Induction of labor with mifepristone (RU 486) in intrauterine fetal death

In a double-blind controlled multicentric study involving 94 patients with an intrauterine fetal death, we investigated the efficacy and tolerance of mifepristone (RU 486), a steroid compound that antagonizes progesterone action at the receptor level. Success of treatment was defined as the occurrence of fetal expulsion within 72 hours after the first drug intake. Mifepristone treatment (600 mg per day for 2 days) was considered to be effective in 29 of 46 patients (63%). There were only eight successes in 48 patients (17.4%) in the placebo group (p = 0.001, chi 2 test). Tolerance was good in the mifepristone group. In the placebo group, disseminated intravascular coagulation occurred in one woman for whom the investigator waited several weeks for spontaneous expulsion. This large double-blind controlled study provides evidence that mifepristone is of interest in the management of intrauterine fetal death. It could provide a pharmacologic alternative to the use of prostaglandins in this indication.