Use of Mirapristone (Mifepristone) to stimulate labor

A drug called mirapristone, also known as mifepristone, is used to help induce labor. By causing contractions and softening the cervix, it can aid the body in getting ready for delivery. When the mother’s or the child’s health requires that labor be medically started, this approach is frequently taken into consideration.

It’s critical to comprehend how mirapristone functions and what to anticipate when using it. After carefully evaluating the circumstances and guaranteeing the safest outcome for mother and child, doctors typically recommend it.

Families may find labor induction with mirapristone less stressful if they are aware of the procedure and possible side effects. During this crucial period, it enables more informed decision-making and improved communication with healthcare providers.

Use of Mirapristone	Purpose
Mirapristone (Mifepristone)	Used to stimulate labor by softening the cervix and preparing the uterus for contractions.
Administration	Usually given orally under medical supervision to ensure safety and effectiveness.
Effectiveness	Helps initiate labor within a few days of administration in most cases.
Side Effects	Possible side effects include nausea, vomiting, or cramping.
Medical Supervision	Essential to monitor both mother and baby during the process.

About the drug

It would not be entirely correct to consider "Mifepristone" as a pill that induces labor. This drug is used both for "fire" (postcoital) contraception and for artificial abortions in the early stages of pregnancy. The drug has also found its niche in the composition of medications that promote the induction of labor (labor induction). The drug we are considering is a synthetic hormone that belongs to steroid antigestagens. It blocks the production of progesterone and the effect of progesterone at the very first level – the receptor. The drug enhances the contractile ability of the uterine tissue (myometrium) due to the fact that after administration, interleukin-8 is released, which increases the susceptibility of the myometrium receptors not to progesterone, but to prostaglandins. The fertilized egg is exfoliated and excreted.

It is well known that a natural cessation of progesterone production is necessary for labor to start in a pregnant woman’s body. If, for some reason, this does not occur, it might be necessary to induce labor with "Mifepristone," which "blocks" progesterone and establishes the hormonal environment required for labor. Women who are in labor shouldn’t be misled by a double name. Mifepristone is the primary active ingredient in "mifepristone," a different medication. These are analogs as a result.

Misoprostol, Mifegin, Mifeprex, and other mifepristone-based medications can be administered for the induction of labor.

How it works?

It should be mentioned that the medication’s effectiveness is estimated to be between 98 and 99% in all situations where it can be used, including emergency contraception, inducing labor, and artificial abortion during the first half of the first trimester. We will concentrate on the drug’s action during labor induction rather than discussing its mechanism of action during medical abortion.

It is advised to use "Mifepristone" to induce labor in women whose cervixes are immature or not sufficiently mature. If an induction of labor is necessary, the medication is approved for both first-time mothers and women giving birth again.

When the due date has already passed, and the cervix of the female reproductive organ is not mature enough, a single dose of "Mifepristone" is given when inducing labor. Its administration causes progesterone blocking, and under the influence of prostaglandins, the cervix begins to mature faster. If the desired degree of maturity cannot be achieved, the introduction of the hormonal gel "Dinoprostone" into the cervix is ​​indicated. Then other stimulation measures can be used if time allows waiting, or a cesarean section is performed if there is no pronounced desired effect. If the cervix is ​​immature, then a single dose of "Mifepristone" in tablets is also taken. If there is no effect, the question of the likelihood of a cesarean section is raised.

In the event that it is decided to use Mifepristone to induce labor, the laboring woman is given one 200 mg tablet in the morning and another one the same day in the morning. It should be mentioned that the medication frequently starts to work after the initial tablet. After that, the second is not really necessary.

Consequently, Mifepristone starts to work in a few hours to a day in the best scenario. The medication may take longer to take effect in certain situations; in other cases, it may take up to 72 hours.

It is important to realize that the medication does not, in and of itself, induce or stimulate contractions. When the desired outcome is reached, the woman may be given an intravenous injection of oxytocin to induce contractions if they do not start spontaneously. It affects the cervix’s consistency and condition as well as the muscles. And when all of this is combined, you can achieve the intended outcome.

Who is prescribed?

"Mifepristone" for induction of labor and preparation of the cervix is ​​prescribed in accordance with the clinical protocol of the Ministry of Health of Russia. It clearly specifies the situations in which the drug can be used, and the situations in which the use of this antigestagen is unacceptable. First of all, the hormonal drug is recommended in order to, stimulate labor in pregnant women who are 41-42 weeks of gestation. This is the very period when the pregnancy itself is not yet considered post-term, but it is time to help the woman prepare for labor faster. This is especially important for women in labor whose cervix is ​​not sufficiently mature or is not mature at all at the current stage.

However, there are a few reasons why inducing labor before the 41st week might be necessary: the baby becoming sensitive due to a Rh conflict; the baby passing away in utero; a condition of fetal hypoxia necessitating an early delivery; or the woman having certain pathologies that, when exacerbated, make it difficult to carry the pregnancy to term. In cases where the water breaks early, "Mifepristone" can be used. In certain situations, stimulation may be administered at the doctor’s discretion if there is a risk of placental abruption, the fetus is developing significantly later than expected, the pregnant woman has severe gestosis, or there are signs of preeclampsia.

Diabetes, liver, and kidney disorders can cause a woman to experience labor stimulation earlier—before 41 weeks.

When prescribed by a doctor, the drug mirapristone (also known as mefepristone) is used to induce labor. It functions by causing the cervix to soften and increasing the uterus’s sensitivity to contractions. To protect the mother and child, this technique is usually applied under strict medical supervision.

