Journal of South Asian Federation of Obstetrics and Gynaecology

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Volume  16 (2024)
Volume  15 (2023)
Volume  14 (2022)
Volume  13 (2021)
Volume  12 (2020)
Volume  11 (2019)
Volume  10 (2018)
Volume  9 (2017)
Volume  8 (2016)
Volume  7 (2015)
Volume  6 (2014)
Volume  5 (2013)
Volume  4 (2012)
Volume  3 (2011)
Volume  2 (2010)
Volume  1 (2009)
Related articles

VOLUME 16 , ISSUE 6 ( November-December, 2024 ) > List of Articles

RESEARCH ARTICLE

Mifepristone for Termination of Intrauterine Fetal Death

Fahmida Rashid, Utpala Mazumder, Shoyela Shahnaz, Mortuza Begum, Afroza Bilkis, Hosne A Begum, Samira A Chowdhury, Zenifar Sharmin, Farid U Ahmed, MA Sattar

Keywords : Induction of labor, Intrauterine fetal death, Mifepristone

Citation Information : Rashid F, Mazumder U, Shahnaz S, Begum M, Bilkis A, Begum HA, Chowdhury SA, Sharmin Z, Ahmed FU, Sattar M. Mifepristone for Termination of Intrauterine Fetal Death. J South Asian Feder Obs Gynae 2024; 16 (6):662-667.

DOI: 10.5005/jp-journals-10006-2520

License: CC BY-NC 4.0

Published Online: 19-11-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Aim: Various medical methods are available to manage intrauterine fetal death (IUFD). The current study aimed to evaluate the effectiveness of mifepristone as a termination method for IUFD. Methods: This prospective observational study included 128 patients with IUFD from the Department of Obstetrics and Gynecology, Chattogram Medical College Hospital (CMCH), Bangladesh, from January 2021 to June 2021. The primary induction method was Mifepristone 200 mg for 8 hours of six doses. Outcome measures included successful vaginal delivery within 72 hours of the onset of induction, maternal complications, and mifepristone's side effects. Results: More than half of the women (52.3%) were 20–29 years. Around 56.3% of the participants were multigravida, and 40.6% were gestational age 24–32 weeks. Ten women (7.8%) reported a previous history of uterine surgery. Mifepristone successfully induced labor as a primary method in 89 (69.5%) cases. In the other cases, secondary induction methods (misoprostol – 18.8%; oxytocin – 10.9%) were needed. Successful delivery within 72 hours was met in 61.7% of cases, and in 35.2% of cases, vaginal delivery occurred after 72 hours of induction. A psychological upset was the most frequent (21.9%) maternal complication, followed by fever (8.6%) and the need for blood transfusion (7.8%). Conclusion: Mifepristone is very effective and safe in the termination of IUFD. However, few cases need augmentation with oxytocin and/or misoprostol.

