Geburtshilfe Frauenheilkd 2011; 71 - A33
DOI: 10.1055/s-0031-1292724

Mifepristone versus intracervical prostaglandin E2 gel for cervical ripening and labor induction

O Baev 1, V Rumyantseva 1
  • 1Federal State Institution “Researh Center for Obstetrics, Gynecology and Perinatology” of Ministry of Healthcare and Social Deve, Obstetrics, Moscow, Russian Federation

Objective: to compare efficiency of mifepristone and intracervical prostaglandin E2 gel for cervical ripening and labor induction.

Study design: a prospective randomised study.

Methods: One hundred and twenty three patients with the singleton term pregnancy (average gestational age 285±4 days), cephalic presentation and Bishop score ≤5 or 6–8 points. The women were randomised to receive either mifepristone 200mg orally twice (with an interval of 24 hours) or intracervical PGE2 gel (0.5mg dinoprostone) with 6 hours intervals (up to three doses) for cervical ripening and labor induction. The criteria of efficiency were ripe cervix uteri (Bishop score 9 or more), necessity of additional methods of labor preinduction, spontaneous onset of labor, active phase labor achievement.

Results:

When comparing women with Bishop score ≤5, ripe cervix more often achieved (RR-0.7; p=0.3) with fewer additional preinduction (RR-0.6; p=0.1) in the mifepristone group. Mifepristone was associated with spontaneous onset of labor in 46.7%, intracervical PGE2 –50% cases. PGE2 gel preinduction was associated with an increasing frequency of uterine contractility abnormalities compared to mifepristone (RR-3.5; p=0.05; 95% CI 1.4–8.5).

Women with initial Bishop score 6–8 points more likely had a ripe cervix (RR-1.3; p=0.02, 95% CI 1.04–1.7) after mifepristone in comparison with PGE2 gel. Nulliparous women significantly more often had spontaneous onset of labor after mifepristone preinduction (RR-1.5, p=0.05, 95% CI 1.1–2.1). We found no difference in spontaneous onset of labor between parous women in mifepriston and PGE2 gel groups (RR=1). Mifepristone was associated with a higher frequency of the active phase labor achievement compared to PGE2 gel (RR-1.3; p=0.04, 95% CI1.1–1.76).

Conclusion: 1. Mifepristone is more efficient for labor preinduction/induction than intracervical PGE2 gel in pregnant women with Bishop score ≤5 and nulliparous. 2. Mifepristone and intracervical PGE2 gel are equally effective for labor preinduction/induction in parous with Bishop score 6–8 points.