Comparative study to evaluate the efficacy and safety of oral Mifepristone versus intracervical Dinoprostone gel for induction of labour and their effects on fetomaternal outcome
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20193024Keywords:
Dinoprostone, Induction of labour, Mifepristone, Oxytocin augmentationAbstract
Background: Mifepristone and Dinoprostone are used in inducing labour in pregnancy by acting as cervical ripening drugs. A randomized case control study to evaluate the efficacy, safety and fetomaternal outcome of induction of labour with oral Mifepristone and intracervical Dinoprostone gel was done.
Methods: About 300 patients were included after taking informed consent. 150 patients were placed in each group A and B. In group A patients received 200 mg oral Mifepristone tablet and in group B 0.5 mg Dinoprostone gel was given intracervically and 2nd dose was repeated after 6 hours later if adequate uterine contractions were not achieved. A detailed analysis was carried out in both groups regarding efficacy and safety of drugs in terms of necessity of augmentation of labour with oxytocin, induction to delivery interval, fetal outcome in terms of NICU admission.
Results: 59.33% cases in Mifepristone group and 72% case in Dinoprostone group required augmentation with oxytocin. Mean induction delivery interval in Mifepristone group in primigravida was 17.998±1.128 hrs and mean induction delievery interval in multigravida was 11.648±1.112 hours. 88% cases in mifipristone group and 80% cases in Dinoprostone group delivered vaginally. NICU admission was 1.33% in Mifepristone group and 2.66% in PGE2 gel group.
Conclusions: Mifepristone when compared with intracervical Dinoprostone gel, acts as a better cervical ripening agent and requires lesser need for Oxytocin augmentation. Though, mean induction delivery interval was more with Mifepistone, the incidence of successful vaginal delivery was higher as compared to Dinoprostone.
References
Caughey AB et al.Maternal and neonatal outcomes of elective induction of labour.Evidence Report/Technology Assessment No.176.(prepared by the Stanford University-UCSF Evidence based Practice Centre). Rockville, MD, Agency for Healthcare Research and Quality, 2009AHRQpublication No. 09-E005)
Declerecq ER et al. Listening to mothers II. Report of the Second National US Survey of Women’sChildbearing Experiences. New York, Childbirth Connection, 2006.
WHO Global Survey on Maternal and perinatal Health.Induction of labour data. Geneva, WHO,2010.
Williams obstetrics 22nd Edition, F. Gary Cunnigham, Kenneth J. Leveno, Steven L. Bloom, John C. Hauth, Larry C. Gilstrap III, kotharine D. Wenstrom, Section II – Chapter 6 Parturition. – Pg 168, Section IV – Chapter 22 Induction. Of labour – Pg 536.
Leon speroff and marc A. Fritz clinical gynecologic endocrinology and
infertility VII edn
Bertois Y, Salat-Baroux J, Cornet, D, Dc Brux J, Kopp F Martin PM. A
multiparametric analysis of endometrial estrogen and progesterone receptors after the postovulatory administration of mifepristone
Mervi Vaisanen-Tommiska, Ralf Butzow, OLAVI Ylikorkala and Tomi S. Mikkola mifepristone induced Nitric oxide release and expression of nitric oxide synthases in human cervix,Human Reproduction 2006 21 (8) 2180-2184.
Gaikwad Vidya, Mittal Bilsi, Mangalpuri. Comparative Analysis of safety, Efficacy and fetomaternal outcome of induction of labour with Mifepristone versus intracervical Dinoprostone gel.RJPBS. 2014;5(2):611
Sailatha R et al. Int J Reprod Contracept Obstet Gynecol. 2017 may;6(5);1880-1884
Yelikar K. The Journal of Obstetrics and Gynecology of India. 2015; 65(4):221–225
Wing DA, Guberman C, Fassett M. A randomized comparison of oral mifepristone to intravenous oxytocin for labour induction in women with prelabour rupture of membranes beyond 36 weeks gestation. Am J Obstet Gynecol.2005 Feb;192(2):445-51.