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Mifepristone for preinduction cervical ripening beyond 41 weeks' gestation: a randomized controlled trial
D A Wing1, M J Fassett, D R Mishell
1Department of Obstetrics-Gynecology, Division of Maternal-Fetal Medicine, Women's & Children's Hospital, Keck School of Medicine of the University of Southern California, Los Angeles, California 90033, dwing@hsc.usc.edu
Obstetrics and Gynecology
|September 27, 2000
Summary
Mifepristone modestly improved cervical ripening for labor induction in prolonged pregnancies, reducing the need for misoprostol and oxytocin. This study found a shorter induction-to-delivery interval and fewer cesarean births in the mifepristone group.
Area of Science:
- Obstetrics and Gynecology
- Reproductive Medicine
- Maternal-Fetal Medicine
Background:
- Prolonged pregnancies (beyond 41 weeks) often require labor induction.
- Cervical ripening is a critical step for successful labor induction.
- Current methods for cervical ripening may have limitations.
Purpose of the Study:
- To evaluate the efficacy of mifepristone in promoting cervical ripening prior to labor induction.
- To compare the outcomes of mifepristone versus placebo in women with prolonged pregnancies and unfavorable cervical conditions.
Main Methods:
- A randomized controlled trial involving 180 women with pregnancies >41 weeks and unfavorable cervices.
- Participants received either mifepristone (200 mg) or placebo, followed by observation for 24 hours.
- Subsequent labor induction utilized intravaginal misoprostol or intravenous oxytocin.
Main Results:
- Mifepristone treatment resulted in a significantly shorter mean induction-to-delivery interval (2209 vs. 2671 minutes; P <.001).
- Higher rates of vaginal delivery within 48 hours were observed with mifepristone (87.5% vs. 70.8%; P =.01), with fewer cesarean deliveries (9 vs. 18; P =.02).
- Mifepristone use was associated with a reduced need for misoprostol (P =.06) and significantly lower oxytocin dosage (P =.02).
Conclusions:
- Mifepristone demonstrates a modest but significant effect on cervical ripening when administered 24 hours before labor induction.
- It appears to reduce the requirement for pharmacologic agents like misoprostol and oxytocin.
- While associated with some adverse events like nonreassuring fetal heart rate patterns, mifepristone did not negatively impact neonatal outcomes.