Comparison of mifepristone combination with misoprostol and misoprostol alone in the management of intrauterine death

ObjectivesTo compare the efficacy and safety of misoprostol and mifepristone combination with misoprostol alone in management of intrauterine death.Materials and MethodsIt is a prospective study carried out in 40 pregnant women admitted with intrauterine death after 28 weeks of gestation at a tertiary care referral centre divided into two groups of 20 each. Every alternate patient was assigned Group I and Group II. Group I (combination group) – the women received 200 mg of mifepristone; and after 36 hours, misoprostol was administered orally (100 μg if pregnancy was <37 weeks and 50 μg if pregnancy was >37 weeks) for every 3 hour till they went into active labor for a maximum of four doses. Group II (misoprostol group) – Women received oral misoprostol (100 μg if pregnancy was <37 weeks and 50 μg if pregnancy was >37 weeks) for every three hours till she went into active labor for maximum of four doses.Primary outcome measures were achievement of successful induction and induction delivery interval (IDI). Women who did not deliver after four doses of misoprostol were considered as failure. In all the women, bishop score before the start of mifepristone and misoprostol, induction delivery interval, and adverse effect of the drug were noted. Data were analyzed by using Student t test and Chi-square test.ResultsIn the Group I, 60% of women, delivered with mifepristone alone. The rest of the patients [8 (40%)] had significant improvement of the bishop score after 36 hour. Parity, gestation, and bishop score did not affect the success of induction in the Group I. IDI was significantly less in the Group I (6.72 ± 3.34) as compared with that of the Group II (11.81 ± 6.33). Parity, gestation, and bishop score did not affect the IDI in the two groups. Number of doses of misoprostol required were significantly less in patients who were pretreated with mifepristone.ConclusionCombination of mifepristone and misoprostol is more effective than the misoprostol alone for induction of labor in women with intrauterine death.