Misoprostol-only versus mifepristone plus misoprostol in induction of labor following intrauterine fetal death

Background. Both misoprostol-alone and a combination of mifepristone plus misoprostol have been used in induction of labor in cases of intrauterine fetal death (IUFD). Methods. Data from 130 women with IUFD at 21-42 weeks of gestation were analysed retrospectively. A total of 82 women received 100 mu g (median) of misoprostol at 4-h intervals. Some 48 women received 200 mg of mifepristone, followed 19 h (median) later by single doses of 25 mu g of misoprostol at 4-h intervals. Results. The induction-to-delivery time did not differ between the groups (13.3 versus 12.8 h). However, between 21 and 25 weeks of gestation, the induction-to-delivery time was shorter with the combination regimen (p = 0.04). The total dose of misoprostol needed was lower in the group pre-treated with mifepristone (p = 0.0028). The 2 groups did not differ as regards complications experienced during labor and delivery. Conclusions. Both regimens, misoprostol-only and the combination of mifepristone and misoprostol, are effective and safe in induction of labor after IUFD. Pre-treatment with mifepristone is more effective at earlier gestational weeks.