Comparative study of oral mifepristone and endocervical prostaglandin-E2 gel as pre-induction cervical ripening agents in parturition


  • Prabhkiran Dhillon Department of Obstetrics and Gynecology, Base Hospital Delhi Cantonment, Delhi, India
  • Manash Biswas Department of Obstetrics and Gynecology, Base Hospital Delhi Cantonment, Delhi, India
  • Priyanka Tripathi Department of Obstetrics and Gynecology, Base Hospital Delhi Cantonment, Delhi, India
  • Vinod G. Nair Department of Obstetrics and Gynecology, Base Hospital Delhi Cantonment, Delhi, India



Bishop’s score, Cervical ripening, Induction of labour, Mifepristone


Background: Intracervical instillation of prostaglandin E2 is a well-known and widely practiced method of pre-induction cervical ripening. Mifepristone, due to its anti-progesterone action has been found to be a potential cervical ripening agent. This study was conducted to compare the safety, efficacy and outcome of these two drugs in pre-induction cervical ripening.

Methods: One hundred antenatal women were recruited for the study; 50 in mifepristone arm and 50 in PG-E2 gel arm. Any singleton term pregnancy in vertex presentation with intact membranes and bishop’s score of <4 was included in the study. Any contraindication for vaginal delivery and any contraindication for mifepristone or PG-E2 were considered as exclusion criteria. Participants in the mifepristone arm were given tablet mifepristone 200 mg orally and those in PG-E2 gel group received endocervical instillation of PGE2 gel 0.5 mg, two doses 6 hours apart (if necessary). Induction of labour was considered successful if the parturient delivered within 48 hours of administration of mifepristone or first dose of PG-E2 gel, with or without labour augmentation with oxytocin. Delivery after 48 hours and caesarean delivery were considered unsuccessful induction.

Results: There was a significant improvement in bishop’s score in mifepristone group 5.0±1.55 as compared to PG-E2 gel group 3.64±2.14; p value 0.001.

Conclusions: Oral administration of 200 mg mifepristone is a safe, effective and convenient alternative to intracervical instillation of prostaglandin-E2 gel for pre-induction cervical ripening.


WHO Global Survey on Maternal and Perinatal Health. Induction of labour data. Geneva, World health Organization, 2010. Available at: best_practices/global_survey. Accessed on 20th May 2020.

Bishop EH. Pelvic scoring for elective induction. Obstet Gynecol. 1964;24:266-8.

Hapangama D, Neilson JP. Mifepristone for induction of labour. Cochrane Database Syst Rev. 2009;(3):Art No:CD002865.

Frydman R, Taylor S, Ulmann A. Transplancental passage of mifepristone: Lancet. 1985;2:1252-2.

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;194:1391-8.

Naegele FC. Erfahrungen und Abhandlungen aus dem Gebiethe der Krankheiten des weibliches Geschlechtes. Mannheim: Loeffler. 1812:280-281.

Tenore JL. Methods for cervical ripening and induction of labor. Am Fam Physician. 2003;67(10):2123-8.

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.

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.

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

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 Gynecol India. 2015;65:221-5.

Giacalone PL, Daurés JP, Faure JM, Boulot P, Hedon B, Laffargue F. The effects of mifepristone on uterine sensitivity to oxytocin and on fetal heart rate patterns. Eur J Obstet Gynecol Reprod Biol. 2001;97(1):30-4.






Original Research Articles