Enlightening a Novel Dimension- Mifepristone in Pre-Induction Cervical Ripening in Term Pregnancy
Journal Title: Indian Journal of Obstetrics and Gynecology - Year 2017, Vol 5, Issue 1
Abstract
Introduction: Mifepristone is a 19- nor steroid that binds to the progesterone receptor and inhibits the activity of progesterone at cellular level. It ripens cervix with minimal effect on uterine contractility, favouring pre-induction cervical ripening to enhance the rate of spontaneous labour without apparent maternal and neonatal side effects. Aims and Objectives: • To determine the efficacy and safety of Mifepristone to prime the cervix and induce labour at term. • To compare the effect of Mifepristone with placebo on cervical ripening before labour induction in term pregnancy. Material and Methods: 100 patients with singleton pregnancy of 37-42 weeks with Modified Bishop’s score 5 were included in the study after their informed consent. Exclusion Criteria: Cephalopelvic disproportion • Previous LSCS • Hypersensitivity to Prostaglandins and Mifepristone Patients were given either oral Tablet Mifepristone 200mg (n=50) or Placebo (n=50) after assessing Modified Bishop’s score. Change in Modified Bishop’s score is assessed after 24 hrs and 48 hrs. Even after 48 hrs if labour had not begun or Modified Bishop’s score 5 induction with Prostaglandin E2 0.5mg gel or Prostaglandin E1 tablet 25 µg done. Results: Out of 100 patients, 29 patients entered spontaneous labour within 48 hrs, of which 19 were treated with Mifepristone (38%) & 10 with placebo-(20%). 9 of Mifepristone treated (18%) & 3 of placebo treated (6%) patients required only oxytocin for labour augmentation. 59 patients required Prostaglandins for induction, of which 22 were Mifepristone treated (44%) & 37 Placebo treated (74%). Mifepristone treated patients had 72% vaginal delivery rate with reduced induction-delivery interval while it was 46% with placebo. Cesarean rate was 14% in those treated with Mifepristone while 42% with placebo. There was no statistical difference in instrumental delivery. There was no significant difference in intrapartum uterine contractile abnormality and fetal heart rate pattern. There was no significant difference in neonatal outcome measured by APGAR score and NICU admission. Conclusion: Mifepristone is safe & efficient in cervical ripening and initiation of labour at term with increased chance of vaginal delivery in 48hrs.In this era of high primary cesarean rates, Mifepristone provides a new milestone to enhance vaginal delivery rates with safe maternal and neonatal outcome. Theme: “Let Mifepristone unveil the curtains to a new era with drastically decreased primary cesarean rates”
Authors and Affiliations
Mahendra G
Keywords
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- EP ID EP456810
- DOI 10.21088/ijog.2321.1636.5117.9
- Views 123
- Downloads 0
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