Current Practices of Cervical Ripening and Induction of Labour in Intrauterine Foetal Demise: An Observational Study
- 19 Downloads
Objectives of the current study were to find the most effective method of induction of labour in case of intrauterine foetal death (IUFD), with efficacy described as least induction-to-delivery time, and the agent with the best safety profile, i.e. least maternal complications.
This was a prospective observational descriptive study carried out between January and November 2015 in a tertiary care centre. Hundred consecutive cases of IUFD after 20 weeks of gestation requiring induction of labour and fulfilling inclusion criteria were selected. The method of induction decided by each consultant was noted, and results were analysed. As this was a purely observational study, all agents used for induction of labour (misoprostol, dinoprostone gel, intracervical Foley catheter) and all dose variations were included.
The induction-to-delivery interval was shortest with dinoprostone (12.52 h) followed by Foley catheter (13.28 h) and misoprostol (15.82 h). However, the p value (0.301) was not statistically significant. Misoprostol was used more often in second trimester, while dinoprostone gel was most commonly used in third trimester. Failure occurred in 3 cases; all required lower segment caesarean section (LSCS). No significant complications were associated with any of the methods.
Dinoprostone gel, misoprostol and Foley catheter are safe for induction of labour in all cases of IUFD, even for those with previous LSCS with IUFD.
KeywordsIntrauterine foetal death Dinoprostone Misoprostol Foley Induction of labour
Compliance with Ethical Standards
Conflict of interest
Dr Kinnari Amin, Dr Anahita Chauhan and Dr Anchal Goel declare that they have no conflict of interest.
All procedures followed were in accordance with the ethical standards of the institutional ethics committee and with the Helsinki Declaration of 1975, as revised in 2008 (5).
Informed consent was obtained from all patients for being included in the study.
- 1.MacDorman MF, Kirmeyer SE, Wilson EC. Fetal and perinatal mortality, United States, 2006. Natl Vital Stat Rep. 2012;60(8):1–22.Google Scholar
- 2.Clinical Practice Guideline: Investigation and management of late fetal intrauterine death and stillbirth. Institute of Obstetrician and Gynaecologists, Royal College of Physicians Ireland, and Directorate of Strategies and Clinical Programmes, Health Service Executive. October 2011, revised 2013. Version 1.0, guideline no. 4.Google Scholar
- 5.Biswas T. Misoprostol (PGE1) versus dinoprostone gel (PGE2) in induction of labour in late intra uterine fetal death with unfavourable cervix: a prospective comparative study. Int J Reprod Contracept Obstet Gynecol. 2015;4:35–7.Google Scholar