Effect of mifepristone-misoprostol versus misoprostol in the management of intrauterine fetal death: A comparative study

摘要

Background and Aim: The most undesirable consequence of pregnancy is intrauterine fetal death (IUFD) which causes a lot of emotional and medical distress for which medical induction of labor, by routinely used prostaglandins, is recommended. Therefore, the main aim of the study was to determine the management of IUFD using misoprostol alone and mifepristone-misoprostol combination. Materials and Methods: The study included 57 women of gestational age 24 weeks with IUFD, who were divided into two groups. Women between 24–34 and 34 weeks of gestation received 200 μg and 100 μg of misoprostol, respectively. Group A received misoprostol alone and Group B received oral mifepristone (200 mg), 24 h prior to receiving misoprostol. IUFD duration, number of misoprostol doses, induction-delivery interval (IDI), and bishop score were recorded. A majority of 23 patients in Group A had a bishop score 3 while 28 in Group B had a score between 4 and 6 at 0 h. The IUFD duration varied between 1 and 2 weeks in both the groups. Results: Group A received 4 doses and Group B received 1 dose of misoprostol (P 0.001). Delivery induction was successfully achieved between 3.3–5 h (48.27%) and 5–8.3 h (51.72%) in Group B and between 11.6 and 16.6 h (57.1%) in Group A (P 0.001). IDI was found to be shorter with increasing gestational age. Conclusion: It was observed that a lesser number of misoprostol doses and shorter duration of IDI in the combination therapy of mifepristone-misoprostol was a more effective and safer approach to induce labor than misoprostol alone in women with IUFD.