Medical management of late intrauterine death using a combination of mifepristone and misoprostol

Prabhath Thanuja Wagaarachchi, Premila Wencesiaus Ashok, N. N. Narvekar, Norman Smith, Alexander Allan Templeton

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

Objective To assess the efficacy and safety of mifepristone in combination with misoprostol in the management of late fetal death.

Design Observational study.

Setting Aberdeen Maternity Hospital, Aberdeen.

Methods A consecutive series of 96 women with intrauterine death after 24 weeks of gestation were studied. Each woman received a single dose of 200mg mifepristone orally, following which a 24-48 hour interval was recommended before administration of misoprostol. For gestations of 24-34 weeks, 200mug of intravaginal misoprostol was administered, followed by four oral doses of 200mug at three hourly intervals. Gestations over 34 weeks were given a similar regimen but a reduced dose of 100mug misoprostol.

Results The average induction to delivery interval was 8.5 hours. Ninety-five women (98.9%) were delivered within 72 hours of administration of first dose of misoprostol, with 66.7%, 87.5%, 92.7% and 95.8% women delivering within 12, 24, 36 and 48 hours, respectively. No significant correlation was found between mean induction to delivery interval and maternal age, parity, Bishop's score, birthweight and mifepristone/ misoprostol interval. The induction to delivery interval was shorter with increasing gestation (P = 0.04). Mild side effects were noted in eight (8.3%) women. Three (3.1%) women had treatment for presumed or proven pelvic sepsis. No cases of uterine tachysystole, haemorrhage or coagulopathy were recorded.

Conclusion The combination of mifepristone and misoprostol for induction of labour following late fetal death is an effective and safe regimen. The induction to delivery interval with this regimen appears shorter than studies using mifepristone or misoprostol.

Original languageEnglish
Pages (from-to)443-447
Number of pages4
JournalBJOG-An International Journal of Obstetrics and Gynaecology
Volume109
Issue number4
DOIs
Publication statusPublished - 2002

Keywords

  • FETAL DEATH
  • VAGINAL MISOPROSTOL
  • MANUAL REMOVAL
  • INDUCTION
  • LABOR
  • ABORTION
  • EVACUATION
  • PLACENTA
  • RU-486

Cite this

Medical management of late intrauterine death using a combination of mifepristone and misoprostol. / Wagaarachchi, Prabhath Thanuja; Ashok, Premila Wencesiaus; Narvekar, N. N.; Smith, Norman; Templeton, Alexander Allan.

In: BJOG-An International Journal of Obstetrics and Gynaecology, Vol. 109, No. 4, 2002, p. 443-447.

Research output: Contribution to journalArticle

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abstract = "Objective To assess the efficacy and safety of mifepristone in combination with misoprostol in the management of late fetal death.Design Observational study.Setting Aberdeen Maternity Hospital, Aberdeen.Methods A consecutive series of 96 women with intrauterine death after 24 weeks of gestation were studied. Each woman received a single dose of 200mg mifepristone orally, following which a 24-48 hour interval was recommended before administration of misoprostol. For gestations of 24-34 weeks, 200mug of intravaginal misoprostol was administered, followed by four oral doses of 200mug at three hourly intervals. Gestations over 34 weeks were given a similar regimen but a reduced dose of 100mug misoprostol.Results The average induction to delivery interval was 8.5 hours. Ninety-five women (98.9{\%}) were delivered within 72 hours of administration of first dose of misoprostol, with 66.7{\%}, 87.5{\%}, 92.7{\%} and 95.8{\%} women delivering within 12, 24, 36 and 48 hours, respectively. No significant correlation was found between mean induction to delivery interval and maternal age, parity, Bishop's score, birthweight and mifepristone/ misoprostol interval. The induction to delivery interval was shorter with increasing gestation (P = 0.04). Mild side effects were noted in eight (8.3{\%}) women. Three (3.1{\%}) women had treatment for presumed or proven pelvic sepsis. No cases of uterine tachysystole, haemorrhage or coagulopathy were recorded.Conclusion The combination of mifepristone and misoprostol for induction of labour following late fetal death is an effective and safe regimen. The induction to delivery interval with this regimen appears shorter than studies using mifepristone or misoprostol.",
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T1 - Medical management of late intrauterine death using a combination of mifepristone and misoprostol

AU - Wagaarachchi, Prabhath Thanuja

AU - Ashok, Premila Wencesiaus

AU - Narvekar, N. N.

