Labor induction in women at term with mifepristone (RU 486): A double-blind, randomized, placebo-controlled study

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Citations from the Literature

phospholipase AZ concentrations among pregnant women may play roles in the pathogenesis of pretenn labor and birth. Identification of pregnant women with increased concentrations in vaginal fluid may allow for development of effective intervention strategies to reduce the risk of preterm birth. The diagnosis and management of dystocia of the shoulder Morrison J.C.; Sanders J.R.; Magann E.F.; Wiser W.L. USA SURG GYNECOL OBSTET 1992 175/6 (515-522) Dystocia of the shoulder is an unpredictable obstetric emergency that may result in injury to the mother or fetus. In an effort to reduce such risks, attempts have been made to identify patients having a fetus who may subsequently develop shoulder dystocia. The literature, however, clearly reflects that even the combination of prenatal historic facts, estimated fetal weight and sequence of intrapartum events is ineffective in prospectively identifying infants whose births are complicated by shoulder dystocia. During a ten year period at the University of Mississippi Medical Center, the incidence of macrosomia, shoulder dystocia and subsequent brachial plexus injury was reviewed. The majority of instances (89%) of shoulder dystocia occurred in patients weighing less than 8 pounds 13 ounces at birth. In the current retrospective review, only 11% of the women had risk factors for macrosomia or shoulder dystocia and among these, none were identified prospectively. Additionally, 91% of patients with brachial plexus injury recovered with no sequelae. One instance of brachial plexus injury occurred at the time of cesarean section. These data reveal that macrosomia and subsequent shoulder dystocia cannot be predicted. Therefore, it is not feasible to prevent brachial plexus injury prospectively by prophylactic cesarean section. Great clinical acumen and technical expertise by the obstetrician using a variety of methods may be useful in avoiding, as much as possible, injury to the mother and fetus when shoulder dystocia does occur.

RU 486 Labor induction in women at term with mifepristone (RU 486): A double-blind, randomized, placebo-controlledstudy Frydman R.; Lelaidier C.; Baton-Saint-Mleux C.; Fernandez H.; Vial M.; Bourget P. FRA OBSTET GYNECOL 1992 80/6 (972-975) Objective: To determine the efficacy and safety of mifepristone as an induction agent for the initiation of labor or as a cervical ripening agent in women at term. Methods: Our study group contained 120 women at term (after 37.5 weeks’ amenorrhea) who had clear clinical indications for labor induction. They were randomized to receive either 200 mg of mifepristone or placebo on days 1 and 2 of a 4-day observation period, with labor induction planned for day 4. Eight patients, three treated with mifepristone and five receiving placebo, had to be excluded from the survey because they required cesareans for medical reasons (fetal distress or maternal complications)

Int J Gynecol Obstet 42

less than 12 h after taking the first tablet. Results: Forty-one subjects entered spontaneous labor, 31 treated with mifepristone and ten in the control group (P < 0.001). Forty-five needed cervical maturation with prostaglandins on day 4, 13 of whom had received mifepristone and 32 of whom had been given placebo (P < 0.001). Thirteen women treated with mifepristone and 13 who had taken placebo had mature cervices sufficient for classic labor induction with oxytocin and amniotomy. Patients who delivered vaginally needed a much lower amount of oxytocin when mifepristone had been given, and the mean time interval between day 1 of the survey and the onset of labor was also significantly shorter in this group. Conclusion: Although more studies are needed, we have found mifepristone to be a safe, efficient, and suitable induction agent for initiation of labor in women at term. Inductionof abortion with mifepristow aad misoprostol in early pregnancy Thong K.J.; Baird D.T. GBR BR J OBSTET GYNAECOL 1992 99/12 (1004-1007) Objective: To investigate the clinical efficacy of the combination of mifepristone and an orally active prostaglandin, misoprostol, for early medical termination. Design: Women with amenorrhea d 56 days were given 200 mg mifepristone. 48 h later, 600 gg misoprostol was given orally. Setting: Medical Termination Unit, Simpson Memorial Maternity Pavilion, Edinburgh. Subjects: 100 women requesting medical termination of pregnancy. Interventions: Evacuation of uterus for incomplete abortion or on-going pregnancies. Results: One woman had an incomplete abortion prior to administration of misoprostol. 92 (93%) out of 99 women had complete abortion following administration of misoprostol. There were three ongoing pregnancies (3.0%, 95% confidence limits (CL) 0.6-8.6) and four incomplete abortions with this regimen (4.0%. 95% CL 1.1-10.0). 24% women vomited and 7% had diarrrhea following administration of misoprostol. 62% did not require any analgesia. Conclusions: The combination of misoprostol with mifepristone is inexpensive, simple, effective, noninvasive and an acceptable alternative to current regimens for medical

FERTILITY, STERILITY The prevalenceand predictabilityof depressionin infertile women Domar A.D.; Broome A.; Zuttermeister P.C.; Seibel M.; Friedman R. USA FERTIL STERIL 1992 58/6 (1158-1163) Objective: To determine the prevalence, severity, and predictability of depression in infertile women compared with a control sample of healthy women. Design: Subjects were assessed while waiting to see their physician: infertility patients before a visit with an infertility specialist and control subjects before seeing either a gynecologist or internist for a routine gynecological examination. Subjects completed a demographic