A Comparative Study on the Efficacy of Mifepristone-Misoprostol Combination versus Misoprostol Alone and Intracervical Catheter (ICC) in the Management of IUFD at Rangpur Medical College Hospital

Open Access

Abstract

Background: Intrauterine fetal death (IUFD) presents a profound obstetric challenge requiring safe and effective induction of labour. In Bangladesh, misoprostol alone and mechanical methods like an intracervical catheter (ICC) are commonly used, but evidence on the efficacy of the mifepristone-misoprostol combination in this setting is limited. Objective: To compare the induction-to-delivery interval and maternal outcomes of three methods for managing IUFD: mifepristone-misoprostol combination, misoprostol alone, and intracervical catheter (ICC). Methods & Materials: A prospective cohort study was conducted at Rangpur Medical College & Hospital, Rangpur, from January 2025 to December 2025. Using purposive sampling, 29 women with IUFD (≥24 weeks) were allocated to three groups: Group A (mifepristone 200mg orally followed by oral misoprostol, n=10), Group B (oral misoprostol alone, n=10), and Group C (ICC with oxytocin augmentation, n=9). The primary outcome was the induction-to-delivery interval. Data were analyzed using SPSS version 23.0. Results: The mean induction-to-delivery interval was significantly shortest with mifepristone-misoprostol (10.8±2.9 hours), followed by misoprostol alone (15.4±4.1 hours) and ICC (19.1±5.3 hours) (p<0.001). The 24-hour vaginal delivery success rate was highest in the combination group (90%), versus 70% with misoprostol and 55.6% with ICC. Maternal complication rates (e.g., PPH) were low and comparable across all three methods. Conclusion: The mifepristone-misoprostol regimen was the most efficacious method for labour induction in IUFD, achieving the shortest delivery time and highest success rate. Misoprostol alone was a viable alternative, while ICC was associated with the longest induction interval.