Mifepristone as cervical ripening agent for Labour induction in women with Previous one Caesarean Section
Abstract
Background and Objective: Induction of labour is a common obstetric intervention. Women with a prior caesarean delivery have an increased risk of uterine rupture particularly when labour is induced. In women with previous one caesarean section, it is unclear which method of cervical ripening and labour induction is preferable. With this background current study was done to evaluate the efficacy and safety of mifepristone in women undergoing induction of labour at term after previous caesarean section.
Material and Method: A total of 50 women who had a previous caesarean delivery with a low transverse uterine incision at 37-42 wk of gestation, having clear clinical indication for induction of labour with unfavorable cervical condition (Bishop’s score<5) were taken into the study. All women who meet the inclusion criteria received Tab Mifepristone 200 mg orally which was repeated after 24 hr. Reassessment of Bishop score was done after 48 hrs of first dose, and patient allowed to go into spontaneous labour. Labour was augmented with oxytocin infusion and/or ARM according to the progress of labour.
Results: In our study mean pre induction Bishop’s score was 2.34±0.84 and mean post induction Bishop’s score was 8.24±1.65.In 35(70%) women labour was augmented with oxytocin and /or ARM, whereas 7(14%) women entered into spontaneous active labour and did not required any augmentation. In our study 42(84%) women delivered vaginally, only 8(16%) women had repeat caesarean section. No case of scar dehiscence or uterine rupture was seen.
Conclusion: Mifepristone is a safe, efficient and suitable agent for cervical ripening and for initiation of labor when given 48hr before labour induction.
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References
2. Newhall EP, Winikoff B. Abortion with mifepristone and misoprostol: regimens, efficacy, acceptability and future directions. Am J Obstet Gynecol. 2000 Aug;183(2 Suppl):S44-53. [PubMed]
3. Clark K, Ji H, Feltovich H, Janowski J, Carroll C, Chien EK. Mifepristone-induced cervical ripening: structural, biomechanical, and molecular events. American Journal of Obstetrics&Gynecology. 2006 May; 194(5):1391-8. Epub 2006 Apr 21. Doi: 10.1016/j.ajog.2005.11.026.
4. Grobman WA, Gilbert S, Landon MB, Spongy CY,Levono KJ, Rouse DJ, Varner MW, Moawad AH, Caritis SN, Harper M, Wapner RJ, Sorokin Y, MiodovnikM, Carpenter M, O’Sullivan MJ,Sibai BM, Langer O, Throp JM, Ramin SM, Mercer BM. Outcomes of induction of labour after one prior caesarean. Obstet Gynecol. 2007 February; 109(2 Pt 1): 262-269.doi: 10. 1097/01.AOG.0000254169.49346. e9. [PubMed]
5. Wagaarachchi PT, Ashok PW, Narvekar NN, Smith NC, Templeton A. Medical management of late intrauterine death using a combination of mifepristone and misoprostol. BJOG. 2002 Apr;109(4):443-7. [PubMed]
6. Frydman R, Lelaider C, Baton-Saint-Mleux C, Fernandez H, Vial M, Bourget P. Labour induction in women at term with mifepristone(RU 486): a double-blind, randomized, placebo-controlled study. Obstetrics&Gynecology. 1992 Dec 1;80(6):972-5. [PubMed]
7. Palatnik A, Grobman WA. Induction of labor versus expectant management for women with a prior cesarean delivery. Am J Obstet Gynecol. 2015 Mar;212(3):358.e1-6. doi: 10.1016/j.ajog.2015.01.026. [PubMed]
8. Lelaidier C, Baton C, Benifla JL, Fernandez H, Bourget P, Frydman R. Mifepristone for labour induction after previous caesarean section. Br J Obstet Gynaecol. 1994 Jun;101(6):501-3.
9. Kwee A, Bots ML, Visser GH, Bruinse HW. Emergency Peripartum hysterectomy: a prospective study in The Netherlands. European Journal of Obstetrics& Gynecology and reproductive biology. 2006 Feb 1;124(2):187-92.
10. Silver RM, Landon MB, Rouse DJ, Leveno KJ, Spong CY, Thom EA, Moawad AH, Caritis SN, Harper M, Wapner RJ, Sorokin Y, Miodovnik M, Carpenter M, Peaceman AM, O'Sullivan MJ, Sibai B, Langer O, Thorp JM, Ramin SM, Mercer BM; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol. 2006 Jun;107(6):1226-32.
11. Kwee A, Bots ML, Visser GH, Bruinse HW. Obstetric management and outcome of pregnancy in women with a history of caesarean section in the Netherlands. Eur J Obstet Gynecol Reprod Biol. 2007 Jun;132(2):171-6. Epub 2006 Aug 14. [PubMed]
12. Zwart JJ, Richters JM, Ory F, de Vries JI, Bloemenkamp KW, van Roosmalen J. Uterine rupture in The Netherlands: a nationwide population-based cohort study. BJOG. 2009 Jul;116(8):1069-78; discussion 1078-80. doi: 10.1111/j.1471-0528.2009.02136.x. [PubMed]
13. Landon MB, Hauth JC, Leveno KJ, Spong CY, Leindecker S, Varner MW, Moawad AH, Caritis SN, Harper M, Wapner RJ, Sorokin Y, Miodovnik M, Carpenter M, Peaceman AM, O'Sullivan MJ, Sibai B, Langer O, Thorp JM, Ramin SM, Mercer BM, Gabbe SG; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. N Engl J Med. 2004 Dec 16;351(25):2581-9. Epub 2004 Dec 14.
14. Lydon-Rochelle M, Holt VL, Easterling TR, Martin DP. Risk of uterine rupture during labor among women with a prior cesarean delivery.N Engl J Med. 2001 Jul 5;345(1):3-8. [PubMed]
15. Mozurkewich EL, Hutton EK. Elective repeat cesarean delivery versus trial of labor: a meta-analysis of the literature from 1989 to 1999. Am J Obstet Gynecol. 2000 Nov;183(5):1187-97.
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