INDUCTION OF LABOUR WITH MIFEPRISTONE AFTER INTRAUTERINE FETAL DEATH

Background: Intrauterine fetal death is means- intrapartum death after the fetus has reached the age of viability8. As in IUFD journey, labor pain will be fruitless. So, it is of utmost importance to search for the method which can reduce hours of pain in labor of IUFD cases.Metarials Methods: In this research work patients divided in two groups. Induction of labour in one group was given by combination of mifepristone and misoprostol other group by misoprostol only and we try to find out the best method. To compare the effectiveness, induction to delivery interval, safety and side effects of combination of mifepristone and misoprostol versus conventional use of misoprostol alone in induction of labour in patients with intrauterine fetal death. It is a Prospective randomized comparative study in Anwer Khan Modern Medical College Hospital and Dhaka Medical College Hospital among 70 patients with IUFD after 28 weeks of gestation during January 2014- January 2016.Result: We allowed the patients up to third gravid and after 28 weeks of gestation. Patients were grouped as Group A(35) & Group B (35). In Group A Induction was given by single oral dose of 200 mg mifepristone, and after 48 hours, tab. Misoprostol in post. fornix started if <34 weeks-100 ?gm dose and >34 weeks-50 ?gm dose. Doses were repeated every 6 hourly intervals if required. In Group B Induction was given by 100 ?gm misoprostol at 6 hourly interval in post. Fornix. In both groups we allowed misoprostol maximum 600 ?gm. Oxytocin was given for augmentation if needed. The two study groups did not differ demographically. Induction to delivery time was shorter with combined regimen group (P<0.001). Induction to delivery interval ranges from 10-12 hours in mifepristone plus misoprostole group.In only misoprostol group it was about 24-26 hours. Doses of misoprostol was lower in combined group (P<0.001). 4 patients need Oxytocin for augmentation in only misoprostol group. In combined group oxytocin was not needed. The two groups did not differ as regards complications experienced during labour and delivery significantly. In overall out come 2 failed induction in misoprostol only group but not in combinedgroup.Conclusion: In Induction of IUFD mifepriston plus misoprostol is an effective combined group. It is safe, non invasive, easily tolerable, highly cost effective, had less induction to delivery interval, required less dose of misoprostol and no need of augmentation with oxytocin. So,the combined group is more effective than conventional regimen of misoprostol alone.Anwer Khan Modern Medical College Journal Vol. 8, No. 1: Jan 2017, P 50-54

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Comparative study of mifepristone and misoprostol versus misoprostol alone in induction of labour in late intrauterine fetal death

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20180878 ◽

2018 ◽

Vol 7 (3) ◽

pp. 987

Author(s):

Hemalatha K. R. ◽

Qutejatul Kubra Mulla

Keyword(s):

Fetal Death ◽

Induction Of Labour ◽

Intrauterine Fetal Death ◽

Combination Regimen ◽

Intrauterine Death ◽

Group I ◽

Oral Misoprostol ◽

Undesirable Consequence ◽

Group Ii ◽

A Prospective Study

Background: Intrauterine fetal death is most undesirable consequence of pregnancy and stressful condition for women and family and for health professional. Naturally, majority of women (over 90%) go in for spontaneous labour and deliver within 3 weeks of intrauterine death. Prolonged retention of dead fetus in utero has complications like DIC, psychological stress and infection. Various methods are available to induce labor in intrauterine fetal death. One such regimen is medical management using a combination of Mifepristone and Misoprostol. The objective of this study was to compare efficacy and safety of combination of mifepristone and misoprostol versus misoprostol only in induction of labour in late intrauterine fetal death.Methods: A prospective study was carried out in KIMS, Hubli between Jan 2014 to Dec 2015.Data from 100 women with intrauterine fetal death between gestational age of 24-42 weeks were analysed. They were divided into 2 groups of 50 each. Group I received single oral dose of 200mg mifepristone followed 24 hours later with oral misoprostol (100µg-50µg) every 4 hourly. Group II received only misoprostol. Outcomes were measured in terms of induction to delivery interval and number of misoprostol doses required.Results: Mean induction to delivery interval in Group I was 8.3 hours versus13.4 hours in Group II. Induction delivery interval was shorter in combined regimen. Total dose of misoprostol was also less in Group I.Conclusions: Both regimens are safe for induction of labour in late intrauterine fetal death. However, the induction delivery interval and dose of misoprostol required was decreased in combination regimen.

