Elza Rebecca Kharsyntiew, (2022) Efficacy of Oral Mifepristone for Cervical Ripening and Induction of Labour on an Outpatient Basis in Low-Risk Pregnant Women with Past Dates. Masters thesis, Christian Medical College, Vellore.
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Abstract
OBJECTIVES: The primary objective was to see the change in Bishop score after 48 hours of induction of labour with oral mifepristone. Secondary outcomes looked at were the rate of vaginal delivery in patients who have been induced with mifepristone, need and number of doses of misoprostol required after induction with mifepristone, need and dose of oxytocin for augmentation of labour, maternal morbidity such as ICU admissions, indications for caesarean section, APGAR SCORE at 5 and 10 minutes and neonatal intensive care unit (NICU) admissions. METHODS: This was a quasi-experimental study conducted in Christian Medical College, Vellore from July 2020. Booked inside low-risk pregnant patients, both primigravidas and multigravidas, post-dated (more than 40 weeks and above), planned for induction of labour were recruited for the study. A nonstress test (NST) for foetal wellbeing was done. After a reactive NST, a per vaginal examination was done following which patients were induced with oral mifepristone 200mg if the Bishop score was unfavourable (score <6). They were asked to come for admission after 48 hours from taking mifepristone if they did not go into spontaneous onset of labour before 48 hours. After admission, a repeat non stress test and a repeat per vaginal examination was done. Depending on the change in Bishop score, artificial rupture of membranes or reinduction of labour with misoprostol was done. Rest of labour and delivery was as per routine protocol in our institution. RESULTS: It was found that the mean Bishop score before induction with mifepristone was 3.71±0.69. Reassessment after 48 hours of induction with mifepristone showed a mean Bishop score of 5.64±1.73 with a P value of <0.001 which is statistically significant. Of the 112 subjects who were recruited, 69 patients (61.7%) had spontaneous onset of labour within 48 hours of induction of labour with mifepristone. Out of 112 patients who agreed to take part in the study, 86 patients (76.8%) had a vaginal delivery, and 26 patients (23.2%) had a lower segment caesarean section. The most common indication for LSCS was for foetal distress, that is, 13 patients (50%) out of 26 patients. When it came to maternal complications, 95 patients (84.8%) had a total blood loss of less than 500ml during delivery, 16 patients (14.3%) had blood loss between 500-1000ml and 1 patient (0.9%) had a total blood loss of more than 1litre. When compared with the group that did not take part in the study, there was no significant difference in the total amount of blood loss. The number of patients who required augmentation of labour with oxytocin was 108 (96.4%), out of which, 69 patients (63.9%) required 2.5 units of oxytocin, 35 patients (32.4%) required 5 units of oxytocin and 4 patients (3.7%) required 7.5 units of oxytocin. Hence, a majority (63.9%) needed only 2.5 units of oxytocin for augmentation during labour but when comparing the need for oxytocin with the group that did not give consent for the study, it was not found to be statistically significant. In this study, there were no differences in neonatal outcomes. The most common indication for NICU admission was transient tachypnoea of new-born (2.7%). CONCLUSION: Oral mifepristone is a more convenient method of induction of labour with an added advantage of ease of administration, acceptance and equally safe with similar outcomes as compared to per vaginal misoprostol. The need for augmentation of labour with oxytocin was also decreased with most patients requiring a lesser amount of oxytocin during labour. However, this was not found to be statistically significant in this study. There was no difference in the rates of maternal or neonatal complications when compared with misoprostol for induction of labour at term. Further studies with a larger sample size should be conducted to determine the rate of antenatal and perinatal complications and to compare mifepristone with other methods of induction at term.
| Item Type: | Thesis (Masters) |
|---|---|
| Additional Information: | 221916403 |
| Uncontrolled Keywords: | Efficacy, Oral Mifepristone, Cervical Ripening, Induction of Labour, Outpatient Basis, Low-Risk Pregnant Women, Past Dates. |
| Subjects: | MEDICAL > Obstetrics and Gynaecology > MEDICAL > Obstetrics and Gynaecology |
| Depositing User: | Subramani R |
| Date Deposited: | 18 May 2021 16:29 |
| Last Modified: | 10 Dec 2023 08:09 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/17033 |
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