Mifepristone for an expectant mother: who will help give birth

12/15/2018 Category: Medicines and vitamins Author: Marina Tumanova

Nine months of anxiety, fears and ailments are behind us; a new family member is about to take his first breath; a woman is preparing for childbirth. But not everyone’s contractions occur according to plan - sometimes they are delayed, and sometimes the contractions are weak, intermittent, the process is delayed and it is not clear how it will end. Doctors decide to induce labor; It’s no big deal—it’s just a woman swallowing a pill. For example, Mifepristone. We will evaluate the pros and cons of such drug stimulation, and tell you who it is suitable for and who it is not.

• How the drug will help induce labor
  When it is prescribed

• Rules for taking the drug

  Dosage, duration of action

• Who should not take Mifepristone?
• Adverse drug reactions
• Interaction with other medications

How does Mifepristone work in the body?

The drug is a synthetic hormone, a steroid from the group of antigestagens; Externally, mifepristone is a yellow powder with a greenish tint. The action of the drug is based on suppressing the synthesis of progesterone, one of the main hormones of pregnancy; we can say that mifepristone is a progesterone antagonist.

Use the product for:

• artificial termination of pregnancy at an obstetric period of up to 42 days;
• stimulation of labor when the pregnancy is full term;
• contraception after unprotected sexual intercourse (within three days);
• therapy for uterine leiomyoma, a benign tumor.

How the drug will help induce labor

In order for labor to begin, the level of progesterone, the pregnancy-protecting hormone, naturally decreases in the female body; for nine months, progesterone helped the fetus grow and develop, and prepared the mother’s body for childbirth. And when it’s time for the baby to leave the womb, the mature placenta stops synthesizing the hormone. He completed the task.

But sometimes the amount of progesterone does not decrease before childbirth; the woman is at risk of post-term pregnancy. In such a situation, mifepristone will help, which will block the production of progesterone and provide the hormonal background necessary for the onset of labor. Under the influence of the antigestagen, the muscle activity of the uterus increases and the labor process starts - the mucous plug comes off, followed by water; Contractions of the required intensity begin.

According to medical statistics, in four out of five patients who were given Mifepristone, labor began within two days after the start of therapy.

When is it prescribed?

The hormonal drug is used to stimulate labor in women whose pregnancy is 41 or 42 weeks, and there is no sign of the onset of labor; Doctors have not yet diagnosed a post-term pregnancy, but it is time to give birth.

When pregnancy exceeds 40 weeks, and there are no signs of the onset of labor, the likelihood of drug stimulation of the process increases

However, the need for a speedy delivery also arises at earlier stages - for example, when staying in the womb threatens the death of the fetus . An important condition is that the pregnancy must be full-term.

Mifepristone may be prescribed to those who:

• insufficiently mature or completely immature cervix;
• prolonged and too weak contractions, causing suffering to the woman in labor;
• there were contractions, but they stopped;
• amniotic fluid has broken prematurely;
• Rh conflict in the body; occurs when the Rh factor is negative in the mother and positive in the fetus; the structure of the child’s blood is disrupted, hemolytic disease develops;
• the placenta has begun to exfoliate, the fetus is threatened by hypoxia - oxygen starvation; More often in such a situation, doctors resort to caesarean section, but sometimes, if the condition of the woman and the fetus is normal, a natural birth with stimulation is possible;
• fetal death occurred in the womb.

Before birth, the cervix becomes shorter, softens, and acquires elasticity, as if creating “comfortable” conditions for the baby’s advancement; such a neck is called mature. But it happens that childbirth is approaching, but the muscular organ is still long and hard. Mifepristone is designed to stimulate cervical ripening.

The waters have broken, but contractions do not begin - this condition is dangerous for the life of the fetus; without amniotic fluid, as water is also called, the baby can remain in the womb for a maximum of 12 hours; Then irreversible changes occur in the baby’s body . Stimulation with Mifepristone is designed to speed up the birth of the baby.

