The use of Miropristone (Mifepristone) to stimulate childbirth

Stimulate generic activities, if necessary, doctors can be different methods. This includes mechanical expansion of the neck with a Foley catheter, and the introduction of kelp sticks into the cervical canal. But more often doctors resort to medical stimulation.

One of the most popular drugs is Miropriston (Mifepristone). How the drug works, whether it is safe, we will tell in this article.

To consider "Mifepriston" pills that cause childbirth, it would not be entirely true. This tool is used for "fire" (post-coital) contraception, and for artificial abortions in the early stages of pregnancy. The medication has taken its niche in the composition of medicines that promote induction of labor activity (labor induction).

The drug we are considering is a synthetic hormone related to steroid anti-progestogens. It blocks the production of progesterone and the effects of progesterone at the very first level - the receptor. The tool enhances the contractile ability of uterine tissue (myometrium) due to the fact that after taking interleukin-8, which increases the susceptibility of myometrium receptors not to progesterone, but to prostaglandins, is released. The egg is exfoliated and excreted.

As is known, to start labor in the body of pregnant women, the production of progesterone should stop at the natural level. If this does not happen for some reason, it may be necessary to stimulate labor by taking “Miropristona” (“Mifepristone”), which will “block” progesterone and create the hormonal balance necessary for childbirth.

Dual name should not mislead women. "Miropriston" is a separate drug, but its main active ingredient is mifepristone. That is why they are analogs.

It should be noted that the effectiveness of the tool is estimated at 98-99%, this applies to any area in which it can be used: for artificial abortion in the first half of the first trimester, and for emergency contraception, and for the induction of the birth process.

We will not describe the principle of the action of the drug in case of medical abortion; we will focus on the action of the drug during induction of labor.

When the term of labor has already passed, and the neck of the reproductive female organ has insufficient maturity, they give a single dose of “Mifepriston” when calling the birth. His method causes the blockage of progesterone, and under the action of prostaglandins, the cervix begins to mature faster. If the required degree of maturity cannot be achieved, the introduction of Dinoprostone hormonal gel into the cervix is ​​indicated.. Then other measures of stimulation can be applied, if time allows to wait or a cesarean section is performed, if there is no pronounced desired effect.

If the cervix is ​​immature, then one-time intake of "Mifepristone" in tablets is also carried out. In the absence of an effect, the question of the caesarean section probability is raised.

If the decision is made to stimulate labor with Mifepristone, in the morning a woman gives one pill (200 mg), a day later in the morning she receives a second pill of the same dosage. It should be noted that the remedy very often begins after the first pill. And then in the second there is no practical need.

It is necessary to clearly understand that contractions as such, the drug does not cause and does not 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 begin on their own, by other means, for example, oxytocin intravenously. And this combined allows you to get the desired result.

“Mifepristone” for induction of labor activity 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 the situations in which the use of this anti-progestogen is unacceptable.

First of all, a hormonal medicine is recommended in order to stimulate childbirth in pregnant women who have 41–42 weeks of gestation. This is the very period when the pregnancy itself is not yet considered post-mortem, but now it is time to help the woman to get ready for birth faster. This is especially true for women in labor who have a mature or untreated cervix in the current period.

But the need to cause childbirth can occur up to 41 weeks, and this: baby sensitization during Rh-conflict, baby death in utero, fetal hypoxia, requiring early delivery, some pathologies of a woman who, due to aggravation, prevent the end of pregnancy. "Mifepristone" can be used when the discharge of water ahead of time.

In some cases, at the discretion of the doctor may be stimulated with the threat of placental abruptionwith a significant delay in the development of the fetus, with severe preeclampsia with signs of pre-eclampsia in a pregnant woman.

• The drug is not used for stimulation in the event that a woman has any contraindications to natural childbirth (through the sexual physiological ways). Such indications include: clinically narrow pelvis, abnormal fetal position, large baby weight with abnormal presentation, low location of the placenta or its presentation, etc. In all these cases, caesarean section is considered to be the best way of delivery.