PDF Share
  1. Belkin T, Wilder J. Management options for women with midtrimester fetal loss: A case report. J Midwifery Women Health 2007;52(2):164–167. DOI: 10.1016/j.jmwh.2006.08.015.
  2. Roy RR, Mukhopadhyay A, Mukherjee K. Unexplained stillbirth. In: Mukherjee CG, Chakravarty S, Pal B, editors. Current Obstetrics and Gynaecology, 1st ed. New Delhi: Jaypee Publishers; 2007, pp. 147–145.
  3. Lahra MM, Gordon A, Jeffery HE. Chorioamnionitis and fetal response in still birth. Am J Obstet Gynecol 2007;196(3):229–232. DOI: 10.1016/j.ajog.2006.10.900.
  4. Gomez Ponce de León R, Wing D, Fiala C. Misoprostol for intrauterine fetal death. Int J Gynecol Obstet 2007;99(Suppl 2):S190–S193. DOI: 10.1016/j.ijgo.2007.09.010.
  5. Confidential Enquiry into Maternal and Child Health (CEMACH). Perinatal Mortality 2007: United Kingdom. CEMACH: London, 2009. Available at: http://www.cmace.org.uk/getattachment/1d2c0ebcd2aa-4131-98ed-56bf8269e529/PerinatalMortality2007.aspx.
  6. Lawn JE, Blencowe H, Waiswa P, et al. Stillbirths: Rates, risk factors, and acceleration towards 2030. Lancet 2016;387(10018):587–603. DOI: 10.1016/S0140-6736(15)00837-5.
  7. Parasnis H, Raje B, Hinduja IN. Relevance of plasma fibrinogen estimation in obstetric complications. J Postgrad Med 1992;38(4):183–185. PMID: 1307590.
  8. Fletcher HM, Wharfe G, Simeon D, et al. Introduction of labour with intravaginal misoprostol versus dinoprostone in intrauterine death: A retrospective study. J Obstet Gynecol 1996;16(3):155–158. DOI: 10.3109/01443619609004091.
  9. Silver RM. Fetal death. Obstet Gynecol 2007;109(1):153–167. DOI: 10.1097/01.AOG.0000248537.89739.96.
  10. Rådestad I, Steineck G, Nordin C, et al. Psychological complications after stillbirth – influence of memories and immediate management: Population-based study. BMJ 1996;312(7045):1505–1508. DOI: 10.1136/bmj.312.7045.1505.
  11. Tempfer CB, Brunner A, Bentz EK, et al. Intrauterine fetal death and delivery complications associated with coagulopathy: A retrospective analysis of 104 cases. J Womens Health 2009;18(4):469–4674. DOI: 10.1089/jwh.2008.0938.
  12. Gomez Ponce de León R, Wing DA. Misoprostol for termination of pregnancy with intra-uterine fetal demise in the second and third trimester of pregnancy – A systematic review. Contraception 2009;79(4):259–271. DOI: 10.1016/j.contraception.2008.10.009.
  13. Gawron LM, Kiley JW. Labor induction outcomes in third-trimester stillbirths. Int J Gynaecol Obstet 2013;123(3):203–206. DOI: 10.1016/j.ijgo.2013.06.023.
  14. Teutsch G, Philibert D. History and perspectives of antiprogestins from the chemist's point of view. Hum Reprod 1994;9 Suppl 1:12–31. DOI: 10.1093/humrep/9.suppl_1.12.
  15. Bygdeman M, Swahn ML. Progesterone receptor blockage, effect on uterine contractility and early pregnancy. Contraception 1985;32(1):45–51. DOI: 10.1016/0010-7824(85)90115-5.
  16. Heikinheimo O. Clinical pharmacokinetics of mifepristone. Clin Pharmacokinet 1997;33(1):7–17. DOI: 10.2165/00003088-199733010-00002.
  17. WHO Scientific Group. WHO Technical Report Series. WHO. Vol. 871, Geneva: WHO, 1997.
  18. United Kingdom Multicentre Trial. The efficacy and tolerance of mifepristone and prostaglandin in first-trimester termination of pregnancy. Br J Obstet Gynaecol 1990;97(6):480–486. DOI: 10.1111/j.1471-0528.1990.tb02516.x.
  19. Skjoldebrand-Spare L, Toljvenstam T, Papadogiannakis N, et al. Parvovirus B19 infection association with third-trimester intrauterine foetal death. BJOG 2000;107(4):476–480. DOI: 10.1111/j.1471-0528.2000.tb13265.x.
  20. Ranganath S, Shankaregowda HS. Medical Management of Late Intrauterine Death Using a Combination of Mifepristone and Misoprostol [MS thesis]. Bangalore: The Rajiv Gandhi University of Health Sciences; 2006.
