Efficacy and Safety of Mifepristone Followed by Vaginal PGE1 vs PGE2 Gel Alone for Induction of Labor in Late Intrauterine Fetal Demise

Abstract

Objective: To compare the efficacy and safety of mifepristone followed by vaginal misoprostol vs dinoprostone gel alone in induction of labor in late intrauterine fetal demise. Methods: We conducted a randomized controlled study in 70 patients in tertiary care center from October 2020 to March 2022. In group I, 35 women were induced by using mifepristone (200 mg) orally followed by misoprostol. The dose was 100 µg per vaginal in patients with less than 37 weeks of gestation every 4 hourly and 50 µg in patients with more than 37 weeks of gestational age. In women with previous lower segment cesarean section, one dose was of 50 µg of misoprostol. In group II, 35 women were induced by intravaginal PGE 2 (dinoprostone) gel 0.5 mg intravaginally (maximum two doses in 24 hours). Oxytocin was given in both groups for augmentation when needed. Results:The mean induction delivery interval in group I was 10.67 ± 6.751 hours and in group II was 14.51 ± 5.338 hours. Mean induction delivery interval was significantly shorter in the combined regimen than dinoprostone gel-alone group (p-value=0.0103). Conclusion:To conclude our regimen using mifepristone and misoprostol for induction of labor is an effective, less invasive, and safe combination. It results in shorter induction-to-delivery interval than dinoprostone gel.