Preterm abruption of the placenta can be caused by gestosis, a severe pathology that occurs exclusively in pregnant women. An antigestagen for such symptoms is prescribed if gestosis is sluggish; when the disease develops rapidly and progresses to the stage of preeclampsia or eclampsia (convulsions, sometimes cerebral hemorrhage, coma), Mifepristone is contraindicated.

An insufficiently mature cervix, an incorrect position of the placenta, when it partially covers the uterine os, and a breech presentation of the fetus lead to weak contractions. The result is the same - the woman suffers, but the baby still does not come out.

With a breech presentation, the baby is positioned with the buttocks or legs towards the entrance to the small pelvis; this often complicates childbirth

Every tenth case of labor complications is associated with sluggish contractions; During the first birth, the frequency of their occurrence is higher than during repeated births.

A number of doctors in such a situation rely on Mifepristone, which should affect the muscles of the uterus and soften the tissue of the cervix. The drug does not cause contractions themselves. It is possible, of course, that they will become more intense, but if not, they resort to other methods - for example, they give the woman in labor an IV with Oxytocin.

It is prohibited to use the drug on your own in the hope of bringing the long-awaited birth closer; Mifepristone is used exclusively in hospital settings, where there is modern equipment, including intensive care, and the condition of the mother in labor is monitored by medical staff. An antigestagen is prescribed after a thorough examination of the patient; the doctor first considers the possible negative consequences and correlates them with the benefits for the woman and the fetus.

Why is Mifepristone dangerous?

Not every specialist approves of using the drug to induce labor; The fact is that Mifepristone was originally developed as a means of contraception and termination of pregnancy in the early stages. As such, the medicine underwent clinical trials. Only later did scientists realize that reducing progesterone production would also help induce labor more quickly if the pregnancy was prolonged; But there is not yet enough scientific work on such use of the drug.

The main disadvantage of Mifepristone is its unproven safety for the mother and unborn child. However, no harmful effect has yet been discovered; In general, the medicine is considered controversial.

Other medical claims about the antigestagen:

• a number of scientists claim that expectant mothers who were given the drug more often had increased blood pressure and tachycardia; the fetal heartbeat also changed - but the matter did not reach pathological consequences;
• the drug acts aggressively on the placenta, exfoliating the membranes too quickly, and this threatens rapid labor, resulting in injuries to the baby and ruptures of the woman’s perineum;
• due to the unstudied effect of the substance mifepristone on the baby’s body, it is not recommended to breastfeed the baby in the first two weeks after birth, since the drug passes into breast milk; a woman has to pump; however, the manufacturer claims that the drug is cleared from the body in 2–3 days.

If the expectant mother considers that induction of labor with Mifepristone is not suitable for her, she has the right to refuse the drug; no doctor can force a patient to take medicine.

Mifepristone during labor

Dear mothers, I was recently asked a question about the use of Mifepristone during childbirth. I want to discuss this topic with you today, because I think that it is very important for a mother to be aware of the different drugs used by doctors during childbirth, because the course of labor and the birth of your baby depend on it! Never forget that even in the maternity hospital you have the right to ask for what you think is necessary and refuse what you think could be harmful. We respect doctors and trust them with our lives and the life of our baby. But let's remember that we must listen to our body and trust our intuition. It will also be very useful to study the topic of the most common manipulations and medications during childbirth. That's what we'll do today.

MIFEPRISTONE AND PREPARATION OF THE CERVIX FOR BIRTH.

Mifepristone is one of the drugs that is used in our country to induce labor. These are 2 tablets that are given to the mother at a certain interval. Mandatory with a doctor’s prescription and CTG monitoring of the child’s heartbeat. This is called pre-induction of labor (preparing the cervix) and is only done in a medical setting. ⠀ In our country, the means of choice for insufficiently mature cervix is ​​included in the protocol. According to the authors of Russian-language studies: in terms of the combination of effectiveness/side effects, mifepristone is optimal. ⠀ In some Western countries, mifepristone is not used for induction on live babies due to possible consequences, only for medical abortions and in case of death of the child. ⠀ There are doctors in Russia who do not use mifepristone for pre-induction of labor, precisely because of the high risks for the child. There is an opinion that mifepristone causes placental disturbances, causes peripheral vasospasm, and this leads to hypoxia. Quite often, when using it, rupture of meconium fluid occurs. About the consequences for the mother in detail in Wikipedia, I will not quote here.

