Comparative analysis of safety, efficacy and feto maternal outcome with induction of labour in term live pregnancy with oral mifepristone and intracervical dinoprostone gel

Introduction: The rapid increase in cesarean birth rates from 1996 to 2011 in US without clear evidence of concomitant decreases in maternal or neonatal morbidity or mortality raises significant concern that cesarean delivery is overused. Increasing women’s access to nonmedical interventions during labor, such as continuous labor and delivery support, also has been shown to reduce cesarean birth rates. Several examples of interventions that can contribute to the safe lowering of the primary cesarean delivery rate is by induction of labour by various modes where indicated. In the present study focused on medical method of induction of labour where potential risk of continuing pregnancy is more than terminating. Materials and methods: This study is a parallel group open labeled randomized control trial conducted in the Institute of post graduate medical education and Seth Sukhlal Karnani Memorial Hospital (SSKM), a tertiary care hospital in West Bengal for a period of 1 year and 6 months from April 2016 to October 2017 in the department of obstetrics and gynaecology. During the study period a total of 90 pregnant women, 45 women in mifepristone group and 45 in the dinoprostone group, scheduled for induction of labour. Safety, efficacy and fetomaternal outcome of both the drugs were compared in the study population. Results: The following observations were made: Baseline characteristics like Parity, obesity were comparable in both the groups. Multigravida women had successful induction and vaginal delivery more than primigravida, obese women had less successful induction and vaginal delivery than nonobese with both mifepristone and dinoprostone. Successful induction of labour and postinduction improvement of bishop’s score were more with mifepristone group than dinoprostone (p value=0.0038). Requirement of augmentation with oxytocics were more in the dinoprostone group than mifepristone (p value =0.0567). Uterine hyper stimulation during the period of induction noted in dinoprostone group is more than mifepristone (p value= 0.0112)Vaginal deliveries were more with mifepristone and less with dinoprostone whereas caeserian section rates were more in dinoprostone group than the mifepristone group (p value=0.020). Fetal outcomes were observed with 2 variables NICU admission and APGAR score at 5 minutes after birth which showed that less NICU admission and good APGAR score is noted with mifepristone than dinoprostone group. Discussion and conclusion: Main advantage of mifepristone is that it can be given on outpatient basis and the patient is asked to report after 24hrs or with onset of labour whichever is earlier provided that the patients were thoroughly explained about the outcomes. Whereas with dinoprostone, patient must be hospitalized on induction with first gel of dinoprostone itself. Thus the total duration of hospital stay in mifepristone group is much lesser than in dinoprostone group.