• 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 undergoing treatment with corticosteroid hormones for a long time. Women with blood clotting disorders, with severe anemia also do not show the use of "Mifepristone" for the induction of labor.
• At the discretion of the doctor, the drug is used with great caution when obstruction of the lungs, bronchial asthma, with high pressure in the woman in labor, as well as in women with impaired heart function - arrhythmia, heart failure, some defects.
• The drug is contraindicated in cases of uterine myoma, porphyria, inflammatory processes in the female genitals. Please note - the drug manufacturer is completely prohibited for women over 35 who smoke.

Very often on the Internet you can find an opinion on breastfeeding on the background of "Mifepristone". Instructions for use, indeed, prohibits breastfeeding a child after taking the drug, but this the ban applies only to women who have a medical abortion with this anti-progestogen. They should not feed their child with breast milk for three days after the abortion, if at the time of the abortion they already had a child.

After induction of labor using Mifepristone and other drugs based on it, breastfeeding is not prohibited by the manufacturer, it is not limited. Usually in 2-3 days, while lactation is being established, while the colostrum passes through the transitional milk stage to the main milk, most of the hormonal means, according to the manufacturers, are excreted by the body by the liver, kidneys.

Can I put the baby to the chest immediately after childbirth? Manufacturers do not exclude this possibility. However, in practice, everything is not so rosy.

• 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, abundant and difficult to correct, develops. This requires surgery - the decision is made to conduct an emergency cesarean section.

• Side effects include the aching pains in the abdomen and lower back, which most women in labor complain of, who have been stimulated to give birth with this medication.

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

• The anti-progestogen disrupts the normal intestinal motility, resulting in a broken stool. Some people have a fever. Allergies can develop - from rash to Quincke's edema.

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

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

Discussions about the admissibility and even ethical use of "Mifepristone" to stimulate the generic activity in recent years have not subsided. There are doctors who entrust this tool and often use it, there are categorical opponents of the drug, preferring other methods and methods of induction of labor.

With a greater degree of controversy associated with a fairly large number of deaths on the background of the reception of this anti-progestogen. In Western countries, it was estimated that since the beginning of an active mass use of mifepristone-based drugs, 15 women have died. The first case occurred in France, but then they didn’t take it seriously, because the woman who interrupted an unwanted pregnancy with a remedy smoked a lot and for a long time and had several more contraindications.

Further, there were fatal cases in Canada, USA, UK. In almost all cases, death occurred as a result of a medical abortion, and almost always, with rare exceptions, women and girls had certain contraindications that were simply ignored by them and their doctors. However, the drug has already gained fame dangerous and very controversial.

In other words, there is no convincing evidence base that would help doctors allow themselves to say that the drug is harmless to the mother and her babyto be born.However, to assert that "Mifepriston" is a danger for them, too, there is no reason yet.

Agree to use the funds or not, must decide the woman herself. She has the full right to inform about the method, method and medications for induction of labor. If a woman considers that such a drug is unacceptable for her, she should inform the attending physician., which will select a different method or method of stimulation of childbirth, or give preference to a cesarean section. To force a pregnant woman to sign consent to the use of "Mifepriston" no one has the right.

According to reviews of women who have stimulated labor with this drug, the drug does not always work. Some women in the thematic forums write that even two pills taken a day later did not work - Mifepriston did not work.

There are also reviews that the birth proceeded too quickly, in connection with which the child and the parturient woman had some complications.

Often, women indicate that the attending physician does not even want to hear about the patient’s refusal of the remedy based on personal convictions, and physicians refer to the fact that there are no alternatives. These are private situations in which women are encouraged to be more assertive. There are alternativesthey simply require more flexibility and extra effort from the doctor.

Even more useful information on the stimulation of labor is presented in the video below.