  21. WHO | Safe abortion: Technical and policy guidance for health systems [Internet]. WHO. [cited 2014 Sep 16]. Available from: http://www.who.int/reproductivehealth/publications/unsafe_abortion/9789241548434/en/.
  22. Sharma D, Singhal SR, Poonam, et al. Comparison of mifepristone combination with misoprostol and misoprostol alone in the management of intrauterine death: Condensation – Misoprostol and mifepristone combination is more effective than misoprostol alone in the management of intrauterine death. Taiwan J Obstet Gynecol 2011;50(3):322–325. DOI: 10.1016/j.tjog.2011.07.007.
  23. Jannet D, Aflak N, Abankwa A, et al. Termination of 2nd and 3rd-trimester pregnancies with mifepristone and misoprostol. Eur J Obstet Gynecol Reprod Biol 1996;70(2):159–163. DOI: 10.1016/s0301-2115(95)02593-6.
  24. Wagaarachchi PT, Ashok PW, Narvekar NN, et al. Medical management of late intrauterine death using a combination of mifepristone and misoprostol. BJOG 2002;109(4):443–447. DOI: 10.1111/j.1471-0528.2002.01238.x.
  25. Fairley TE, Mackenzie M, Owen P, et al. Management of late intrauterine death using a combination of mifepristone and misoprostol—the experience of two regimens. Eur J Obstet Gynecol Reprod Biol 2005;118(1):28–31. DOI: 10.1016/j.ejogrb.2004. 04.001.
  26. Nzewi C, Arakliti G, Narvekar N. The use of mifepristone and misoprostol in the management of late intrauterine fetal death. Obstetrician and Gynaecologist 2014;16(4):233–238. DOI: 10.1111/tog.12145.
  27. Royal College of Obstetricians and Gynaecologists (RCOG). Late intrauterine fetal death and stillbirth. London (UK): Royal College of Obstetricians and Gynaecologists (RCOG); 2010. p. 33. (Green-top guideline; no. 55).
  28. Cabrol D, Bouvier D'Yvoire M, Mermet E, et al. Induction of labor with mifepristone (RU 486) after intrauterine fetal death. Lancet 1985;2(8462):1019. DOI: 10.1016/s0140-6736(85)90575-6.
  29. Cabrol D, Dubois C, Cronje H, et al. Induction of labor with mifepristone (RU 486) in intrauterine fetal death. Am J Obstet Gynecol 1990;163(2):540–542. DOI: 10.1016/0002-9378(90)91193-g.
  30. Ahuja N, Dahiya P. A comparative study of mifepristone alone versus mifepristone and misoprostol for induction of labor in intrauterine fetal death. Indian J Obstet Gynecol Res 2016;3(4):348–351. Available from: https://www.ijogr.org/article-details/3111.
  31. Panda S, Jha V, Singh S. Role of combination of mifepristone and misoprostol verses misoprostol alone in induction of labour in late intrauterin fetal death: A prospective study. J Family Reprod Health 2013;7(4):177–179. PMID: 24971122.
  32. Mandade K, Bangal VB. A prospective comparative study to evaluate the efficacy and safety of mifepristone with misoprostol over misoprostol alone in induction of labour. Int J Reprod Contracept Obstet Gynecol 2016;5(12):4321–4328. DOI: 10.18203/2320-1770.ijrcog20164336.
  33. Arora R, Patel PB, Dabral A, et al. Use of Mifepristone for termination of intrauterine fetal demise (IUFD) in previously scarred uterus in later half of pregnancy (>20 weeks). Int J Reprod Contracept Obstet Gynecol 2018;7(7):2668–2671. DOI: 10.18203/2320-1770.ijrcog20182750.
  34. Chaudhuri P, Datta S. Mifepristone and misoprostol compared with misoprostol alone for induction of labor in intrauterine fetal death: A randomized trial. J Obstet Gynaecol Res 2015;41(12):1884–1890. DOI: 10.1111/jog.12815.
  35. Padayachi T, Moodley J, Norman RJ. Termination of pregnancy with mifepristone after intrauterine fetal death. S Afr Med J 1989;75(11):540–542. PMID: 2658142.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.