Mifepristone for labour induction after previous caesarean section

Abstract

Objective To evaluate the efficacy and tolerance of mifepristone in women undergoing induction of labour at term after previous caesarean section. Design A prospective double blind placebo controlled trial. Subjects Thirty‐two women at term (after 37.5 weeks' amenorrhea) who had had a previous caesarean delivery with a low transverse uterine incision. All women had a clear clinical indication for induction of labour with unfavourable cervical conditions (Bishop's score < 4). They were randomised to receive either 200 mg of mifepristone or placebo on days one and two of a four‐day observation period. Results Thirteen women entered spontaneous labour: 11 were treated with mifepristone and two were in the control group (P < 0.01). Thirteen women, still with an unfavourable cervix on day four needed cervical ripening with vaginal tablets of prostaglandins. Of these, four had received mifepristone and nine the placebo. Mean oxytocin requirements were lower in the mifepristone group (P < 0.01) and the mean time interval between day one and start of labour was also significantly shorter in this group. Mode of delivery and neonatal outcome were similar in both groups. Conclusions Induction of labour is facilitated in term women with prior caesarean section by the use of mifepristone. This induction agent appears safe and useful with no adverse events on the fetus or mother.

A Retrospective Case–Control Study Evaluating the Role of Mifepristone for Induction of Labor in Women with Previous Cesarean Section

“…In our study, we observed that mifepristone is associated with favorable outcome in 89 % of women (labor onset in 56 % and cervical ripening 33 %) within 48 h of administration of oral mifepristone. These observations are in accordance with the existing literature where a variable success rate of labor onset at 66-93 % has been observed in pregnant women [8][9][10][11][12][13][14][15]. Also, the effect of cervical ripening after use of mifepristone has been variable ranging from no statistically difference to statistically significant improvement (60-80 % of all cases) [16][17][18][19][20].…”

“…Also, the effect of cervical ripening after use of mifepristone has been variable ranging from no statistically difference to statistically significant improvement (60-80 % of all cases) [16][17][18][19][20]. However, all these studies except one [11] were conducted in women without previous CS.…”

Role of mifepristone in induction of labour in pregnant women with previous lower section caesarean section with IUFD in late preterm and term pregnancies

“…According to various existing literature, the labor onset and cervical ripening observed. [8][9][10][11][12] There is need of oxytocin requirement for augmentation of labour is very minimum so there is very less chances of scar dehiscence and rupture uterus. Mifepristone initiate the labour as naturally, causes cervical ripening (by releasing NO),promote uterine contractions by forming gap junctions and increasing influx of calcium it also increases the prostaglandins release without acting as a direct uterotonic.…”

Different methods for the induction of labour in outpatient settings

“…In view of the small number of studies included in each comparison we were not able to carry out the planned analyses. In all but three of the included studies Lelaidier 1994;) the main indication for induction of labour was 'postdates' pregnancy. The majority of studies recruited both primi-and multiparous women, and separate figures were not provided for subgroups.…”

“…Mifepristone versus placebo (five studies) (Elliott 1998;Giacalone 1998;Lelaidier 1994;Stenlund 1999).…”