Induction of Labour in Intrauterine Death

Recommended Induction Agents for IUFD

• The American College of Obstetricians and Gynecologists (ACOG) recommends high-dose PGE2 vaginal suppositories for management of intrauterine fetal demise in the second trimester 1, 2, 3
• The American College of Obstetricians and Gynecologists (ACOG) recommends intravaginal misoprostol for induction of labor in third-trimester intrauterine fetal demise, with a Level C recommendation based on consensus and expert opinion 1, 2, 3

Specific Dosing Protocols

• Lower dosages of misoprostol (25 µg every 3-6 hours) are effective for cervical ripening and induction of labor, according to ACOG guidelines 1, 2, 3
• Higher dosages of misoprostol (50 µg every 6 hours) may be appropriate in some situations, though they carry increased risk of uterine hyperstimulation, as noted by ACOG 1, 2, 3

Safety Profile and Monitoring

• The American College of Obstetricians and Gynecologists (ACOG) states that dinoprostone gel, misoprostol, and Foley catheter are all safe for induction in IUFD cases, even in women with previous cesarean section 1, 2, 3
• Fetal heart rate monitoring is not applicable in IUFD cases, according to ACOG guidelines 1, 2, 3
• Standard monitoring for maternal vital signs and uterine activity should continue, as recommended by ACOG 1, 2, 3

Important Caveats

• Cost considerations strongly favor misoprostol ($0.36-$1.20 per tablet) over dinoprostone ($65-$165 per kit), as noted by ACOG 1, 2, 3
• Misoprostol is stable at room temperature, unlike dinoprostone which requires refrigeration, according to ACOG guidelines 1, 2, 3