I asked a doctor I respect, Galina Klimenko, to comment on the use of mifepristone (she uses it in her practice), below is the entire text from her, read to the end. I am very close to the conclusion.

DOCTOR'S OPINION

Mifepristone is an antiprogestogenic drug that blocks progesterone-sensitive receptors and leads to termination of pregnancy. ⠀ Despite the many printed works about the minimal risks of developing discoordination, the risks of cesarean section and complications in the form of fetal hypoxia, there are many limitations in using the method - they are also contraindications: ⁃ Kidney and liver failure ⁃ Inconsistency between the sizes of the mother’s pelvis and the fetal head: you should stop here more details, because this diagnosis is made only during childbirth, but it can be suspected earlier: either according to MR pelviometry, or by the presence of an anatomically narrow pelvis and a large fetus and a high-standing head! ⁃ Incorrect positions and presentations of the fetus: transverse, oblique, pelvic, etc. – Anomalies in the location of the placenta – Scar on the uterus – Tumors of the uterus that prevent the birth of the fetus – Severe preeclampsia – Abnormalities in the baby’s condition according to CTG – Bloody discharge from the genital tract of unknown origin – Chorioamniotitis

The patient's informed consent must be obtained for the use of mifepristone!

Possible complications: nausea, vomiting, diarrhea, headache, urticaria, weakness, hyperthermia. Compared to other methods, premature rupture of amniotic fluid is somewhat more common!

Now I would like to discuss why the method of preparation for childbirth and induction of labor has so many opponents? Everything is very simple: childbirth is a complex natural process, any intervention in which can lead to a whole cascade of subsequent actions and take us very, very far from physiology. Therefore, my dears, do not forget that pregnancy is a physiological process; it can normally last up to 42 weeks. Therefore, if the mother and baby are feeling well (ultrasound, Doppler, assessment of the amount of amniotic fluid, CTG up to several times a day at 42 weeks), it is most often better to just wait, using the so-called active surveillance, i.e. constantly monitoring mother and baby.

Is it difficult for a doctor?

Very difficult and very responsible. Sometimes the wait for birth drags on for 1-2 weeks, and this worries your obstetrician-gynecologist very much every time. But sometimes the birth still needs to be brought forward according to indications from the mother or baby.

So, who is indicated for induction, or “calling” labor before it starts on its own?

THERE ARE TWO GROUPS OF INDICATIONS

On the mother's side: – Post-term pregnancy. Most often we talk about 41-42 weeks, but everything is very individual! – Preeclampsia. The severity/duration of the course and the effect of the therapy are important; – Diabetes mellitus, incl. and GDM; – Cholestatic hepatosis: problems characterized by elevated liver enzymes, itching and bleeding disorders.

On the child’s side: – Rhesus conflict. Severe oligohydramnios in full-term pregnancy; – A tendency towards post-maturity and signs of fetal impairment (according to CTG and Doppler), and it is worth saying that the signs should be initial. Because if serious abnormalities are identified in the child’s condition, then it is best not to carry out an induction, but to raise the question of a caesarean section.

Believe me, my friends, it is much easier and calmer for your doctor to arrive at night for a birth that has begun with wonderful contractions, than to rack your brains about which method of pre-induction and induction of labor is right for you and what the consequences of all this will be.

In my opinion, this is the opinion of a competent doctor, do you agree with him?

Regarding induction of labor, I, of course, being a psychologist, do not advise mothers anything. It was important for me to give you information from both sides. Any intervention in the smart birth process is not just a pill, not just a dropper, not just some kind of injection. Everything has its side effects. Any type of so-called help to the body to give birth can lead to a domino effect (a flurry of medical interventions) and unpleasant consequences. Make an informed, informed decision, considering the risks and consequences of both options. Sometimes intervention saves lives, and sometimes it ruins. And only your MIND can distinguish one from the other.

