Evaluating Management Strategies For Late Pregnancy Loss: A Randomized Controlled Trial at Georgetown Public Hospital Corporation
Introduction
Intrauterine fetal demise in the third trimester remains a distressing event with significant
emotional and physical effects on patients and families. Optimal management focuses on ensuring safe,
timely delivery while reducing maternal morbidity.
Objectives
The combination of mifepristone and misoprostol has been shown to shorten induction-to-
delivery times compared to misoprostol alone; however, limited data are available in our settings. This
study aimed to compare the efficacy, safety, and tolerance of a mifepristone-misoprostol regimen versus
misoprostol alone for inducing labor in third-trimester IUFD cases at Georgetown Public Hospital
Corporation.
Method: This Randomized controlled trial included women with confirmed third-trimester IUFD
admitted to the Department of Obstetrics and Gynecology at GPHC between January 1 and December
31, 2023. Participants were randomly assigned to receive either oral mifepristone 200mg, followed
24hours later by vaginal misoprostol, or vaginal misoprostol alone. Statistical analysis was performed
using SPSS Version 29.0.1.1, and the results were expressed in percentages.
Results
The induction-to-delivery time was significantly shorter using the combination group compared
to the misoprostol-only group (p = <0.0001). Secondary outcomes included need for additional doses,
maternal complications, and patient satisfaction showed no significant difference. Safety, tolerance,
analgesia requirements, and oxytocin use were comparable between groups. The combination regimen
demonstrated better overall efficiency without increasing adverse events.
Conclusion
The combination of mifepristone and misoprostol is a more effective regimen for
managing third-trimester IUFD, reducing induction time without compromising safety.