Maternal and neonatal outcomes following additional doses of vaginal prostaglandin E2 for induction of labour

a retrospective cohort study

Huma Ayaz, Mairead Black, Priya Madhuvrata, Ashalatha Shetty

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objective
To assess maternal and neonatal outcomes following the use of additional doses of vaginal prostaglandins (PGE2) above the recommended dose for induction of labour in post-dates pregnancies.

Study design
Retrospective cohort study set in Aberdeen Maternity Hospital, Aberdeen, UK. A total of 3514 nulliparous women with labour induced with vaginal PGE2 (3 mg tablet or 2 mg gel) for a post-dates singleton pregnancy from January 1994 to December 2009 were included. Women receiving ≤ 2 doses of PGE2 were compared with those receiving > 2 doses (maximum 5 doses). Binary logistic regression was used to calculate odds ratios (OR) with 95% confidence intervals (CI). Primary outcomes included mode of delivery, terbutaline use, indication for CS, postpartum haemorrhage, neonatal unit admission, and Apgar score < 7. A further analysis was conducted which stratified for number of doses of PGE2 given.

Results
Of the 3514 women who met inclusion criteria, 605 (17%) received PGE2 that exceeded the licensed dose. They were more likely to deliver by caesarean section (53.4% vs. 31.8%, OR 2.2, 95% CI 1.8–2.6), have a caesarean section for ‘failed’ induction of labour (11.4% vs. 1.9%, OR 4.1, 95% CI 1.3–13.2) or lack of progress in labour (37% vs. 17%, OR 2.8, 95% CI 2.3–3.4), but not for fetal concerns (8.2% vs. 8.8% OR 0.9, 95% CI 0.7–1.3). Terbutaline use and postpartum haemorrhage was no more likely (0.7% vs. 0.9% OR 0.6 95% CI 0.3–1.5 and 19.8% vs. 18.9% OR1.01, 95% CI 0.97–1.06 respectively). Apgar score < 7 (1.1% vs. 1.3% OR 0.9 95% CI 0.8–1.1) and neonatal unit admission (13.7% vs. 10.7% OR 1.2 95% CI 0.8–1.6) were similar in both groups.

Conclusion
The use of additional doses of vaginal PGE2 above the recommended dose for induction of labour was not associated with increased maternal or neonatal morbidity and almost half of these women achieved a vaginal delivery.
Original languageEnglish
Pages (from-to)364-367
Number of pages4
JournalEuropean Journal of Obstetrics & Gynecology and Reproductive Biology
Volume170
Issue number2
Early online date8 Aug 2013
DOIs
Publication statusPublished - Oct 2013

Fingerprint

Induced Labor
Dinoprostone
Cohort Studies
Retrospective Studies
Mothers
Confidence Intervals
Odds Ratio
Terbutaline
Postpartum Hemorrhage
Apgar Score
Cesarean Section
Maternity Hospitals
Pregnancy
Tablets
Prostaglandins
Logistic Models
Gels
Morbidity

Keywords

  • induction of labour
  • post-dates pregnancy
  • prostaglandins
  • licensed dose

Cite this

@article{a6bb00438a8343efbcdf1a4ad315b0f6,
title = "Maternal and neonatal outcomes following additional doses of vaginal prostaglandin E2 for induction of labour: a retrospective cohort study",
abstract = "ObjectiveTo assess maternal and neonatal outcomes following the use of additional doses of vaginal prostaglandins (PGE2) above the recommended dose for induction of labour in post-dates pregnancies.Study designRetrospective cohort study set in Aberdeen Maternity Hospital, Aberdeen, UK. A total of 3514 nulliparous women with labour induced with vaginal PGE2 (3 mg tablet or 2 mg gel) for a post-dates singleton pregnancy from January 1994 to December 2009 were included. Women receiving ≤ 2 doses of PGE2 were compared with those receiving > 2 doses (maximum 5 doses). Binary logistic regression was used to calculate odds ratios (OR) with 95{\%} confidence intervals (CI). Primary outcomes included mode of delivery, terbutaline use, indication for CS, postpartum haemorrhage, neonatal unit admission, and Apgar score < 7. A further analysis was conducted which stratified for number of doses of PGE2 given.ResultsOf the 3514 women who met inclusion criteria, 605 (17{\%}) received PGE2 that exceeded the licensed dose. They were more likely to deliver by caesarean section (53.4{\%} vs. 31.8{\%}, OR 2.2, 95{\%} CI 1.8–2.6), have a caesarean section for ‘failed’ induction of labour (11.4{\%} vs. 1.9{\%}, OR 4.1, 95{\%} CI 1.3–13.2) or lack of progress in labour (37{\%} vs. 17{\%}, OR 2.8, 95{\%} CI 2.3–3.4), but not for fetal concerns (8.2{\%} vs. 8.8{\%} OR 0.9, 95{\%} CI 0.7–1.3). Terbutaline use and postpartum haemorrhage was no more likely (0.7{\%} vs. 0.9{\%} OR 0.6 95{\%} CI 0.3–1.5 and 19.8{\%} vs. 18.9{\%} OR1.01, 95{\%} CI 0.97–1.06 respectively). Apgar score < 7 (1.1{\%} vs. 1.3{\%} OR 0.9 95{\%} CI 0.8–1.1) and neonatal unit admission (13.7{\%} vs. 10.7{\%} OR 1.2 95{\%} CI 0.8–1.6) were similar in both groups.ConclusionThe use of additional doses of vaginal PGE2 above the recommended dose for induction of labour was not associated with increased maternal or neonatal morbidity and almost half of these women achieved a vaginal delivery.",
keywords = "induction of labour, post-dates pregnancy, prostaglandins, licensed dose",
author = "Huma Ayaz and Mairead Black and Priya Madhuvrata and Ashalatha Shetty",
note = "Copyright {\circledC} 2013 Elsevier Ireland Ltd. All rights reserved.",
year = "2013",
month = "10",
doi = "10.1016/j.ejogrb.2013.07.021",
language = "English",
volume = "170",
pages = "364--367",
journal = "European Journal of Obstetrics & Gynecology and Reproductive Biology",
issn = "0301-2115",
publisher = "Elsevier Ireland Ltd",
number = "2",

