Systematic review and meta-analysis was conducted to assess the effectiveness of combination mifepristone and misoprostol compared to misoprostol alone for induction of labor (IOL) for intrauterine fetal demise (IUFD) after 20 gestational weeks.METHODS:
Medline, Scopus, ClinicalTrials.gov, Embase, Science Direct, Cochrane Central Register of Controlled Trials, and Scielo were searched for the following terms: “mifepristone”, “misoprostol”, and “IUFD” from inception until September 2017. All randomized controlled trials (RCTs) examining misoprostol versus the combination of misoprostol and mifepristone were included. Primary outcome was induction to delivery interval. Intragroup differences in parity, gestational age and bishop score was examined. Meta-analysis (Review Manager v.5.3) was performed using a fixed effects model to produce summary treatment effects in terms of mean difference, with 95% confidence intervals. Heterogeneity was measured using Chi-square and I2 statistics. GRADE approach was used to assess the quality of evidence.RESULTS:
Two RCTs, including 140 women met inclusion criteria. The combination of mifepristone and misoprostol lead to a shorter interval to delivery mean difference -4.19 hours (95% CI, -5.58, -2.81). Chi-square 0.39, I2 =0%. There was no significant difference between groups in regard to parity, gestational age and bishop score. The quality of evidence was judged as low due to lack of clear randomization, allocation concealment, and blinding.CONCLUSION:
Combination mifepristone and misoprostol is effective and leads to a shorter induction to delivery interval as compared to misoprostol alone for IOL for IUFD after 20 gestational weeks. Further well-designed RCTs are necessary given the low quality of evidence.