How to learn to listen to your body? How to feel confident during childbirth, be calm in any situation and make decisions that will benefit both you and the baby?

In the hypnobirthing course we have a whole lesson that is dedicated to situations where childbirth does not go according to plan.
In addition, you will find a lot of useful and interesting things in the course, for example, techniques for reducing the level of sensations during childbirth and ways to naturally and safely stimulate the onset of labor if it does not begin on time. I want to take the Hypnobirthing course

Rules for taking the drug

Mifepristone is available in tablets for oral administration (by mouth); one piece contains either 50 or 200 milligrams of the active substance. Take the pills with water, and the instructions emphasize that a doctor should be nearby.

Dosage, duration of action

So, in the hospital, in the morning, the pregnant woman is given one tablet (the one with 200 milligrams). Sometimes the antigestagen causes labor just a few hours after administration (the highest concentration in the blood occurs after 4 hours), then a second pill is unnecessary. If there is no change in the woman’s condition during the day, she takes the second tablet exactly one day after the first use, the last one, since the maximum dose of the drug to induce labor is 400 milligrams.

A lot of expectant mothers have heard about the effectiveness of Mifepristone; the expression “two magic pills” is even used among pregnant women. However, some patients are disappointed - the notorious “magic” does not help.

A single tablet of Mifepristone is enough for labor to begin. It happens that
the medicine works later - after two or three days; if 72 hours pass and labor does not begin, it means that Mifepristone did not lead to the desired result. The doctor evaluates the patient's birth canal; The cervix still began to soften - then therapy can be continued. Prescribed if necessary:

• medications with prostaglandins (a gel containing the substance dinoprostone is injected into the cervical canal) or droppers with Oxytocin; after Mifepristone they usually give the desired effect;
• kelp - dense sticks of algae are inserted into the cervical canal; under the influence of plant matter, biochemical changes occur, the neck softens and opens;
• Foley catheter - a tube with a small balloon; inserted into the cervix, water is pumped into the balloon; a container of water expands the uterus, increases its motility; The method was found to be painful and not effective enough.

It happens that the cervix is ​​completely ripe with the help of medications, but labor does not develop; then they resort to amniotomy - puncture of the amniotic sac.

If the cervix does not respond to therapy at all, doctors, with the written consent of the patient, perform a cesarean section. You can refuse, because natural childbirth will eventually begin - it will only turn out to be long, difficult and “bloody”; It is possible that the baby will suffer a birth injury or suffocation.

Who should not take Mifepristone?

Drug stimulation is excluded for those expectant mothers for whom natural childbirth is generally contraindicated; This group, for example, includes pregnant women:

• with a narrow pelvis (the baby’s head cannot squeeze through the bones);
• with complete placenta previa, when the temporary organ completely blocks the exit from the uterus; with incomplete presentation, natural childbirth is also possible;
• with oblique or transverse presentation of the fetus; with breech presentation, most women are also indicated for cesarean section;
• with a post-term pregnancy - as a rule, the fetus is already too large and will not pass through the birth canal.

Other contraindications for taking the drug:

• intolerance to the substance mifepristone;
• severe gestosis - a condition of preeclampsia, eclampsia;
• long-term therapy with glucocorticoids - hormonal drugs that are used for insufficient adrenal function;
• impaired renal and liver function;
• the presence of a scar on the uterus;
• fibroids (benign tumor) of the uterus;
• porphyria is a hereditary pathology, accompanied by the appearance of blisters on the skin and photophobia;
• inflammatory processes in the genital organs;
• increased or decreased blood clotting;
• severe anemia;

  
  A low level of hemoglobin in a pregnant woman provokes anemia, most often expressed in a perversion of taste preferences; in severe cases of pathology, labor cannot be stimulated with Mifepristone

• premature pregnancy (before the 37th week);
• multiple pregnancy;
• fifth, sixth and so on births in a row.

Also, women over 35 years old should not take antigestagen when they smoke - but it is unlikely that among reasonable expectant mothers there will be smokers, and even in later stages.

