Tafoxiparin, a novel drug candidate for cervical ripening and labor augmentation: results from 2 randomized, placebo-controlled studies

Mifepristone versus Foley balloon catheter for outpatient cervical ripening at term: A non-inferiority randomised controlled trial

OBJECTIVE

To evaluate whether the success rate of oral mifepristone was not inferior to that of Foley balloon catheter for outpatient cervical ripening of term pregnancies, and whether there were differences in side effects for mothers and newborns.

DESIGN

Open-label, non-inferiority randomised controlled trial.

SETTING

A tertiary care European university hospital in an urban setting.

POPULATION OR SAMPLE

A total of 101 women with a Bishop's score < 6 and with an indication for outpatient cervical ripening at term.

METHODS

Participants were randomly allocated to receive either mifepristone 200 mg per os, or an intracervical Foley catheter balloon.

MAIN OUTCOMES MEASURES

Women going into labour in the first 24 h after the intervention or with a favourable Bishop's score (≥6) at the first re-evaluation, conducted 18-24 h after the intervention. We hypothesized that the incidence of the main outcome in the mifepristone group would be similar to that of the Foley balloon catheter group, within a margin of 10 %.

RESULTS

Onset of labour or favourable Bishop's score were achieved in 33.3 % of women receiving mifepristone and 30.2 % of those receiving the Foley balloon catheter (risk difference 0.03, 95 % confidence intervals -0.15 to 0.21). This confidence interval indicates that mifepristone can be 21 % superior but can also be 15 % inferior to the Foley catheter balloon, therefore not meeting our non-inferiority target of less than 10 %.

CONCLUSIONS

Similar rates of onset of labour or favourable Bishop's score were achieved with mifepristone and Foley balloon catheter in outpatient cervical ripening at term, but mifepristone could not be shown to be noninferior.

Parturition at term: induction, second and third stages of labor, and optimal management of life-threatening complications-hemorrhage, infection, and uterine rupture

Childbirth is a defining moment in anyone's life, and it occurs 140 million times per year. Largely a physiologic process, parturition does come with risks; one mother dies every two minutes. These deaths occur mostly among healthy women, and many are considered preventable. For each death, 20 to 30 mothers experience complications that compromise their short- and long-term health. The risk of birth extends to the newborn, and, in 2020, 2.4 million neonates died, 25% in the first day of life. Hence, intrapartum care is an important priority for society. The American Journal of Obstetrics & Gynecology has devoted two special Supplements in 2023 and 2024 to the clinical aspects of labor at term. This article describes the content of the Supplements and highlights new developments in the induction of labor (a comparison of methods, definition of failed induction, new pharmacologic agents), management of the second stage, the value of intrapartum sonography, new concepts on soft tissue dystocia, optimal care during the third stage, and common complications that account for maternal death, such as infection, hemorrhage, and uterine rupture. All articles are available to subscribers and non-subscribers and have supporting video content to enhance dissemination and improve intrapartum care. Our hope is that no mother suffers because of lack of information.