}

TY - JOUR

T1 - Maternal and neonatal outcomes following additional doses of vaginal prostaglandin E2 for induction of labour

T2 - a retrospective cohort study

AU - Ayaz, Huma

AU - Black, Mairead

AU - Madhuvrata, Priya

AU - Shetty, Ashalatha

N1 - Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

PY - 2013/10

Y1 - 2013/10

N2 - ObjectiveTo assess maternal and neonatal outcomes following the use of additional doses of vaginal prostaglandins (PGE2) above the recommended dose for induction of labour in post-dates pregnancies.Study designRetrospective cohort study set in Aberdeen Maternity Hospital, Aberdeen, UK. A total of 3514 nulliparous women with labour induced with vaginal PGE2 (3 mg tablet or 2 mg gel) for a post-dates singleton pregnancy from January 1994 to December 2009 were included. Women receiving ≤ 2 doses of PGE2 were compared with those receiving > 2 doses (maximum 5 doses). Binary logistic regression was used to calculate odds ratios (OR) with 95% confidence intervals (CI). Primary outcomes included mode of delivery, terbutaline use, indication for CS, postpartum haemorrhage, neonatal unit admission, and Apgar score < 7. A further analysis was conducted which stratified for number of doses of PGE2 given.ResultsOf the 3514 women who met inclusion criteria, 605 (17%) received PGE2 that exceeded the licensed dose. They were more likely to deliver by caesarean section (53.4% vs. 31.8%, OR 2.2, 95% CI 1.8–2.6), have a caesarean section for ‘failed’ induction of labour (11.4% vs. 1.9%, OR 4.1, 95% CI 1.3–13.2) or lack of progress in labour (37% vs. 17%, OR 2.8, 95% CI 2.3–3.4), but not for fetal concerns (8.2% vs. 8.8% OR 0.9, 95% CI 0.7–1.3). Terbutaline use and postpartum haemorrhage was no more likely (0.7% vs. 0.9% OR 0.6 95% CI 0.3–1.5 and 19.8% vs. 18.9% OR1.01, 95% CI 0.97–1.06 respectively). Apgar score < 7 (1.1% vs. 1.3% OR 0.9 95% CI 0.8–1.1) and neonatal unit admission (13.7% vs. 10.7% OR 1.2 95% CI 0.8–1.6) were similar in both groups.ConclusionThe use of additional doses of vaginal PGE2 above the recommended dose for induction of labour was not associated with increased maternal or neonatal morbidity and almost half of these women achieved a vaginal delivery.

AB - ObjectiveTo assess maternal and neonatal outcomes following the use of additional doses of vaginal prostaglandins (PGE2) above the recommended dose for induction of labour in post-dates pregnancies.Study designRetrospective cohort study set in Aberdeen Maternity Hospital, Aberdeen, UK. A total of 3514 nulliparous women with labour induced with vaginal PGE2 (3 mg tablet or 2 mg gel) for a post-dates singleton pregnancy from January 1994 to December 2009 were included. Women receiving ≤ 2 doses of PGE2 were compared with those receiving > 2 doses (maximum 5 doses). Binary logistic regression was used to calculate odds ratios (OR) with 95% confidence intervals (CI). Primary outcomes included mode of delivery, terbutaline use, indication for CS, postpartum haemorrhage, neonatal unit admission, and Apgar score < 7. A further analysis was conducted which stratified for number of doses of PGE2 given.ResultsOf the 3514 women who met inclusion criteria, 605 (17%) received PGE2 that exceeded the licensed dose. They were more likely to deliver by caesarean section (53.4% vs. 31.8%, OR 2.2, 95% CI 1.8–2.6), have a caesarean section for ‘failed’ induction of labour (11.4% vs. 1.9%, OR 4.1, 95% CI 1.3–13.2) or lack of progress in labour (37% vs. 17%, OR 2.8, 95% CI 2.3–3.4), but not for fetal concerns (8.2% vs. 8.8% OR 0.9, 95% CI 0.7–1.3). Terbutaline use and postpartum haemorrhage was no more likely (0.7% vs. 0.9% OR 0.6 95% CI 0.3–1.5 and 19.8% vs. 18.9% OR1.01, 95% CI 0.97–1.06 respectively). Apgar score < 7 (1.1% vs. 1.3% OR 0.9 95% CI 0.8–1.1) and neonatal unit admission (13.7% vs. 10.7% OR 1.2 95% CI 0.8–1.6) were similar in both groups.ConclusionThe use of additional doses of vaginal PGE2 above the recommended dose for induction of labour was not associated with increased maternal or neonatal morbidity and almost half of these women achieved a vaginal delivery.

KW - induction of labour

KW - post-dates pregnancy

KW - prostaglandins

KW - licensed dose

U2 - 10.1016/j.ejogrb.2013.07.021

DO - 10.1016/j.ejogrb.2013.07.021

M3 - Article

VL - 170

SP - 364

EP - 367

JO - European Journal of Obstetrics & Gynecology and Reproductive Biology

JF - European Journal of Obstetrics & Gynecology and Reproductive Biology

SN - 0301-2115

IS - 2

ER -