A number of pregnant women are advised to take Mifepristone with caution - this group includes those who:

• bronchial asthma;
• chronic obstructive pulmonary disease;
• persistently elevated blood pressure;
• heart failure;
• cardiac arrhythmia.

Adverse drug reactions

A number of articles mention heavy bleeding that occurs every now and then after using Mifepristone, but such a reaction accompanies only artificial termination of pregnancy - abortion.

During stimulation of labor with pills, the following are possible:

• dizziness, headache;
• feeling of weakness;
• discomfort in the lower abdomen;
• aching pain in the lumbar region;
• nausea, vomiting;
• diarrhea;
• increased body temperature;
• skin rash (if you are allergic to the drug).

One of the consequences of taking Mifepristone can be rapid labor, due to which both newborns and women in labor often suffer injuries (women experience perineal ruptures).

Interaction with other medications

In addition to taking glucocorticoids, when using Mifepristone it is not recommended to take non-steroidal anti-inflammatory drugs, for example:

• Nurofen;
• Ibuprofen;
• Diclofenac;
• Indomethacin;
• Voltaren.

In combination with Mifepristone, they weaken the effect of the antigestagen. However, according to the instructions, all these drugs are prohibited in the 3rd trimester.

The tactics of labor management during full-term pregnancy and premature rupture of amniotic fluid (PROM) are still controversial. The most common opinion is that it is necessary to induce labor several hours after the rupture of amniotic fluid in order to prevent a long anhydrous interval [6, 14]. However, this approach is not always optimal, especially in the absence of biological readiness of the pregnant woman’s body for childbirth, as it often leads to labor anomalies, fetal hypoxia and, as a consequence, to an increase in the frequency of surgical delivery and obstetric injuries [7, 10]. In this regard, active expectant tactics for managing pregnancy and childbirth at full term against the background of PIOV, which allows labor to develop without the use of uterotonic drugs or to achieve optimal biological readiness for childbirth before induction of labor, is very relevant [1, 3, 10]. However, despite the presence of effective antibacterial drugs used to prevent purulent-septic complications in PIOV, an anhydrous period of more than 3 days, according to a number of authors, is not optimal [3, 10]. Based on this, there is a need to improve active expectant management of pregnancy and childbirth during PIOV using modern methods of preparing the soft birth canal for childbirth.

A number of authors suggest using prostaglandins of the E2 group in the form of intravaginal suppositories for PIOV. However, this method did not give positive results for the pathology under discussion. The use of kelp for PIOV is not recommended by many researchers, as the development of an ascending infection is accelerated. In recent years, antigestagen drugs have been actively studied and put into practice [2, 11]. In 1980, the first antigestagen, mifepristone (Ru 486), was developed and licensed in the laboratory of the Russel Uclaf company. Mifepristone has a high affinity for progesterone receptors, which determines the receptor mechanism of its action. Mifepristone binds to progesterone receptors, which leads to their conformational rearrangement, and further transcriptional effects become impossible. Thus, mifepristone blocks the effects of progesterone through competitive inhibition of its receptors [5]. When 100-800 mg of mifepristone is taken orally, the drug is rapidly absorbed from the gastrointestinal tract, and after 0.7-1.5 hours its concentration in the blood plasma averages 2.5 mg/l. In blood plasma, 98% of mifepristone is in a protein-bound state. After 12-72 hours, the concentration of mifepristone is reduced by half [9]. When mifepristone is prescribed to prepare for childbirth, pronounced signs of collagenolysis occur in the cervix. According to P. Stenlund et al. [12], after using mifepristone at a dose of 200 mg once a day, spontaneous labor began within the first 48 hours after taking the drug in 79.2% of patients (compared to 16.7% of pregnant women in the control group receiving placebo). It was noted that during vaginal delivery, women in labor who received mifepristone required lower doses of oxytocin than in the control group [8]. The use of antigestagens does not have a negative effect on the development of lactation and menstrual functions of women after childbirth and the condition of newborns [4, 8, 14].

