- Design
- Systematic review and meta-analysis of 15 randomised trials
- Population
- 1,874 women with singleton pregnancies at 37 weeks or more undergoing induction
- Primary outcome
- Caesarean delivery
- Effect
- 33.1% vs 41.9%, OR 0.67 (95% CI 0.54 to 0.82); high-quality trials OR 0.58 (0.40 to 0.83)
A meta-analysis in Obstetrics & Gynecology pooled 15 randomised trials of mifepristone for induction in singleton pregnancies at 37 weeks or more, comparing 1,063 women given mifepristone with 811 receiving placebo or a standard method. Trials combining mifepristone with other ripening agents were excluded so its effect could be isolated.
Caesarean delivery occurred in 33.1% with mifepristone against 41.9% in controls (OR 0.67, 95% CI 0.54 to 0.82). Restricting to placebo-controlled and high-quality trials gave a similar result (OR 0.58, 0.40 to 0.83). Bishop scores at 24 hours were higher, induction-to-delivery intervals shorter, and fewer women needed prostaglandin or oxytocin.
Safety is the gap. No differences were found in postpartum haemorrhage, NICU admission or low Apgar scores, but most trials did not report these outcomes. Dosing regimens also varied.
This is not yet guideline practice for term induction, and mifepristone availability is restricted in many settings. It is a strong case for a well-designed trial, and for units already using mifepristone in other obstetric indications to think about it as an outpatient ripening option.
- Mifepristone before induction at term was associated with about one fewer caesarean per 11 women in pooled trials.
- Expect better cervical ripening at 24 hours and less need for prostaglandin and oxytocin.
- Neonatal and haemorrhage safety data are thin because most trials did not report them.
- Current induction guidelines have not changed; use mifepristone for term ripening only within local protocols or a trial.
- In India, mifepristone is licensed for termination of pregnancy; its use for term induction would be off label.
Why it matters
A drug already in obstetric units may cut caesareans after induction, which no current ripening method has reliably done.
Don't overread it
Safety outcomes were reported in a minority of trials, so short-term neonatal safety is not established.
The statistics, in plain English
An odds ratio of 0.67 with an interval of 0.54 to 0.82 stays well below 1, so the reduction is unlikely to be chance. The absolute difference, 33.1% against 41.9%, is about 9 percentage points.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for obstetrics & gynaecology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free