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Abdominal pregnancy misdiagnosed as an intrauterine pregnancy: a cause of failed induction of labour for fetal death

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20193569 ◽

2019 ◽

Vol 8 (8) ◽

pp. 3382

Author(s):

Nkencho Osegi ◽

Olakunle I. Makinde ◽

Peter O. Eghaghe ◽

Zakaa Zawua ◽

Bright N. Ohaka

Keyword(s):

Maternal Mortality ◽

Preoperative Diagnosis ◽

Fetal Death ◽

Delayed Diagnosis ◽

Clinical Signs ◽

Signs And Symptoms ◽

Induction Of Labour ◽

Intrauterine Fetal Death ◽

Abdominal Pregnancy ◽

Intrauterine Pregnancy

Abdominal pregnancy is a rare form of ectopic pregnancy usually associated with fetal death among other complications, although very rare cases of live births have been reported. There is also a high risk of maternal mortality. A high index of suspicion is required to make a preoperative diagnosis as diagnosis from history, examination and ultrasound is often missed. Misdiagnoses as an intrauterine pregnancy usually occur. This misdiagnosis makes management of patients with an abdominal pregnancy a challenge and may affect treatment outcome. We managed a 35 year old pregnant multipara who was referred to us on account of repeated failed attempts at induction of labour for intrauterine fetal death. Three obstetric ultrasound scans done during the course of patient’s management reported an intrauterine dead fetus. We also failed to achieve uterine evacuation. We resorted to carry out a hysterotomy and following laparotomy, we found an abdominal pregnancy. This finding was unexpected by us, however, we delivered the dead fetus and was able to successfully manage the placenta. Discovering an abdominal pregnancy at surgery carried out for a supposed intrauterine pregnancy is usual for many cases of abdominal pregnancy. Clinicians should be aware of the clinical signs and symptoms that raise a suspicion of abdominal pregnancy as prompt preoperative diagnosis of abdominal pregnancy helps to plan and offer early and appropriate intervention. This reduces the incidence of maternal mortality usually due to massive intra-abdominal haemorrhage arising from delayed diagnosis and poor placenta management.

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Management of stillbirths: an observational analysis at a rural tertiary care centre in Kerala, India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20191222 ◽

2019 ◽

Vol 8 (4) ◽

pp. 1583

Author(s):

Ajini K. K. ◽

Reena R. P. ◽

Radha K. R.

Keyword(s):

Cesarean Section ◽

Fetal Death ◽

Tertiary Care ◽

Induction Of Labour ◽

Intrauterine Fetal Death ◽

Elective Cesarean Section ◽

Care Centre ◽

Tertiary Care Centre ◽

Elective Cesarean ◽

Previous Cesarean

Background: Stillbirth is a distressing event, both for the expecting mother and the obstetrician. Several maternal, social and circumstantial factors influence its occurrence. These women with intrauterine fetal death need to be treated in a considerate manner. Our aim was to analyse different methods of induction, management of labour and their outcomes in women with antepartum fetal demise.Methods: All women admitted to a tertiary care centre with intrauterine fetal death after 22 weeks during the study period of 24 months were recruited. Maternal sociodemographic characteristics and relevant investigations were studied. Induction of labour was achieved with mechanical and pharmacological methods. Stillborn babies, placentae and umbilical cord were examined after delivery.Results: There were 175 women with IUFD admitted during the study period. The stillbirth rate was 38.6 per1000 live births.148 women (84.57%) required induction of labour while16 women had spontaneous onset of labour. Among the 44 women with previous Cesarean section, 11 underwent elective Cesarean section. 19 women (57.6%) out of 33 cases of trial of labour after Cesarean had a successful vaginal delivery. There were 2 cases of rupture uterus and 10 women required ICU admissions. Intrauterine growth restriction was the leading cause of stillbirth (41.8%) followed by hypertensive disorders (27.7%).Conclusions: Present study has shown that vaginal birth can be achieved in most women with mechanical and pharmacological methods of induction within a reasonable period of time.

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A COMPARATIVE STUDY OF MIFEPRISTONE AND MISOPROSTOL VERSUS MISOPROSTOL ALONE IN INDUCTION OF LABOUR IN LATE INTRAUTERINE FETAL DEATH

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i2.1756 ◽

2021 ◽

Vol 5 (2) ◽

Author(s):

Shivpal Moond ◽

K.P. Banerjee ◽

Rakhi Arya

Keyword(s):

Single Dose ◽

Comparative Study ◽

Fetal Death ◽

Induction Of Labour ◽

Labour Induction ◽

Intrauterine Fetal Death ◽

P Value ◽

Group A ◽

The Mean ◽

Group B

Objective: To compare efficacy, safety and tolerance of combination of Mifepristone and Misoprostol versus Misoprostol alone in induction of labour in late intrauterine fetal death (>24 weeks). Methods: This prospectively study included 160 women with late intrauterine fetal death (IUFD) after 24 weeks of gestation and divided the women randomly into two groups each containing 80 women. In Group-A : Mifepristone 200 mg single dose was given and after 24 hrs Tab Misoprostol (intravaginally) administered and repeated 4 hourly upto a maximum of 5 doses, while in Group-B : Only Tab Misoprostol administered intravaginally 4 hourly upto maximum 5 doses. Induction-delivery interval and number of doses of Misoprostol was calculated. Results: The mean induction-delivery interval in Group-A was 13.02 ± 3.74 hours and in Group-B was 16.09 ± 2.99 hours (p-value <0.0001). Mean doses of Misoprostol required in Group-A was 3.36 ± 1.08 hours and in Group-B was 4.32 ± 0.65 hours (p-value <0.0001). Conclusion: Combination of Mifepristone and Misoprostol is more effective as comparison to Misoprostol in terms of induction-delivery interval and number of doses of misoprostol required. Keywords: IUFD, mifepristone, misoprostol, induction of labour, induction-delivery interval.

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