Modern approaches to the pre-induction cervical ripening of mifepristone

О. В. Кравченко

Abstract


The article deals modern approaches used of mifepristone in order to prepare the cervix for delivery. The results of a study of 222 patients in the gestation period of 37–42 gestation weeks which given orally administered 200 mg of mifepristone at intervals of 24 hours for 2 days are presented.

The criteria for inclusion in the study: the age of the pregnant 18–40 years, the independent onset of pregnancy, singleton pregnancy, head presentation, the presence of intact fetal membranes; absence of contraindications to the use of mifepristone. Before the preparation of the cervix for delivery, an assessment was made of the condition of the mother and fetus, which included clinical examinations and cardiotocography before pre-induction, as well as cardiotocography control in dynamics.

Before receiving mifepristone, the cervix was evaluated as “immature” in 60.3% of pregnant women, in 39.6% of patients it was “not mature enough”. After taking the first pill of mifepristone, 44.6% of pregnant women against the background of the already “mature” cervix of the uterus developed an independent labor activity. Development of labor activity occurred in 32.3% of pregnant women within 12 hours after taking the drug, in 26.3% in the interval from 12 to 24 hours, in 46.5% – later than in 24 hours. The remaining 55.4% of patients needed the appointment of a second tablet of mifepristone, after which the cervix became “mature” in 69.1% of patients, of which 90.6% of women developed independent labor.

As a result of the research it was proved that the use of mifepristone is a highly effective method of preparing the body for pregnant women to delivery, the efficiency of labor is 79.3%. Pre-induction of mifepristone for more than 41 weeks is less effective in relation to cervical maturation and the development of regular birth activity, which makes it possible to characterize the gestational period of 40–41 weeks, as optimal for the cervical effacement and the induction of labor. The use of mifepristone does not lead to a negative effect of the fetal condition.


Keywords


pregnancy; pre-induction preparation; efficacy factors; mifepristone

References


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Bodner-Adler, B., Bodner, K., Pateisky, N., et al. “Influence of labor induction on obstetric outcomes in patients with prolonged pregnancy: a comparison between elective labor induction and spontaneous onset of labor beyond term.” Wien Klin Wschr 117.7–8 (2005): 287–92.

Jiang, X., Wang, H., Zhang, Z. “Determination of fetal umbilical artery flow velocity during induction of term labor by mifepristone.” Zhonghua Fu Chan Ke Za Zhi 32.12 (1997): 732–4.

Miao, M.H., Gao, E.S., Chen, A.M., et al. “Mifepristone-induced abortion and duration of third stage labour in a subsequent pregnancy.” Paediatr Perinat Epidemiol 24.2 (2010): 125–30.

Treger, M., Hallak, M., Silberstein, T., et al. “Postterm pregnancy: should induction of labor be considered before 42 weeks?” J Matern Fetal Neonatal Med 11 (2002): 50–3.

Giacalone, P.L., Daures, J.P., Faure, J.M., et al. “The effects of mifepristone on uterine sensitivity to oxytocin and on fetal heart rate patterns.” Eur J Obstet Gynecol Reprod Biol 97.1 (2001): 30–4.

Berkane, N., Verstraete, L., Uzan, S., et al. “Use of mifepristone to ripen the cervix and induce labor in term pregnancies.” Am J Obstet Gynecol 192.1 (2005): 114–20.


GOST Style Citations


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4. Hapangama, D., Neilson, J.P. “Mifepristone for induction of labour.” Cochrane Database Syst Rev 3 (2009).

5. Heikinheimo, O. “Clinical pharmacokinetics of mifepristone.” Clin Pharmacokinet 33.1 (1997): 7–17.

6. Bodner-Adler, B., Bodner, K., Pateisky, N., et al. “Influence of labor induction on obstetric outcomes in patients with prolonged pregnancy: a comparison between elective labor induction and spontaneous onset of labor beyond term.” Wien Klin Wschr 117.7–8 (2005): 287–92.

7. Jiang, X., Wang, H., Zhang, Z. “Determination of fetal umbilical artery flow velocity during induction of term labor by mifepristone.” Zhonghua Fu Chan Ke Za Zhi 32.12 (1997): 732–4.

8. Miao, M.H., Gao, E.S., Chen, A.M., et al. “Mifepristone-induced abortion and duration of third stage labour in a subsequent pregnancy.” Paediatr Perinat Epidemiol 24.2 (2010): 125–30.

9. Treger, M., Hallak, M., Silberstein, T., et al. “Postterm pregnancy: should induction of labor be considered before 42 weeks?” J Matern Fetal Neonatal Med 11 (2002): 50–3.

10. Giacalone, P.L., Daures, J.P., Faure, J.M., et al. “The effects of mifepristone on uterine sensitivity to oxytocin and on fetal heart rate patterns.” Eur J Obstet Gynecol Reprod Biol 97.1 (2001): 30–4.

11. Berkane, N., Verstraete, L., Uzan, S., et al. “Use of mifepristone to ripen the cervix and induce labor in term pregnancies.” Am J Obstet Gynecol 192.1 (2005): 114–20.





DOI: https://doi.org/10.18370/2309-4117.2018.39.55-58

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ISSN 2411-1295 (Online), ISSN 2309-4117 (Print)