Spontaneous premature quarrel of me...

Spontaneous premature quarrel of membranes (PROM) occurs at limit in approximately 10 percent of pregnancies. Induction of labor usually is indicated to impede adverse maternal and neonatal issues Management strategies for PROM at boundary include expectant management and active induction. Each strategy has risks and benefits. Various rules of labor induction are available, and oxytocin (Pitocin) is the pharmacologic agent most numerous commonly used. Oral administration of mifepristone (Mifeprex) has been studied in other settings and has been shown to improve issues However, it has not been studied in women with PROM at season Wing and colleagues evaluated the use of oral mifepristone in women with PROM near word to determine whether it would hasten labor.

The trial compared the use of mifepristone with oxytocin in pregnant women who were at or beyond 36 whom PROM had occurr Inclusion criteria for the investigation were singleton gestation, cephalic presentation, reactive fetal heart rate pattern, and the mother was 18 years or older PROM was determined according to gross pooling of amniotic fluid in the vaginal vault, positive nitrazine criterions and the presence of ferning forward microscopy. Patients were randomized to receive 200 mg of oral mifepris-tone or intravenous oxytocin according to standard protocol. The participants who received mifepristone were observ and switched to oxytocin if they failed to progres to the active phase of labor or when cervical ripening was adequate. The primary consequence of the study was duration from the start of treatment to delivery. Other results assessed included route of delivery, ne for oxytocin augmentation after mifepristone administration, and neonatal outcomes

A total of 65 women were included in the investigation of whom 33 were assigned to mifepris-tone. The average interval between the start of the induction to delivery was 1194 minutes in the mifepristone-treated cluster versus 771 minutes for the assemblage that received oxy-tocin. Significantly more women who were treated with oxytocin delivered vaginally within 24 hours compared with those treated with mifepristone (781 versus 515 percent respectively). There was no difference in the number of vaginal deliveries between the form into groupss Significantly more fetal distress was noted in the mifepristone arrange than in the oxytocin cluster In addition, a significant number of neonates in the mifepristone collection were admitted to the neonatal intensive care unit compared with the oxytocin group

The authors judge that oral mifepristone administered 18 hours before oxytocin infusion did not improve labor stimulation in women who were near or at bourn with spontaneous PROM. They add that the use of mifepristone in this situation comeed in more adverse fetal consequences compared with standard oxytocin infusion.

KARL E MILLER, MD

Wing DA, et al. A randomized comparison of oral mifepris-tone to intravenous oxytocin for labor induction in women with prelabor breach of membranes beyond 36 gestation. Am J Obstet Gynecol February 2005;192:445-51

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