Publication:

Effectiveness of combined use of mifepristone and misoprostol in comparison to misoprostol alone in induction of labor in intrauterine fetal death

Background Intrauterine fetal death (IUFD) remains a significant obstetric challenge, with a global prevalence of 1-4% of pregnancies. Timely and effective induction of labor is critical to minimizing complications like coagulopathy and infection. Prostaglandins, especially misoprostol, are widely used for labor induction. This study compared the efficacy and safety of the combined regimen of mifepristone and misoprostol in comparison to misoprostol alone in IUFD management.

Methods This randomized controlled trial was conducted in the department of obstetrics and gynecology, Institute of Child and Mother Health (ICMH), Matuail, Dhaka, from October 2023 to March 2025. A total of 68 patients with intrauterine fetal death (IUFD) requiring induction of labor were enrolled.

Results The induction to labour interval was significantly shorter in group A (6.32±2.16 hours) compared to group B (16.06±5.59 hours) p=0.00. The induction-to-delivery interval was significantly shorter in group A (13.88±5.36 hours) compared to group B (26.62 ±11.86 hours, p=0.00). The mean dose of misoprostol was lower in group A (2.85±0.61) versus group B (3.97±0.30, p<0.001). Group A demonstrated fewer side effects like fever which was statistically significant (p-0.008). Other side effects like diarrhoea vomiting headache were not statistically significant. There were no statistically significant differences in the observed complication like PPH retained placenta hyperstimulation gastrointestinal symptoms in both groups. Group A also demonstrated shorter hospital stay (4.71±0.63 versus 5.21±0.77 days, p=0.005).

Conclusions Combined mifepristone and misoprostol therapy is more effective and safer than misoprostol alone for labor induction in intrauterine fetal death.