Studies by D. Wing [13] show that the time interval from the start of treatment to the onset of labor averages 36.8±11.6 hours when using mifepristone and 44.5±14.7 hours after taking placebo. Vaginal delivery occurred in 87.5% of women receiving mifepristone and in 70.8% of women receiving placebo [13]. Currently, mifepristone is used to prepare the cervix for labor and induce labor at a dose of 200 or 400 mg [2, 4, 12, 13]. In the absence of biological readiness of the body for childbirth, pregnant women with PIOV have a need for more intensive preparation of the soft birth canal for it. However, the administration of 400 mg of mifepristone once in preparation for childbirth leads to a slight decrease in the average assessment of the newborn’s condition on the Apgar scale at 1 minute, but the difference with the control group is not significant. No differences were noted at the 5th and 10th minutes [12]. The use of this drug in a dosage of 200 mg once in pregnant women with PIOV, according to D. Wing and C. Guberman [14], did not give positive results compared to labor induction with oxytocin. Thus, there is a need to develop and implement new regimens for the use of antigestagens for PIOV.

The purpose of the study was to evaluate the effectiveness of using a drug from the antigestagen group - mifepristone - during full-term pregnancy and PIOV in the absence of the body’s biological readiness for childbirth.

Material and research methods

The main group consisted of 63 pregnant women with a gestational age of 37-40 weeks, in whom PIOV occurred against the background of an “immature” or “ripening” cervix. In these patients, active expectant management with mifepristone was used. The control group included 67 patients of the same period with PIOV in the absence of biological readiness for childbirth. In this group, standard tactics were used - labor induction 2-3 hours after the rupture of amniotic fluid.

Active expectant management included a comprehensive examination: clinical blood test 2 times a day, general urine test 1 time a day, bacterial culture from the cervical canal every 12 hours, thermometry every 3 hours, cardiotocography, ultrasound, Doppler. The pregnant woman was transferred to a separate ward. Vaginal examination was carried out once a day. Preparation for childbirth was carried out with antispasmodics and antioxidants.

Mifepristone was prescribed after PIOV, 0.2 g 2 times. The first time is immediately after the rupture of amniotic fluid. The second time - after 6 hours in the absence of regular labor (patent application for invention No. 2009121368/14 dated 06/04/2009).

If irregular uterine contractions occurred, therapy was supplemented with β-mimetics and calcium antagonists, and medicated sleep and rest were provided at night. If the water-free interval was more than 12 hours, antibacterial therapy was prescribed: amoxiclav 1.2 g intravenous bolus, 2 times a day. When optimal biological readiness of the body for childbirth was achieved, labor induction was carried out. In the absence of labor and a water-free interval of 72 hours, labor induction was planned.

Clinical characteristics of the study groups were as follows. The main group included 47 (74.6±5.5%) primiparous and 16 (25.4±5.5%) multiparous. In the control group there were 49 (73.13±5.4%) primiparous and 18 (26.87±5.4%) multiparous. In the main group, the average age of primiparous women was 27.2±6.4 years, multiparous women - 33.5±6.2 years. The average age of primiparous women in the control group was 26±5.4 years, multiparous women—35.4±6.8 years.

There were 3 older primigravidas in the main group (4.7±2.7%), and 2 (2.9±2.1%) in the control group. In the main group, infertility was detected in 9 (14.29±4.4%) patients, in the control group - in 11 (16.42±4.5%). During pregnancy, 17 (26.9±5.6%) patients in the main group and 21 (31.34±5.7%) in the control group were diagnosed with various types of genital tract infections that required antibacterial therapy. In the main group, PIOV occurred against the background of a “ripening” cervix in 44 (69.84±5.8%) patients, in 19 (30.16±5.8%) - against the background of an “immature” cervix. In the control group, PIOV occurred on the cervix in 49 (73.1±5.4%) pregnant women, in 18 (26.9±5.4%) - against the background of “immature”.

