepristone in pre-induction cervical ripening and labor induction.

Methods: A total of 200 pregnant women at term with Bishop Score 4 or less were selected for this prospective randomized placebo-controlled study. The sample was equally divided into study group to receive 200 mg of mifepristone and control group to receive placebo orally for 2 days. Bishop score was assessed at every 24 hours interval till patient entered in spontaneous labor or 72 hours after 1st dose. Women who did not enter labor spontaneously, labor induction was planned with per vaginal insertion of prostaglandin (PG) E2 analogue, Dinoprostone gel 2.5 mg or PGE1 analogue Tab. Misoprostol 25 µg.

Results: Ninety-six subjects in the study group and eighty-one in the control achieved successful ripening of cervix and the difference was statistically significant. Sixty-eight of study group and thirty-nine of placebo group entered in spontaneous active labor within 72 hours. Requirement of oxytocin as adjuvant treatment was significantly lower in the study group. Nineteen women of study group and fifteen of control group delivered within 24 hours, and eighty-one of study group and sixty-two of placebo delivered in 48 hours. The mean induction delivery interval was 35.53±13.67 hours in the study group, whereas it was significantly prolonged in the placebo group 50.49±20.92 hours. Eighty-two subjects of study group and seventy-eight of the control group delivered vaginally, the differences were statistically not significant.

Conclusions: Mifepristone was found to be an effective agent for cervical priming prior to labor induction in women at term and significantly reduces the induction delivery interval compared with placebo.


Sanchez-Ramos L. Induction of labor. Obstet Gynecol Clin North Am. 2005;32:181-200.

Laughon SK, Zhang J, Grewal J, Sundaram R, Beaver J, Reddy UM. Induction of labor in a contemporary obstetric cohort. Am J Obstet Gynecol. 2012;206:486.e1-486.e9.

Surita FG de C, Cecatti JG, Kruppa F, Tedesco RP, Parpinelli MÂ. Cervical ripening methods for labor induction. Rev Bras Saúde Materno Infant. 2004;4:125-33.

Jackson GM, Sharp HT, Varner MW. Cervical ripening before induction of labor: a randomized trial of prostaglandin E2 gel versus low-dose oxytocin. Am J Obstet Gynecol. 1994;171:1092-6.

Srisomboon J, Tongsong T, Tosiri V. Preinduction cervical ripening with intravaginal prostaglandin E1 Methyl analogue Misoprostol: a randomized controlled trial. J Obstet Gynaecol Res. 1996;22:119-24.

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

Van Look PF, von Hertzen H. Clinical uses of antiprogestogens. Hum Reprod Update. 1995;1:19-34.

Kulier R, Kapp N, Gülmezoglu AM, Hofmeyr GJ, Cheng L, Campana A. Medical methods for first trimester abortion. Cochrane Database Syst Rev. 2011;CD002855.

Wildschut H, Both MI, Medema S, Thomee E, Wildhagen MF, Kapp N. Medical methods for mid‐trimester termination of pregnancy. Cochrane Database Syst Rev. 2011. Available at:

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

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;80:972-5.

Baev OR, Rumyantseva VP, Tysyachnyu OV, Kozlova OA, Sukhikh GT. Outcomes of mifepristone usage for cervical ripening and induction of labour in full-term pregnancy. Randomized controlled trial. Eur J Obstet Gynecol Reprod Biol. 2017;217:144-9.

Giacalone PL, Targosz V, Laffargue F, Boog G, Faure JM. Cervical ripening with mifepristone before labor induction: a randomized study. Obstet Gynecol. 1998;92:487-92.

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

Yelikar K, Deshpande S, Deshpande R, Lone D. Safety and efficacy of oral mifepristone in pre-induction cervical ripening and induction of labour in prolonged pregnancy. J Obstet Gynaecol India. 2015;65:221-5.

Elliott CL, Brennand JE, Calder AA. The effects of mifepristone on cervical ripening and labor induction in primigravidae. Obstet Gynecol. 1998;92:804-9.

McGill J, Shetty A. Mifepristone and misoprostol in the induction of labor at term. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet. 2007;96:80-4.

Athawale R, Acharya N, Samal S, Hariharan C. Effect of mifepristone in cervical ripening for induction of labour. Int J Reprod Contracept Obstet Gynecol. 2016;2:35-8.

Nayak SR, Rao B. Mifepristone in the induction of labour at term. Int J Pharm Biomed Res. 2013;4:164-6.






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