Study on Mifepristone for Cervical Ripening and Induction of Labor in Previous LSCS Cases-Experience from a Single Centre of North India

Introduction: The obstetrician faces a big hurdle while inducing labour in a previous caesarean section(CS). Globally rates of induction of labour in women with previous CS are decreasing. Whenever a pregnancy must be terminated for obstetric reasons, the trend is toward elective repeat caesarean sections. Vaginal birth is associated with less complications as compared to repeat CS more so in population like ours where multiparity is more common. Therefore, a need for an agent with better outcome in terms of vaginal birth is desirable.

Aim of Study: The study was aimed to evaluate the efficacy of Mifepristone for cervical ripening and induction of labour in previous caesarean cases. It was also aimed to assess induction delivery interval and maternal and fetal outcomes.

Methods: This was a prospective study carried out in a tertiary care centre in North India on fifty two term pregnant females with previous one caesarean section admitted for labour induction for various indications. They were randomly divided into two study groups of twenty six each. Group A females received tablet Mifepristone and group B females received placebo.

Results: There was no difference between both groups in age, period of gestation and Bishop score at induction. Most common indication of induction was post dated pregnancy in both groups. When compared to the control group, there was a statistically significant difference in induction to onset of labour with Mifepristone. In the mifepristone and control groups, the time gap between induction and onset of labour was 24 hrs 7 min and 37 hrs 3 min, respectively. Mean induction delivery interval was 33 hrs 1 min and 46 hrs 9 min in cases and control group, but this was not statistically significant. Twenty one patients (80.7%) delivered vaginally in the mifepristone group as compared to 15(57.6%) in the control group.

Conclusions: This study showed that Mifepristone is simple and effective method in term women with previous LSCS for IOL with a favourable outcome and its use provides an interesting new alternative to classic uterotonic agents when induction is necessary in previous LSCS cases.