Research results and discussion

According to the analysis of the dynamics of the birth act, in the main group the anhydrous interval in primiparous women averaged 14 hours 20 minutes, in multiparous women - 11 hours 50 minutes. In the control group, the anhydrous period averaged 12 hours 35 minutes for primiparous women and 11 hours 55 minutes for multiparous women. Thus, as shown in Fig. 1,

Figure 1. Duration of the anhydrous interval with different labor management tactics. The duration of the anhydrous interval is slightly longer in primiparas of the main group, and almost the same in multiparous ones.

The latent period (the time interval between the discharge of amniotic fluid and the onset of labor) in the main group averaged 8 hours 25 minutes and 5 hours 15 minutes in the control group. The average duration of labor in primiparas of the main group was 7 hours 50 minutes, in multiparous women - 6 hours 35 minutes. The average duration of labor in primiparas in the control group was 8 hours 50 minutes, in multiparous women - 7 hours 15 minutes (Fig. 2).

Figure 2. Duration of labor with different management tactics. Thus, with active expectant management, the duration of labor increases, but not statistically significant.

Anomalies of labor in the main group were noted in 6 (9.5±3.7%) women in labor. Of these, 5 (7.9±3.4%) had weak labor and 1 (1.6±1.6%) had rapid labor. Anomalies of labor were detected in 21 (31.34±5.7%) parturients in the control group. Of these, 12 (17.9±4.7%) had weak labor, 4 (5.9±2.9%) had discoordinated labor, and 5 (7.5±3.2%) had rapid labor. childbirth. Thus, the use of mifepristone with active expectant management tactics statistically significantly reduces the incidence of labor anomalies (Table 1).

In the main group, 4 (6.3±3.1%) patients delivered through the abdominal route. The reason for one operation was fetal hypoxia. Intraoperatively, a double entanglement of the umbilical cord around the fetal neck was detected. The indication for the remaining three operations was weakness of labor, which was not amenable to drug correction. In the control group, 15 (22.4±5.1%) women gave birth using cesarean section. Indications for operative delivery were the lack of effect from induction of labor in 8 (11.9±3.9%) cases, weakness of labor combined with fetal hypoxia in 3 (4.5±2.55) cases, weakness of labor not responding to drug correction, in 2 (2.9±2.1%) women in labor, fetal hypoxia in 2 (2.9±2.1%) cases. Two births (2.9±2.1%) in the control group were completed by applying exit forceps due to fetal hypoxia.

A total of 8 (12.7±4.2%) cases of fetal hypoxia were identified in the main group. There were no cases of children being born in a state of asphyxia. The diagnosis of fetal hypoxia in the control group was recorded in 21 (31.3±5.7%) births. In 7 (10.45±3.7%) cases, children were born in a state of asphyxia, with one (1.49±1.48%) of them in a state of severe asphyxia (2 points on the Apgar scale).

Labor induction in the main group was performed in 13 (20.6±5.1%) cases. The cause of labor induction was the presence of a “mature” cervix. In the remaining cases (46 women, 73.0%), labor developed spontaneously. In the control group, labor began spontaneously within 3 hours after PIOV in only 3 (4.5±2.5%) women. In 65 (97.1±2.1%) examined patients, labor was induced. Thus, the use of mifepristone during active expectant management significantly reduced (p<0.01) the need for induction of labor.

Perineotomy was performed in the main group in 14 (22.2±5.1%) cases, in the control group - in 27 (40.3±5.2%). This difference is statistically significant and, according to our observations, is associated with a high incidence of labor weakness and fetal hypoxia in the control group.

Drug pain relief during labor was performed in 21 (33.3±5.9%) women in labor in the main group, and in 23 (36.5±6.1%) in the control group. Long-term epidural anesthesia (LPA) in the main group was performed in 9 (13.4±4.1%) women, in the control group - in 14 (22±5.2%).

In the postpartum period, 4 (6.3±3.1%) cases of uterine subinvolution were noted in the main group. In 2 (3.2±2.2%) cases, infiltrate was detected in the area of ​​the perineal sutures, in 1 (1.6±1.6%) - endometritis (Table 2).

