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Randomized Controlled Trial
. 2023 Nov;49(11):2671-2679.
doi: 10.1111/jog.15772. Epub 2023 Sep 7.

Randomized controlled trial comparing efficacy of a combination regime containing two cervical sensitizers (mifepristone + Foley's catheter) versus single agent mifepristone or Foley's catheter for labor induction in women attempting TOLAC at late third trimester with a dead fetus in utero

Subhankar Dasgupta  1 , Jija Dasgupta  2 , Barnali Goswami  3 , Joyeeta Mondal  4
Affiliations
Randomized Controlled Trial

Randomized controlled trial comparing efficacy of a combination regime containing two cervical sensitizers (mifepristone + Foley's catheter) versus single agent mifepristone or Foley's catheter for labor induction in women attempting TOLAC at late third trimester with a dead fetus in utero

Subhankar Dasgupta et al. J Obstet Gynaecol Res. 2023 Nov.

Abstract

Randomized controlled trial comparing efficacy of a combination regime containing two cervical sensitizers (mifepristone + Foley's catheter) versus single agent mifepristone or Foley's catheter for labor induction in women attempting TOLAC at late third trimester with a dead fetus in utero.

Aim: To compare efficacy and safety of a new combination regime comprising of two cervical sensitizers used simultaneously with single agents, for labor induction in women attempting TOLAC at ≥34 weeks' gestation with a dead fetus.

Method: This was a multiarm randomized controlled trial (RCT) where participants received one of the three regimes-single agent oral Mifepristone 200 mg, intracervical Foley's catheter (16 Fr size, filled with 40 mL normal saline after intracervical instillation), and combination regime consisting of both used simultaneously. Number of women undergoing vaginal birth within 48 h of induction (VB48 ) was the primary outcome compared between groups.

Results: VB48 was higher in participants on combination regime in comparison to participants on Foley's catheter (54 vs. 42). Total vaginal births were higher in participants on combination regime compared to both single agents (58 vs. 48 and 44). Duration and dose of oxytocin augmentation was lower in participants on combination regime compared to both single agents. Induction birth interval was short in participants on combination regime compared to those on Foley's catheter. Maternal complications between groups were similar.

Conclusion: Combination of cervical sensitizers for labor induction in late third trimester among women with dead fetus attempting TOLAC resulted in higher proportion of vaginal births and might reduce risk of scar dehiscence due to requirement of a lower dose of oxytocin for augmentation.

Keywords: TOLAC; combination regimen; fetal death; induction of labor (IOL); oxytocin augmentation; third trimester; vaginal birth within 48 h (VB48).

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References

REFERENCES

    1. Moraitis AA, Oliver-Williams C, Wood AM, Fleming M, Pell JP, Smith G. Previous caesarean delivery and the risk of unexplained stillbirth: retrospective cohort study and meta-analysis. BJOG. 2015;122(11):1467-1474.
    1. Rådestad I, Steineck G, Nordin C, Sjögren B. Psychological complications after stillbirth-influence of memories and immediate management: population based study. BMJ. 1996;312:1505-1508.
    1. Wagaarachchi PT, Ashok PW, Narvekar NN, Smith NC, Templeton A. Medical management of late intrauterine death using a combination of mifepristone and misoprostol. BJOG. 2002;109:443-447.
    1. Cayrac M, Faillie JL, Flandrin A, Boulot P. Second- and third-trimester management of medical termination of pregnancy and fetal death in utero after prior caesarean section. Eur J Obstet Gynecol Reprod Biol. 2011;157(2):145-149.
    1. Birth After Previous Caesarean Birth Green-top Guideline No. 45 October 2015.

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