Lingammal, P (2022) Role of Oral Mifepristone for Cervical Ripening and Induction of Labour in Term Pregnancy: Randomized Controlled study. Masters thesis, Kilpauk Medical College, Chennai.
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Abstract
INTRODUCTION: Induction of labour is defined as the stimulation of uterine contractions to bring about the delivery before the onset of spontaneous labour or after the period of viability. Induction of labour is indicated when complications of pregnancy may have a negative impact on the health of the mother, fetus, or both. Induction of labour is therapeutic option when the benefits of the delivery outweigh the risks of continuing the pregnancy. AIM AND OBJECTIVES: Induction of labour is artificial initiation of uterine contractions before spontaneous onset of labour or after the period of viability of the fetus. Induction of labour is indicated when complications of pregnancy may have a negative impact on the health of the mother, fetus, or both. Induction of labour is therapeutic option when the benefits of the delivery outweigh the risks of continuing the pregnancy. Routine antenatal ultrasound for confirmation of EDD has been shown to reduce induction rates for post dated pregnancies after correction of dates. Prolonged pregnancy is known to be associated with significantly increased risks of perinatal and maternal complications. PRIMARY OBJECTIVES: 1. To study the effectiveness and safety of mifepristone for cervical ripening for induction of labour in term pregnancies. 2. To compare the effect of mifepristone in study group with control group of same size. 3. To observe the improvement in cervical score as compared to control group. 4. To critically evaluate the effect of these drugs on primigravida and multigravida. SECONDARY OBJECTIVES: 1. Induction to Delivery interval, 2. Mode of delivery, 3. Maternal and Fetal outcome. METHODOLOGY: After Institutional ethical committee approval and informed written consent, 88 patients will be selected for the study based on inclusion and exclusion criteria. Patient will be randomly allocated into 2 groups (i.e. Group A and Group B) using computerized random number. A computer-generated randomization schedule will be prepared and placed into numbered opaque envelopes by an uninvolved third party before the initiation of the study. Randomization will be done after the decision had been made that the patient required an induction of labour and after a cervical examination demonstrated a Bishop’s score of <6. On admission detailed history, and complete general and obstetric examination carried out. Vaginal examination was done under strict aseptic precautions and the cervical status, fetal station are assessed. Gestational age was calculated by Naegele's rule and a routine obstetric scan for fetal maturity and wellbeing was done. Out of 88, 44 pregnant women will be given tablet mifepristone 200mg orally and other 44 are allowed for spontaneous onset of labour. After the waiting period of 24 hours or when the bishop’s score was > 6 or when the membranes ruptured or when the patient was well in labour whichever is earlier labour is accelerated with oxytocin drip,2nd dose of PGE2 gel will be given after 6 hours if there is no improvement in Bishop’s score. The efficacy was assessed by favourability of bishop’s score at 24 hours, need of oxytocin for augmentation, duration of first, second, third stage of labour, drug administration to delivery interval, mode of delivery ,c-section rate, APGAR Score, neonatal complications, maternal complications. RESULTS: Our study included 88 patients out of which 44 were treated with Mifepristone, 44 were allowed for spontaneous onset of labour with waiting period of 24 hours. Among the study group, 64 women are Primigravida and 24 women are multigravida. Out of 44 in Group A, more than half of them were belonged to 18-24 years and 29% were in 25-29 years of age group. In Group B 56% were fall in 18-24 years age category and nearly 40% (38.6%) were belonged to 25-29 years of age. Both the groups are similar in age. The mode of delivery in the women who were enrolled in the study was found to be significant as 84% of patient in group A delivered vaginally compared to 68% in group B(Spontaneous onset of labour with waiting period of 24 hrs). 16% patients were undergone caesarean section in mifepristone group A as compared to 32% in group B. The mean duration of induction –delivery interval was found to be 25 hours in group A compared to 35 hours in group B. The incidence of Meconium stained liquor in group A was found to be 5% compared to 21% in group B. The incidence of PPH observed in the study was found to be insignificant. CONCLUSION: Thus, based on the results observed in our study, Tab.Mifepristone can be considered as effective in induction of labour in term pregnancy. (40 Weeks).
| Item Type: | Thesis (Masters) |
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| Additional Information: | 221916156 |
| Uncontrolled Keywords: | Induction of labour, Mifepristone, induction-delivery interval, neonatal outcome. |
| Subjects: | MEDICAL > Obstetrics and Gynaecology > MEDICAL > Obstetrics and Gynaecology |
| Depositing User: | Subramani R |
| Date Deposited: | 16 Apr 2022 11:06 |
| Last Modified: | 03 Dec 2023 12:46 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/19295 |
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