AU - Smith, Norman

AU - Templeton, Alexander Allan

PY - 2002

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N2 - Objective To assess the efficacy and safety of mifepristone in combination with misoprostol in the management of late fetal death.Design Observational study.Setting Aberdeen Maternity Hospital, Aberdeen.Methods A consecutive series of 96 women with intrauterine death after 24 weeks of gestation were studied. Each woman received a single dose of 200mg mifepristone orally, following which a 24-48 hour interval was recommended before administration of misoprostol. For gestations of 24-34 weeks, 200mug of intravaginal misoprostol was administered, followed by four oral doses of 200mug at three hourly intervals. Gestations over 34 weeks were given a similar regimen but a reduced dose of 100mug misoprostol.Results The average induction to delivery interval was 8.5 hours. Ninety-five women (98.9%) were delivered within 72 hours of administration of first dose of misoprostol, with 66.7%, 87.5%, 92.7% and 95.8% women delivering within 12, 24, 36 and 48 hours, respectively. No significant correlation was found between mean induction to delivery interval and maternal age, parity, Bishop's score, birthweight and mifepristone/ misoprostol interval. The induction to delivery interval was shorter with increasing gestation (P = 0.04). Mild side effects were noted in eight (8.3%) women. Three (3.1%) women had treatment for presumed or proven pelvic sepsis. No cases of uterine tachysystole, haemorrhage or coagulopathy were recorded.Conclusion The combination of mifepristone and misoprostol for induction of labour following late fetal death is an effective and safe regimen. The induction to delivery interval with this regimen appears shorter than studies using mifepristone or misoprostol.

AB - Objective To assess the efficacy and safety of mifepristone in combination with misoprostol in the management of late fetal death.Design Observational study.Setting Aberdeen Maternity Hospital, Aberdeen.Methods A consecutive series of 96 women with intrauterine death after 24 weeks of gestation were studied. Each woman received a single dose of 200mg mifepristone orally, following which a 24-48 hour interval was recommended before administration of misoprostol. For gestations of 24-34 weeks, 200mug of intravaginal misoprostol was administered, followed by four oral doses of 200mug at three hourly intervals. Gestations over 34 weeks were given a similar regimen but a reduced dose of 100mug misoprostol.Results The average induction to delivery interval was 8.5 hours. Ninety-five women (98.9%) were delivered within 72 hours of administration of first dose of misoprostol, with 66.7%, 87.5%, 92.7% and 95.8% women delivering within 12, 24, 36 and 48 hours, respectively. No significant correlation was found between mean induction to delivery interval and maternal age, parity, Bishop's score, birthweight and mifepristone/ misoprostol interval. The induction to delivery interval was shorter with increasing gestation (P = 0.04). Mild side effects were noted in eight (8.3%) women. Three (3.1%) women had treatment for presumed or proven pelvic sepsis. No cases of uterine tachysystole, haemorrhage or coagulopathy were recorded.Conclusion The combination of mifepristone and misoprostol for induction of labour following late fetal death is an effective and safe regimen. The induction to delivery interval with this regimen appears shorter than studies using mifepristone or misoprostol.

KW - FETAL DEATH

KW - VAGINAL MISOPROSTOL

KW - MANUAL REMOVAL

KW - INDUCTION

KW - LABOR

KW - ABORTION

KW - EVACUATION

KW - PLACENTA

KW - RU-486

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DO - 10.1111/j.1471-0528.2002.01238.x

M3 - Article

VL - 109

SP - 443

EP - 447

JO - BJOG-An International Journal of Obstetrics and Gynaecology

JF - BJOG-An International Journal of Obstetrics and Gynaecology

SN - 1470-0328

IS - 4

ER -