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

Abstract

Combination of mifepristone and misoprostol is more effective than the misoprostol alone for induction of labor in women with intrauterine death.

Mifepristone and misoprostol compared with misoprostol alone for induction of labor in intrauterine fetal death: A randomized trial

“…Despite marked heterogeneity in terms of the study design and dose, the frequency of dosing and route of misoprostol, three previous studies of the induction of labor in IUFD showed significantly shorter IDI with the use of combined mifepristone and misoprostol, in comparison with the use of misoprostol alone, in line with our observations . In addition, Wagaarachchi et al ., in a retrospective analysis of a series of 96 consecutive cases, also found a comparable median IDI (8.5 h) using the combined regime …”

“…in a prospective study failed to show any significant difference in IDI among the groups receiving mifepristone and misoprostol versus misoprostol alone . The trials showing a favorable outcome with the combined regime used a higher and more frequent dose of misoprostol than the trials which failed to document such benefits . Fairly et al ., in a retrospective comparison between high and low dose misoprostol regimes after priming both groups with mifepristone, further established that the success of the combined regime depended on the dose of misoprostol …”

“…As delivery after administration of mifepristone only has been documented in previous trials, we preferred to admit all participants after recruitment . Vital signs and labor progress were recorded in modified World Health Organization (WHO) partographs.…”

“…Power calculation was used to determine the sample size. Based on a previous trial, the mean induction delivery interval (IDI) after the administration of misoprostol only was approximately 12 h with a standard deviation of six h . If we assumed that the addition of mifepristone would reduce the IDI by 30%, 49 participants were required in each group to have an 80% chance of detecting (as significant at the 5% level) a decrease in the primary outcome measure from 12 h in the control group to 8.4 h in the experimental group.…”

“…However, the evidence related to the use of the such a combination for the induction of labor in second and third trimester IUFD is deficient in the absence of well‐designed randomized controlled trials (RCT) . Of the seven available studies that used mifepristone‐misoprostol in cases of fetal death, four were retrospective and three, although prospective, lacked the quality of randomized trials …”