Doctors can stimulate labor activity in different ways, if necessary. This is a mechanical expansion of the neck with a Foley catheter, and the introduction of kelp rods into the cervical canal. But more often, doctors resort to drug stimulation.
One of the most popular drugs is Miropristone (Mifepristone). We will tell you about how the drug works, whether it is safe, in this article.
About the drug
It would not be entirely correct to consider "Mifepristone" as pills that induce labor. This tool is used for "fire" (postcoital) contraception, and for induced abortions in the early stages of pregnancy. The remedy also took its niche in the composition of medications that promote the induction of labor (labor arousal).
The drug we are considering is a synthetic hormone related to steroid antigestogens. 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 taking interleukin-8 is released, which increases the susceptibility of myometrial receptors not to progesterone, but to prostaglandins. The fertilized egg exfoliates and is brought out.
As you know, for the start of labor in the body of pregnant women, the production of progesterone must stop at a natural level. If this does not happen for some reason, it may be necessary to stimulate labor by taking "Miropristone" ("Mifepristone"), which "blocks" progesterone and creates the hormonal background necessary for childbirth.
The double name should not mislead women in labor. Miropristone is a separate drug, but mifepristone is its main active ingredient. Therefore, these are analogs.
For the induction of labor, other medications can be offered, the basis of which is mifepristone - "Mifegin", "Mifeprex", "Misoprostol" and others.
How does it work?
It should be noted that the effectiveness of the remedy is estimated at 98–99%, this applies to any area in which it can be used: for induced abortion in the first half of the first trimester, and for urgent contraception, and for induction of labor.
We will not describe the principle of action of the drug in medical abortion, we will focus on the action of the drug in the induction of labor.
"Mifepristone" is recommended for induction of labor, if a woman has an immature or insufficiently mature cervix. The remedy is allowed for both primiparous and those giving birth again, if there is a need to induce labor.
When the term of labor has already passed, and the cervix of the reproductive female organ has insufficient maturity, a single dose of "Mifepristone" is given when labor is called. Taking it causes a blockage of progesterone, and under the influence of prostaglandins, the cervix begins to ripen faster. If the desired degree of maturity cannot be achieved, the introduction of the hormonal gel "Dinoproston" into the cervix is indicated.... Then other stimulation measures can be applied, if time allows waiting, or a cesarean section is performed if there is no pronounced desired effect.
If the cervix is immature, then a one-time intake of "Mifepristone" in tablets is also carried out. In the absence of an effect, the question is raised about the likelihood of a caesarean section.
If a decision is made to stimulate labor with "Mifepristone", then in the morning the woman in labor is given one tablet (200 mg), a day later in the morning she receives a second tablet of the same dosage. It should be noted that the remedy very often begins to act after the first pill. And then there is no practical need for the second.
Thus, in the best case, "Mifepristone" begins to act in a few hours, up to a day. In some cases, the drug will act later, sometimes the duration of action is extended by 72 hours.
You need to clearly understand that contractions as such, the drug does not cause or stimulate. It affects the condition, the consistency of the cervix, affects the muscles, and when the desired effect is achieved, a woman can be provoked by contractions, if they do not start on their own, by other means, for example, intravenous drip oxytocin. And this, in combination, allows you to get the desired result.
Who is appointed?
"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 indicates the situations in which the agent can be used, and situations in which the use of this antigestagen is unacceptable.
First of all, a hormonal medication is recommended for 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's time to help the woman prepare for childbirth faster. This is especially true for women in labor who, at the current stage, have an insufficiently mature or generally immature cervix.
But the need to induce childbirth can occur up to 41 weeks, and this: sensitization of the baby during Rh-conflict, the death of the baby in utero, the state of fetal hypoxia, requiring an early delivery, some pathologies of a woman, which, due to exacerbation, interfere with the continuation of pregnancy to the end. "Mifepristone" can be used when water is discharged ahead of time.
In some cases, at the discretion of the doctor stimulation can be performed in case of a threat of placental abruption, with a significant delay in fetal development, with severe gestosis with signs of preeclampsia in a pregnant woman.
Women with diabetes, liver and kidney diseases are shown to induce labor earlier, up to 41 weeks.
Contraindications
- The drug is not used for stimulation if the woman has any contraindications to natural childbirth (through the genital physiological tract). These indications include: clinically narrow pelvis, abnormal position of the fetus, large weight of the baby with incorrect presentation, low location of the placenta or its presentation, etc. In all these cases, the optimal way of delivery is considered a cesarean section in a planned mode.
- The drug has a large list of side effects, and therefore its use is prohibited if a woman has renal or hepatic insufficiency, if she has been treated with corticosteroid hormones for a long time. Women with blood clotting disorders, with severe anemia are also not shown the use of "Mifepristone" for the induction of labor.
