Inducing labor after fetal demise: a systematic review and meta-analysis of the efficacy and safety of mifepristone and misoprostol combination versus misoprostol alone.

Abstract

<h4>Introduction</h4>Intrauterine fetal demise (IUFD), one of the most tragic outcomes of pregnancy, affects approximately 1% of pregnancies. This systematic review aims to assess the efficacy and safety of mifepristone combined with misoprostol versus misoprostol alone in inducing labor in women with IUFD.<h4>Methods</h4>We conducted a comprehensive literature search of scientific databases from their inception up to July 29, 2024. Randomized controlled trials (RCTs) comparing the Efficacy and Safety of mifepristone and misoprostol with misoprostol alone in women with IUFD were included. The quality of the included RCTs was assessed using the Cochrane risk of bias tool (RoB). All analyses were performed using RevMan version 5.4. To determine the quality of evidence, we used the GRADE tool.<h4>Results</h4>Ten RCTs were included in the qualitative and quantitative synthesis. The analysis revealed a significant reduction in the induction delivery interval with the combination treatment, with a total mean difference of - 7.86 h (MD = - 7.86, 95% CI: - 9.98 to - 5.73, p < 0.00001), favoring mifepristone plus misoprostol. There was a significant reduction in the number of misoprostol doses needed (MD = - 1.38, 95% CI: - 1.82 to - 0.94, p < 0.00001) and in the total misoprostol dose (MD = - 60.51, 95% CI: - 106.98 to - 14.04, p = 0.01), favoring the use of mifepristone plus misoprostol. The quality of evidence ranged from low to moderate.<h4>Conclusion</h4>Our study provides compelling evidence that the combination therapy of mifepristone and misoprostol results in a significant reduction in the induction delivery interval and total dosage of misoprostol required for successful labor induction compared to misoprostol administered alone. Further high-quality research is essential to confirm these results.