Contraindications

• The drug is not used for stimulation if the woman has any contraindications to natural childbirth (through the genital physiological tract). Such indications include: a clinically narrow pelvis, an incorrect position of the fetus, a large baby weight with an incorrect presentation, a low location of the placenta or its presentation, etc. . In all these cases, the optimal method of delivery is considered to be a planned cesarean section.

• The drug has a large list of side effects, and therefore its use is prohibited if the woman has renal or hepatic insufficiency, if she has been treated with corticosteroid hormones for a long time. Women with blood clotting disorders and severe anemia are also not shown the use of "Mifepristone" for induction of labor.
• At the discretion of the doctor, the drug is used with great caution in case of pulmonary obstruction, bronchial asthma, high blood pressure in women in labor, as well as in women with heart problems – arrhythmia, heart failure, some defects.
• The drug is contraindicated in uterine fibroids, porphyria, inflammatory processes in the female genitals. Please note – the drug is completely prohibited by the manufacturer for women over 35 years old who smoke.

Effect on lactation

You can frequently find opinions about breastfeeding against the backdrop of "Mifepristone" on the Internet. The usage guidelines do, in fact, forbid nursing a child after taking the medication, but this restriction only extends to women who use the antigestagen during a medical abortion. If they were pregnant when they had the abortion, they shouldn’t nurse their infant for three days following the procedure.

The manufacturer of "Mifepristone" and similar drugs does not forbid or restrict breastfeeding following labor induction. As lactation progresses and colostrum transitions from transitional milk to main milk in 2-3 days, the majority of the hormonal agent is eliminated by the body through the kidneys and liver, according to the manufacturers.

Is it feasible to nurse the newborn right away after birth? The makers do not rule out the possibility. But in real life, things are not always as clear-cut.

Russian doctors advise expressing breast milk containing traces of mifepristone for two weeks after the baby is born, and only then transferring to full breastfeeding, as the hormone’s effects on the child have not yet been thoroughly studied.

Possible consequences

• Potential complications are due to the list of side effects of "Mifepristone". Thus, in 5% of cases, extensive bleeding from the uterus and genital tract develops, profuse and difficult to correct. This requires surgical intervention – a decision is made to perform an emergency cesarean section.

• Side effects include aching pain in the abdomen and lower back, which bo?most of the women in labor who were induced labor with the help of this drug.

• Many complain of feelings of severe weakness, dizziness, headaches and even loss of consciousness.

• Antigestagen disrupts normal intestinal peristalsis, resulting in stool disturbance. Some have a fever. Allergies can also develop – from a rash to Quincke"s edema.

• Possible complications after the use of "Mifepristone" and drugs based on it include the likelihood of rapid, rapid labor, which will create a serious danger for the baby and mother, in terms of higher risks of birth injuries.

• Complications also include subsequent inflammatory processes in the uterus and appendages, in the ovaries, infectious postpartum complications from local to general (sepsis).

Pros and cons

In recent years, there have been ongoing discussions concerning the admissibility and even the ethics of using "Mifepristone" to induce labor. While some physicians firmly believe in and frequently utilize this medication, others are vehement opponents who would rather employ alternative approaches to induce labor.

The controversy is more closely linked to a sizable number of deaths that occurred in conjunction with the use of this antigestagen. It was estimated that 15 women have died as a result of mifepristone-based medications in Western nations since they were first widely used. The first instance happened in France, but it was not taken seriously at the time because the woman who used the medication to end an unintended pregnancy smoked heavily, for a long time, and had multiple contraindications.

Moreover, there were deadly cases in the United States, Canada, and Great Britain. With very few exceptions, women and girls almost always had certain contraindications that their attending physicians chose to ignore, and in almost all cases, drug abortions resulted in death. But the drug has already become well-known for being highly controversial and dangerous.

Certain experts base their arguments on the fact that the medication was initially developed only for use in emergency situations and for 42-day abortions. Because it was not intended for use by women going into labor, the medication underwent this kind of clinical testing.

Put another way, there isn’t any solid evidence to support medical professionals’ claims that the medication won’t harm the expectant mother or the unborn child. But there’s also no reason to suggest that "Mifepristone" poses a risk to them.

The antigestagen may cause the fetus to develop abnormalities because some medical professionals, including obstetricians, feel that it acts too aggressively on the placenta and separates the fetal membranes too soon.

It is up to the laboring woman to choose whether or not to take the medication. She has every right to know the procedure, the drugs, and the means of inducing labor. A woman should let her doctor know if she feels that taking such a medication is inappropriate for her; in that case, the doctor will either choose an alternative approach to inducing labor or will recommend a cesarean section. A pregnant woman should not be forced to sign a consent form before using "Mifepristone."

When used under close medical supervision, mirapristone, also known as mefepristone, can be a useful tool for inducing labor. It can aid in preparing for childbirth by softening the cervix and enhancing the body’s responsiveness to contractions.

But it’s crucial to keep in mind that not everyone should take this medication. A medical professional should decide whether to use it after taking the particulars of the pregnancy into account.

There are risks associated with any medical procedure, so close observation is necessary to guarantee the mother’s and the child’s health and safety.

Video on the topic

Medical abortion. Acceptable terms and methods of termination of pregnancy.

No. 29 It is important to know that Artificial Stimulation of Labor begins with Pre-Induction

Medical abortion #doctor #gynecologist #pregnancy

👩 Medical termination of pregnancy or abortion

Mifepristone

Labor induction what is it? Is it possible to refuse labor induction in the maternity hospital?