Role of combination of mifepristone and misoprostol versus misoprostol alone in the management of late intrauterine fetal death

Background: Intrauterine fetal death (IUFD) occurs in 1% of pregnancies and has devastating consequences. Previous methods for inducing labor in IUFD involved oxytocin and prostaglandins. The combination of mifepristone and misoprostol is commonly used for early first-trimester termination. This study aimed to compare the effectiveness of mifepristone and misoprostol combination versus misoprostol alone for labor induction in intrauterine fetal death.Methods: A randomized controlled clinical trial was conducted at Sir Salimullah Medical College, Mitford Hospital, Dhaka, from January 2017 to June 2017. Sixty-four pregnant women with intrauterine fetal death after 28 weeks of gestation were included. Participants were randomly assigned to either group-I (mifepristone and misoprostol) or group-II (misoprostol alone). Statistical analyses were performed using statistical package for the social sciences (SPSS) version 20.0 for Windows.Results: The mean age was 27.7±5.6 years in group I and 27.5±4.3 years in group II. Majority of patients in group I were housewives (87.5%), while in group II, it was 78.1%. Most patients in group I (56.3%) came from lower-income families, compared to 65.6% in group II. The gestational age did not significantly differ between the groups. The induction to delivery interval was significantly shorter in group I (8.6±2.0 hours) compared to group II (15.1±3.5 hours). The dose administration pattern of misoprostol differed significantly between the groups.Conclusions: Both methods are equally safe and effective for managing intrauterine fetal death. However, the combination of mifepristone and misoprostol showed greater efficacy in terms of reducing the induction to delivery interval and requiring a lower dose of misoprostol.