Postpartum women received conservative therapy with a positive outcome. Thus, 7 (10.45±3.7%) women had complications in the postpartum period in the main group.

In the postpartum period, 7 (10.45±3.7%) cases of uterine subinvolution were noted in the control group. In 2 (2.9±2.1%) postpartum women, infiltrates were detected in the area of ​​the perineal sutures. In total, the number of complications in the postpartum period in the control group was 9 (13.4±4.2%). It is obvious that active expectant management of pregnancy and childbirth during PIOV does not affect the course of the postpartum period.

conclusions

1. The use of mifepristone during active expectant management of urgent labor after PIOV in the absence of the body’s biological readiness for childbirth can reduce the incidence of labor anomalies, operative delivery, fetal hypoxia and asphyxia of the newborn.

2. The use of antigestagens during PIOV promotes the spontaneous development of labor and helps reduce the frequency of labor induction.

3. When choosing active expectant tactics for PIOV with the use of mifepristone, there is no significant increase in the anhydrous interval, as well as the incidence of purulent-septic complications during childbirth and the postpartum period.

4. These data give reason to believe that the use of antigestagens in PIOV will be further developed.

Mifepristone analogs

The pharmaceutical industry produces a number of drugs synonymous with Mifepristone, created on the basis of the same active substance - these are Ginestril, Ginepristone, Zhenale and others. However, these drugs are intended for contraception, treatment of fibroids, or medical abortion. Only the original drug, according to the clinical protocol of the Russian Ministry of Health, is used in maternity hospitals to stimulate labor.

If you are offered to induce labor with Miropriston, do not be surprised; this is another name for the same Mifepristone.

Miropriston is the same antigestagen, only under a different brand name

But the drug Misoprostol, which is an artificial analogue of prostaglandin E1, is contraindicated for pregnant women, although in some countries these tablets are taken to stimulate labor (so to speak, without official permission).

Mifepristone is an expensive drug; one tablet costs from one thousand to one and a half thousand rubles. The drug is purchased by maternity hospitals and used strictly according to indications.

Among the functional analogues of antigestagen, which are used to induce labor, are drugs with a different composition; sometimes they are used in combination with Mifepristone, sometimes separately . Substitutes also help with the patient’s allergy to Mifepristone.

Table: functional analogues of Mifepristone

Oxytocin reinforces the action of Mifepristone; if necessary, the drug is administered after the antigestagen.
Although kelp sticks have a minimum of contraindications and adverse reactions, administering the herbal remedy at home is unacceptable; The procedure is performed exclusively by a doctor, and later the medical staff monitors the patient’s condition.

Once at the scene of action, the kelp stick swells and fills the entire space of the cervical canal

A few words about natural stimulation of labor

It is possible that you can speed up the approach of labor without the help of medications. This work is only possible when:

• pregnancy is full term;
• the doctor approved the method.

Here are some tips on how to speed up the birth of your baby if the due date has already approached:

• when the cervix is ​​ripe, but labor is not noticeable, try massaging the nipples; sometimes it helps, and the process starts in the next three days;
• walking up and down the stairs often provokes the onset of labor; Walking is also suitable - the main thing is to maintain a vertical body position so that the baby drops lower and causes the cervix to dilate;

  
  Walking brings many mothers closer to the onset of labor.

• sex without a condom - not just once, but many times; the uterus will become toned, and the sperm contains prostaglandins, which will soften the cervix;
• talk to the baby, explain to the baby how loved and expected he is, tell him that the whole family is preparing for his birth; this kind of meditation will calm the woman, relieve anxiety, stress - and ultimately childbirth will come;
• some practice cleaning floors while standing on all fours;
• introduce more foods with a laxative effect into your diet: prunes, cucumbers, cabbage, vegetable oil; active intestinal peristalsis will cause the uterus to “move” - the tone of the organ will increase; just don’t overdo it so as not to provoke intestinal upset.

Be careful with traditional medicine - some recommend drinking primrose oil, castor oil and other remedies; you risk causing allergies or acute diarrhea, which is especially dangerous on the eve of childbirth .