[Results of pregnancy termination for foetal congenital or chromosomal disorders or intrauterine foetal death by oral mifepristone and/or intravaginal misoprostol; results of a retrospective study]

Abstract

Objective: To evaluate the method of mifepristone and misoprostol for pregnancy termination during the second trimester or for intrauterine foetal death during the second or third trimester. The primary outcome measure was time to delivery. Secondary outcomes included: complication registration, need for pain relief and side effects.

Design: Retrospective study of medical records.

Method: Data were collected from patients in whom labour was induced due to intrauterine foetal death or in whom pregnancy was terminated due to a severe foetal congenital or chromosomal disorder between 1 September 2002 and 1 September 2005 in the Amphia Hospital, Breda, the Netherlands. Patients who experienced premature rupture of membranes, spontaneous abortion, or in whom labour was induced by insertion ofa intra-cervical balloon catheter were excluded.

Results: A total of 99 patients were included in the study. The mean age was 32 years in the intrauterine foetal-death group and 33 years in the pregnancy-termination group. The median gestational age was 21 weeks at the time of intrauterine foetal death and 19 weeks at the time of pregnancy termination. The median duration of treatment was 10 hours (range: 1-29) for intrauterine foetal death and 8 hours (range: 3-39) for pregnancy termination; the difference was statistically significant (p = 0.02). The mean duration of treatment did not differ statistically significant between these groups. The proportion of patients who delivered within 24 hours was 96% in the intrauterine foetal-death group and 92% in the pregnancy-termination group. Surgical removal of placenta or partially retained placenta was performed in 33% of all patients. There was no statistically significant difference in the median duration of treatment in nulliparous and multiparous patients; however, the risk of surgical removal of placenta or partially retained placenta was 5-fold greater in the nulliparous group (p < 0.05). No cases of uterine rupture were reported. Overall, 6% experienced severe haemorrhage, 18% had fever, 15% had nausea and 5% had vomiting. Epidural anaesthesia and intramuscular pethidine were administered in 28% and 24% of patients, respectively.

Conclusion: The median duration of treatment was longer in patients in whom labour was induced due to intrauterine foetal death than in those in whom pregnancy was terminated for foetal disorders. The incidence of secondary outcomes such as complications, need for anaesthesia and side effects were comparable to numbers from earlier studies with mifepristone and misoprostol.