Pre-induction of labor: analysis of the mifepristone effectiveness in primiparous and multiparous women

Background: The development of labor against the background of the lack of biological readiness for childbirth, irrational use of uterotonic drugs lead to the formation of obstetric complications – labor abnormalities, placental complex decompensation, premature placental abruption, which requires emergency surgical delivery.

Objective: Evaluation of the effectiveness of pre-induction of labor using mifepristone in primiparous and multiparous women.

Materials and methods: Using the continuous sampling method, a retrospective comparative analysis of pregnancy and labor outcomes in 205 women using pre-induction/induction with mifepristone was conducted. The study was conducted in a second-level hospital, clinical base of the Department of Obstetrics and Gynecology. In our study, we divided pregnant women into two groups: comparison group 1 – primiparous women (n=117); comparison group 2 – multiparous women (n=88).

Before pre-induction/induction of labor, a complete clinical and laboratory examination of the pregnant woman and the intrauterine condition of the fetus was carried out, and the gestational age was clarified. During a vaginal examination, the maturity of the cervix was assessed according to the Bishop scale.

Results: Analysis of the presented data showed that in the general observation cohort, primiparous women prevailed (p1<0.001) (57.07%), in whom preinduction was performed significantly more often at a gestation period of 40–42 weeks (p1<0.001), compared to multiparous women (p1<0.001), in whom preinduction was performed at 37–39 weeks.

Among the indications for preinduction in case of an “immature” cervix (0–5 points), the following indications prevailed: in first place – postmaturity (p<0.001); in second place in terms of frequency of occurrence was chronic fetal hypoxia (p<0.001).

The frequency of cesarean section in the general observation cohort (primiparous and multiparous) was 24.4% (50 women), i.e. statistically significantly predominated per vias naturalis births (p<0.001).

Nevertheless, the frequency of cesarean sections in primiparous women was statistically significantly higher (37.62% – 37 people) than in multiparous women (14.77% – 13 people) (p<0.001).

Conclusion: Based on the results of the study, it can be stated that the use of mifepristone for the purpose of preparing the cervix and further induction of labor is an effective method. The drug is safe, does not have a negative effect on the fetus and the mother’s body; creates favorable conditions for the development of spontaneous labor, without significantly affecting the frequency of labor anomalies. At the same time, our data indicate a significantly lower effectiveness of mifepristone in primiparous women (with a cervical maturity level of 0–5 points according Bishop scale), as well as a higher frequency of meconium staining of the amniotic fluid. Therefore, when performing preinduction/induction in primiparous women, it is necessary to carefully justify the choice of the delivery method, especially when the gestational period is complicated by chronic fetal hypoxia.