DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20205771

A comparative study on the role of oral mifepristone and endocervical prostaglandin as preinduction cervical ripening agent

Sanghamitra Mohapatra, Samarpita .

Abstract


Background: Induction of labour is one of the most common interventions practised in modern obstetrics with up to 20% of pregnant women having labour induced in some countries. Induction rates have been influenced by several reports worldwide, which claimed that an active induction policy, led to substantial reduction in perinatal and maternal morbidity and mortality. A ripe or favourable cervix is a pre-requisite for successful vaginal birth. This study is conducted with an aim to compare the efficacy of mifepristone and dinoprostone as a cervical ripening and priming agent for induction of labour and their safety and fetomaternal outcome.

Methods: It was a prospective comparative study in the Department of Obstetrics and Gynecology, M.K.C.G. Medical college, Berhampur from October 2017 to October 2019. 100 cases with bishop score less than 6 were subjected for pre induction ripening. These cases were assigned at random either  to study group, who were given single dose oral mifepristone 200 mg and control group with  single dose intracervical E2 gel. All the cases were examined to check the bishop score. In cases of control cases, second dose was given after 6 hours, if there was no improvement in bishop score. At the end of 24 hour if bishop score <6, it was called as failed induction.

Results: 90% of mifepristone gr and 56% of dinoprostone gr had improved Bishop score>6 after 6hr.32 cases required oxytocin augmentation in mifepristone gr where as it was 57 in dinoprostone. Drug administration to delivery interval was 19.40 hour in mifepristone gr and 15 hour in dinoprostone gr. More vaginal delivery and less fetal distress in mifepristone gr.

Conclusions: Mifepristone is an effective agent for cervical ripening with better fetomaternal outcome compaired to dinoprostone.


Keywords


Dinoprostone, Mifepristone, Preinduction cervical ripening

Full Text:

PDF

References


Arulkumaran, Leonie K, Penna K, Rao B. The management of Labour. Second edition. Wiley Online Library. 2007:11,12,14,281,292-6.

Cunnigham FG, Leveno KJ, Bloom SL, Hauth JC, Gilstrap LC. Williams Obstetrics. 22nd Edition, McGraw-Hill Education. 2006:168,536.

Cunnigham FG, Leveno KJ, Bloom SL. Induction and augmentation of labor. In: William’s obstetrics. 24th edition. McGraw Hill Professional. 2014:525.

Heikinheimo O, Kekkonen R, Lahteenma P. The pharmacokinetics of mifepristone in humans reveal insights into differential mechanisms of antiprogestin action. Contraception. 2003;68(6):421-6.

Wing DA. Mifepristione for pre induction cervical ripening beyond 41 weeks gestation: a randomized controlled trial. Obstet Gynecol. 2000;96(4):543-8.

Arumugaselvi B, Sujathasenthil S, Anandan H, Comparative study of oral mifepristone and endocervical prostaglandins E2 Gel as preinduction cervical ripening agent in parturation. Int J Sci Stud. 2017;5(3):129-33.

Sailatha R, Famida AM, Chellaiyan VGD, Vijayalakshmi K, Sathiya S, Renuka S. Mifepristone: an alternate to dinoprostone in induction of labour. Int J Reprod Contracept Obstet Gynecol. 2017;6:1880-4.

Saranya A, Pradeeba S. Comparative analysis of safety, efficacy and fetomaternal outcome following induction of labour with mifepristone vs intracervical dinoprostone gel. Indian J Res. 2019;(3):10-24.

Shanitha F, Nayak SR, Bharathi R, Gandhi P, Shameem VPA. Mifepristone in the induction of labour at term. Int J Pharm Biomed Res. 2013;4(3):164-6.

Su H, Li E, Weng L. Mifepristone for induction of labor. Zhonghua Fu Chan Ke Za Zhi. 1996;31(11):676-80.

Bashutheen NS, Sharon M. A study of intracervical PGE2 gel for cervical ripening and induction of labour. Int J Contemp Med Res. 2018;5(3):C4-C7.

Deepika N, Kumar A. Mifepristone for cervical ripening and induction of labour. J obstet Gynecol India. 2018;5:15-29.

Yellikar K, Deshpande S, Deshpande R, Lone D. Safety and efficacy of oral mefipristone in preinduction cervical ripening and induction of labor in prolonged pregnancy. J Obstet Gynaecol India. 2015;65(4):221-5.

Sah MK, Padhye SM. Mifepristone versus intracervical prostaglandin E2 gel for cervical ripening in primigravid patients at term. Int J Reprod Contracept Obstet Gynecol. 2014;4:43-7.

Vidya G, Bilsi M, Puri M. Comparative analysis of safety, efficacy and fetomaternal outcome of induction of labour with mifepristone versus intracervical dinoprostone gel. RJPBCS. 2014;5(2):611.

Ramesh B, Vidyaravi, Mareeswari. Role of oral mifepristone as acervical priming agent for induction of labour. J Evid Based Med Healthc. 2018;5(3):280-5.

Hapangama D, Nielson JP. Mifepristone for induction of labour. Cochrane Database Syst Rev. 2009;3:CD002865.

Giacalone PL. Cervical ripening with mifepristone before labour induction: a randomized study. Obstet Gynecol. 1998;92:487-92.

Elliot P. The effects of mifepristone on cervical ripening and labour induction in primigravida. Obstet Gynecol. 1998;92(5):804-9.

Lelaider C. Mifepristone for labour induction after previous caesarian section. Br J Obstet Gynaecol. 1994;101(6):501-3.

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.