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Objective  To assess adverse event ( AE ) resolution, delivery mode and neonatal outcomes after misoprostol or dinoprostone vaginal insert ( MVI  or  DVI ) retrieval due to  AE  during induction of labour ( IOL ).    Design  Randomised, double‐blind trial,  EXPEDITE .    Setting  Thirty five obstetric departments,  USA .    Population  Consisted of 1358 pregnant women with modified Bishop score ≤4 eligible for pharmacological  IOL .    Methods   Post hoc  analysis.    Main outcome measures   AE s prompting insert retrieval, times to  AE  resolution, delivery, delivery mode and neonatal intensive care unit ( NICU ) admissions.    Results  77/678 (11.4%) and 27/680 (4.0%) women had  MVI  and  DVI  retrieved due to  AE , respectively ( P  < 0.001). The most common  AE s prompting retrieval were uterine tachysystole with fetal heart rate ( FHR ) involvement and category  II / III FHR  pattern. Time to  AE  resolution varied for both treatments depending on the type of  AE . For uterine tachysystole with  FHR  involvement, median resolution times were 1 hour 34.5 minutes ( n  = 36) and 8.5 minutes ( n  = 8) for  MVI  and  DVI , respectively. Caesarean delivery occurred in a high proportion of women with insert retrieved due to  AE  ( MVI : 44/77 (57.1%);  DVI : 19/27 (70.4%)); the majority of caesareans were performed at least several hours after insert retrieval. Median times from retrieval to any delivery were not increased for women with insert retrieved due to  AE .  NICU  admissions were 8/77 (10.4%) and 1/27 (3.7%) for  MVI  and  DVI , respectively ( P  = 0.440).    Conclusions   AE s leading to insert retrieval were primarily uterine tachysystole with  FHR  involvement and category  II / III FHR  patterns. Insert retrieval due to an  AE  did not prolong time to delivery for either prostaglandin insert.    Tweetable abstract  Induction with prostaglandin vaginal inserts: outcomes following retrieval due to intrapartum adverse event.

Induction of labour with retrievable prostaglandin vaginal inserts: outcomes following retrieval due to an intrapartum adverse event