Mifepristone as pre-induction cervical ripening agent: a review article
Keywords:Bishop’s score, Cervical ripening, Induction of labour, Mifepristone, PGE2 gel, RU486
Induction of labour after the period of viability by any methods medical, surgical or combined, for the purpose of vaginal delivery. The success of induction, to a great extent, depend upon pre-induction cervical status i.e. cervical ripening. So, ripening of cervix prior to induction i.e. pre-induction cervical ripening is one of the important steps for successful induction of labour. There are different methods for cervical ripening like prostaglandins (PGE). However, use of prostaglandins (PGE) and oxytocin as labour inducing agent has its own adverse effects on maternal and perinatal outcome. So, constant efforts are made for the less use of uterotonins. The present review aims to study the efficacy of oral Mifepristone for improvement in Bishop’s score, requirement of additional uterotonics, induction delivery interval, mode of delivery and neonatal outcome. Electronic databases were searched by using keywords ‘Mifepristone, RU486, PGE2 gel, Cervical ripening, Bishop’s score and Induction of labour’ and eleven articles were found from 2009 to 2018 which fulfils our study criteria and thus they were taken for review. Based on all the studies, Mifepristone appears to be effective cervical ripening in comparison to other agents with significant improvement in Bishop’s score, higher vaginal delivery rate, shorter induction delivery interval and good neonatal outcome.
Dutta DC. Induction of labour. In: Hiralal Konar (ed). Text Book of Obstetrics. 9th ed. Kolkata: Jaypee Brothers Medical. Publisers (P) Ltd; 2018:485-491.
Mealing NM, Roberts CL, Ford JB, Simpson JM, Morris JM. Trends in induction of labour, 1998-2007: a population-based study. Gel Res J Pharm. 2009;49(6):599-605.
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(4):221-5.
Gaikwad V, Mittal B, Puri M. Comparative analysis of safety, efficacy and fetomaternal outcome of induction of labour with mifepristone versus intracervical dinoprostone gel. Res J Pharm Biol Chem Sci. 2014;5(2):611-6.
Muhlstein C, Moukengee L, Lutringer G. Lutringer G. Induit Historique. Rev Fr Gynecol Obstet. 1986;81:507-8.
Speert H. In: obstetrics and gynecology in America: a history. Waverty Press Ind., Baltimore; 1980:139.
York R. The history of induction. Midwife Heal Visit. 1984;20(4):109-16.
Dunn PM. Dr Thomas Denman of London: Rupture of the membranes and management of the cord. Arch Dis Child. 1992;67(7 Spec No):882-4.
Brennand JE, Calder AA. Methods of induction. Curr Obstet Gynaecol. 1994;4(2):79-84.
Kerr M. Induction of labour. In: Baskett TF, Calder AA, Arulkumaran S. (eds.) Munro Kerr's Operative Obstetrics. 12th ed. London: The Elsevier Health Sciences; 2014:71-79.
Gary C, Kenneth JL, Steven LB, John CH. Induction of labour. William Obstetrics. 23rd ed. New York: The Mc Graw-Hill Companies; 2010:500-510.
Nott JP, Bonney EA, Pickering JD, Simpson NAB. The structure and function of the cervix during pregnancy. Transl Res Anat. 2016;2:1-7.
Vogel JP, Souza JP, Gülmezoglu AM. Patterns and outcomes of induction of labour in africa and asia: a secondary analysis of the WHO global survey on maternal and neonatal health. PLoS One. 2013;8(6):656-62.
Ludmir J, Sehdev HM. Anatomy and physiology of the uterine cervix. Clin Obstet Gynecol. 2000;43(3):433-9.
World Health Organisation. WHO recommendations for augmentation of labour. Geneva: World Health Organisation; 2014.
Nabi HA, Aflaifel NB, Weeks AD. A hundred years of induction of labour methods. Eur J Obstet Gynecol Reprod Biol. 2014;179:236-9.
Fraser W, Boulvain M. Induction of labour: indications and methods. J SOGC. 1996;18(11):1125-31.
Lili S, Deborah A. Induction of labour. In: Steven GG, Jennifer N, Joe LS, Laura G, Mark L, et al. (eds). Obstetrics Normal and Problem Pregnancies. 5th ed. Philadelphia: Churchill Livingstone Elsevier; 2007:271-88.
Sinkey RG, Lacevic J, Reljic T, Hozo I, Gibson KS, Odibo AO, et al. Elective induction of labor at 39 weeks among nulliparous women: The impact on maternal and neonatal risk. PLoS One. 2018;13(4):e0193169.
Cadepond F, Ulmann A, Baulieu EE. RU486 (mifepristone): mechanisms of action and clinical uses. Annu Rev Med. 1997;48:129-56.
Sarkar NN. Mifepristone: bioavailability, pharmacokinetics and use-effectiveness. Eur J Obstet Gynecol Reprod Biol. 2002;101(2):113-20.
Hapangama D, Neilson JP. Mifepristone for induction of labour. Cochrane database Syst Rev. 2009. Available at: https://www.ncbi. nlm.nih. gov/pubmed/19588336.
Sah G. Mifepristone versus intracervical prostaglandin E2 gel for cervical ripening in primigravid patients at term. Int J Reprod Contracept Obs Gynecol. 2018;7(3):824-8.
Arumugaselvi B, Sujathasenthil S, Anandan H. Comparative study of oral mifepristone and endocervical prostaglandins E2 gel as preinduction cervical ripening agent in parturition. Int J Sci Study. 2017;129:129.
Fathima S, Nayak SR, Rao B. Mifepristone in the induction of labour at term. Int J Pharm Biomed Res. 2013;4(3):164-6.
Ramesh B. Role of oral mifepristone as a cervical priming agent for induction of labour. Orig Res Artic J Evid Based Med Heal. 2018;5:1-8.
Athawale R, Acharya N, Samal S, Hariharan C. Effect of mifepristone in cervical ripening for induction of labour. Int J Reprod Contraception, Obstet Gynecol. 2013;2(1):35.
Berkane N, Verstraete L, Uzan S, Boog G, Maria B. Use of mifepristone to ripen the cervix and induce labor in term pregnancies. Am J Obstet Gynecol. 2005;192(1):114-20.
Archana A, Shilpa C, Amrapali G, Tanvi W, Manika S, Shreya K, et al. Comparative analysis of safety, efficacy and fetomaternal outcome of induction of labor with tablet mifepristone and tablet misoprostol versus tablet misoprostol. J Evol Med Dent Sci. 2014;3(49):11706-14.
Mandade G. A prospective comparative study to evaluate the efficacy and safety of mifepristone with misoprostol over misoprostol alone in induction of labour. Int J Reprod Contracept Obs Gynecol. 2016;5(12):4321-8.
Baev OR, Rumyantseva VP, Tysyachnyu O V, 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.