- At the discretion of the doctor, the drug is used with great caution in obstruction of the lungs, bronchial asthma, with high pressure in a woman in labor, as well as in women with impaired heart function - arrhythmia, heart failure, some defects.
- The drug is contraindicated for uterine myoma, porphyria, inflammatory processes in the genitals of a woman. Please note that the manufacturer is completely banned from the drug for women over 35 who smoke.
Effect on lactation
Very often on the Internet, you can find an opinion regarding breastfeeding against the background of "Mifepristone". Instructions for use, indeed, prohibit breastfeeding a baby after taking the drug, but this the prohibition applies only to women who have medical abortion with this antigestagen... They should not breastfeed their child for three days after the abortion if they already had a child at the time of the abortion.
After induction of labor with the help of "Mifepristone" and other drugs based on it, breastfeeding by the manufacturer is not prohibited, not limited. Usually in 2-3 days, while lactation is being established, while colostrum passes the stage of transitional milk to the main milk, most of the hormonal agent, according to manufacturers, is excreted by the body by the liver, kidneys.
Can I breastfeed my baby immediately after giving birth? Manufacturers do not exclude this possibility. However, in practice, things are not so rosy.
Due to the fact that the effect of mifepristone on a child has not yet been sufficiently studied, Russian doctors recommend expressing breast milk with traces of the hormonal substance for two weeks after the birth of a baby, and only then proceed to full breastfeeding.
Possible consequences
- Potential complications are due to the list of side effects of "Mifepristone". So, in 5% of cases, extensive bleeding from the uterus and genital tract develops, abundant and difficult to correct. This requires surgical intervention - a decision is made to perform an emergency caesarean section.
- Side effects include aching pain in the abdomen and lower back, which most women in labor complain about when they have been stimulated to labor with this medication.
- Many complain of feeling very weak, dizziness, headaches, and even loss of consciousness.
- The antigestagen disrupts normal intestinal motility, resulting in impaired stool. Some have fever. Allergies can also develop - from rashes to Quincke's edema.
- Possible complications after the use of "Mifepristone" and drugs based on it include the likelihood of rapid, rapid birth, which will pose a serious danger to the baby and mother, in terms of higher risks of getting them birth injuries.
- Also, complications are considered subsequent inflammatory processes in the uterus and appendages, in the ovaries, infectious postpartum complications from local to general (sepsis).
Pros and cons
Discussions about the admissibility and even the ethics of using "Mifepristone" for the stimulation of labor activity have not subsided over the past years. There are doctors who trust this tool and often use it, there are categorical opponents of the drug who prefer other methods and methods of induction of labor.
To a greater extent, the controversy is associated with a fairly large number of deaths while taking this antigestagen. In Western countries, it is estimated that since the beginning of the active mass use of drugs based on mifepristone, 15 women have died. The first case occurred in France, but then they did not take it seriously, because a woman who interrupted an unwanted pregnancy with the help of a drug smoked a lot and for a long time and had several more contraindications.
Further, there were deaths in Canada, USA, UK. In almost all cases, death occurred as a result of medical abortion, and almost always, with rare exceptions, women and girls had certain contraindications that were simply ignored by them and their attending physicians. However, the drug has already gained fame as dangerous and very controversial.
Some experts rely on the fact that the drug was originally created exclusively for emergency contraception and abortion for up to 42 days. It was not developed for women in childbirth, and therefore the drug was tested in this way.
In other words, there is no convincing evidence base that would help doctors afford to assert that the drug is harmless to a woman in labor and her babywho is about to be born. However, there is no reason to assert that Mifepristone poses a danger to them either.
Some doctors and obstetricians are inclined to believe that the antigestagen has too aggressive an effect on the placenta and exfoliates the membranes too quickly, and therefore it is possible that fetal disorders may occur.
It is up to the woman in labor to decide whether to agree to the use of the product or not. She has every right to be informed about the method, method and medicines for induction of labor. If a woman thinks that such a drug is unacceptable for her, she should inform her doctor about it., who will select a different method or method of stimulating labor or give preference to a cesarean section. Nobody has the right to force a pregnant woman to sign a consent to use "Mifepristone".
Reviews
According to the reviews of women who were stimulated to labor with this medication, the drug does not always work. Some women write on thematic forums that even two pills taken a day later did not give any result - "Mifepristone" did not work.
There are also reviews that childbirth proceeded too quickly, in connection with which the child and the woman in labor had some complications.
Often women indicate that the attending physician does not even want to hear about the patient's refusal from the remedy for personal reasons, doctors refer to the fact that there are no alternatives. These are particular situations in which women are encouraged to be more assertive. There are alternativesthey just require more flexibility and extra effort from the doctor.
See the video below for even more useful information on stimulating labor.
