Abstract
Objective
This study aims to evaluate the impact of the implementation a mifepristone-misoprostol
protocol (MIFE/MISO) on the induction-to-expulsion interval in the context of second-
and third-trimester pregnancy termination or intrauterine fetal death (IUFD) compared
with misoprostol alone (MISO), and to share the experience of a Canadian tertiary
hospital concerning the feasibility and safety of such a protocol.
Methods
This is a single-centre retrospective pre–post cohort study carried out at the Centre
Hospitalier Universitaire (CHU) Sainte-Justine between 2017 and 2019. Women in the
MIFE/MISO group were instructed to take mifepristone 24-48 hours before induction.
Induction in the MIFE/MISO group was performed with misoprostol dosages adjusted to
gestational age and the presence of previous uterine scars, while, in the MISO group,
all patients received 400 μg of misoprostol vaginally every 4 hours.
Results
Ninety-four patients were included in the MIFE/MISO group and 103 patients, in the
MISO group. Median time to expulsion was significantly lower in the MIFE/MISO group
than the MISO group (13.5 and 19.5 h respectively; P < 0.001). The total dose of misoprostol administered was significantly lower in the
MIFE/MISO group than the MISO group, and adverse effects were reported in 60% and
82% of patient records, respectively (P < 0.001). Complication rates were similar between the 2 groups.
Conclusion
The MIFE/MISO protocol is highly effective for second- and third-trimester induction
for pregnancy termination or IUFD, without increasing complication rates and with
fewer reported adverse effects. Its implementation is safe and feasible in a tertiary
medical centre.
Résumé
Objectif
Cette étude cherche à évaluer l’effet de la mise en œuvre d’un protocole mifépristone-misoprostol
(MIFE-MISO) sur le délai déclenchement-expulsion en contexte d’interruption de grossesse
ou de mort fœtale intra-utérine (MFIU) au deuxième ou troisième trimestre par comparaison
au misoprostol seul (MISO). L’étude vise aussi à diffuser l’expérience d’un hôpital
de soins tertiaires canadien en ce qui concerne la faisabilité et l’innocuité d’un
tel protocole.
Méthodologie
Il s’agit d’une étude de cohorte rétrospective monocentrique menée au Centre hospitalier
universitaire (CHU) Sainte-Justine de 2017 à 2019. Les patientes du groupe MIFE-MISO
ont reçu l’instruction de prendre la mifépristone 24 à 48 heures avant le déclenchement
du travail. Le déclenchement du travail pour ce groupe a été effectué en utilisant
une dose de misoprostol adaptée en fonction de l’âge gestationnel et de la présence
de cicatrices utérines préexistantes. Dans le groupe MISO, toutes les patientes ont
reçu 400 mcg de misoprostol par voie vaginale toutes les 4 heures.
Résultats
Le groupe MIFE-MISO comptait 94 patientes; le groupe MISO en comptait 103. Le délai
déclenchement-expulsion médian était significativement plus court dans le groupe MIFE-MISO
que dans le groupe MISO (13,5 et 19,5 h respectivement; p < 0,001). La dose totale de misoprostol était significativement plus faible dans
le groupe MIFE-MISO, et des effets indésirables ont été rapportés dans 60 % (MIFE-MISO)
et 82 % (MISO) des dossiers de patientes (p < 0,001). Le taux de complications était comparable entre les deux groupes.
Conclusion
Le protocole MIFE-MISO est très efficace pour le déclenchement du travail en cas d’interruption
de grossesse ou de MFIU au deuxième ou troisième trimestre, sans augmenter le taux
de complications tout en ayant moins d’effets indésirables rapportés. La mise en œuvre
de ce protocole est sécuritaire et réalisable dans un centre de soins tertiaires.
Keywords
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Article info
Publication history
Published online: January 31, 2022
Accepted:
December 24,
2021
Received:
October 8,
2021
Footnotes
Disclosures: I. Boucoiran is a recipient of a salary award from FRQ-S (Quebec’Health research fund).
All authors have indicated they meet the journal’s requirements for authorship.
Identification
Copyright
© 2022 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
