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

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.