title: Induction of Labor Using Misoprostol With or Without Mifepristone in Intrauterine Death.
abstract: BACKGROUND
  Rapid expulsion of fetus in intrauterine fetal death is usually requested without any medical grounds for it. So an efficient, safe method for induction of labor is required. The objective of this study is to determine if pre-treatment with mifepristone followed by induction of labor with misoprostol in late intrauterine fetal death is more efficacious.
  
  
  METHODS
  We conducted a randomized controlled trial in 100 patients in B.P.Koirala Institute of Health Sciences, Nepal from June 2011 to May 2013. Group A women received single oral dose of 200 mg mifepristone, followed by induction with vaginal misoprostol after 24 hours. Group B women were induced only with vaginal misoprostol. In each group, five doses of misoprostol was used four hourly. If first cycle was unsuccessful, after break of 12 hour, second course of misoprostol was started. The primary outcome was a measure of induction to delivery time and vaginal delivery within 24 hours. Secondary outcome was to measure need of oxytocin and complications.
  
  
  RESULTS
  Maternal age, parity and period of gestation were comparable between groups. Number of misoprostol dose needed in group A was significantly less than group B. Mann Whitney U test showed, women in group A had significantly earlier onset of labor, however total induction to delivery interval was not significant. In group A, 85.7% delivered within 24 hours of first dose of misoprostol while in group B 70% delivered within 24 hours (p=0.07). More women in Group B required oxytocin.
  
  
  CONCLUSIONS
  Pretreatment with mifepristone before induction of labor following late intrauterine fetal death is an effective and safe regimen. It appears to shorten the duration of induction to onset of labor.
authors.affiliation: B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
authors.forename: A
authors.initials: A
authors.lastname: Agrawal
authors.affiliation: B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
authors.forename: P
authors.initials: P
authors.lastname: Basnet
authors.affiliation: B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
authors.forename: A
authors.initials: A
authors.lastname: Thakur
authors.affiliation: B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
authors.forename: P
authors.initials: P
authors.lastname: Rizal
authors.affiliation: B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
authors.forename: R
authors.initials: R
authors.lastname: Rai
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage*; D000021:Abortifacient Agents, Steroidal / Q000008:administration & dosage*; D000328:Adult; D005260:Female; D005313:Fetal Death; D006801:Humans; D007751:Labor, Induced / Q000379:methods*; D015735:Mifepristone / Q000008:administration & dosage*; D016595:Misoprostol / Q000008:administration & dosage*; D011247:Pregnancy; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D000021:Abortifacient Agents, Steroidal; D016595:Misoprostol; D015735:Mifepristone
keywords: induction of labor; intrauterine fetal death; mifepristone; misoprostol.