Publication:

Efficacy and safety of mifepristone as a sole induction agent in intrauterine fetal demise in scarred and unscarred uterus

Background Termination of pregnancy in the second and third trimester due to intrauterine fetal demise (IUFD) or lethal fetal anomalies requires safe and effective methods of induction of labour. Mifepristone, an antiprogestin, has been used for cervical ripening and labour induction. This study aimed to evaluate the efficacy and safety of mifepristone as a sole agent for induction of labour in pregnancies beyond 20 weeks of gestation in women with both scarred and unscarred uterus.

Methods This prospective clinical study was conducted in the Department of Obstetrics and Gynaecology at Shaheed Hasan Khan Mewati Government Medical College, Nalhar, Haryana over a period of one year after approval from the institutional ethics committee. A total of 54 antenatal women with gestational age >20 weeks requiring termination due to intrauterine fetal demise, lethal fetal malformation or PPROM were included. Tablet mifepristone 200 mg was administered orally at 12-hour intervals for a maximum of three doses. Patients were monitored for onset of labour and delivery. Primary outcome measured was successful vaginal delivery following induction with mifepristone alone. Secondary outcomes included induction-delivery interval, requirement of additional uterotonics and maternal complications.

Results Most patients belonged to the age group of 18–24 years (48.14%), and the majority were multiparous. Scarred uterus was present in 24.07% of cases while 75.93% had unscarred uterus. A total of 87.04% of women delivered within 72 hours of the first dose of mifepristone without the need for additional uterotonics. Additional induction methods such as misoprostol or intracervical Foley’s catheter were required in 12.96% of cases. The majority of patients (59.25%) delivered between 24–72 hours following the first dose of mifepristone. No cases of uterine rupture, scar dehiscence, retained products of conception, or requirement of caesarean section or hysterotomy were observed.

Conclusions Mifepristone is an effective and safe agent for induction of labour in pregnancies beyond 20 weeks with intrauterine fetal demise or lethal fetal anomalies in both scarred and unscarred uterus. Its use is associated with a high rate of successful vaginal delivery with minimal maternal complications.