Obstetrics & Gynecology · 2 h ago
Mifepristone Linked to Fewer Cesarean Deliveries in Term Labor Induction Review
A systematic review and meta-analysis of 15 randomized trials involving 1,874 term pregnancies found lower odds of cesarean delivery with mifepristone than with control induction methods. Maternal and neonatal safety outcomes showed no differences, but were reported in relatively few studies.
- 15 randomized trials included 1,874 participants.
- Cesarean delivery odds were lower with mifepristone.
- Safety outcomes were sparsely reported.
This systematic review and meta-analysis assessed mifepristone, a progesterone receptor antagonist, for labor induction in singleton pregnancies at 37 weeks or later. The authors included 15 randomized controlled trials, comprising 1,063 participants receiving mifepristone across different dosing regimens and 811 in control groups. The primary outcome was cesarean delivery; secondary outcomes included induction efficiency and maternal and neonatal safety measures.
Cesarean delivery occurred in 33.1% of the mifepristone group and 41.9% of controls (odds ratio 0.67, 95% CI 0.54–0.82). Mifepristone was also associated with higher Bishop scores at 24 hours, shorter induction-to-delivery intervals, and less use of prostaglandins and oxytocin. A sensitivity analysis restricted to placebo-controlled and high-quality trials also found lower odds of cesarean delivery (OR 0.58, 95% CI 0.40–0.83).
No differences were observed in postpartum hemorrhage, neonatal intensive care admission, or low 5-minute Apgar scores. However, most trials did not report these outcomes, limiting conclusions about short-term safety. The findings indicate potential efficacy for term labor induction, but do not establish robust maternal or neonatal safety across settings.
In practice
For clinicians considering induction in singleton pregnancies at term, this review suggests mifepristone may improve cervical ripening and induction efficiency and may be associated with fewer cesarean deliveries than control induction methods. The evidence pools 15 randomized trials, but includes differing dosing regimens and control conditions. No differences were reported in selected short-term maternal and neonatal outcomes, yet most studies did not report these outcomes, so safety evidence remains limited. The findings alone do not establish a practice change.
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Obstetrics & Gynecology: Progesterone Receptor Antagonists for Labor Induction ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.