Premium
Induction of labour with retrievable prostaglandin vaginal inserts: outcomes following retrieval due to an intrapartum adverse event
Author(s) -
Rugarn O,
Tipping D,
Powers B,
Wing DA
Publication year - 2017
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.14147
Subject(s) - medicine , adverse effect , misoprostol , neonatal intensive care unit , obstetrics , vaginal delivery , population , post hoc analysis , gynecology , pregnancy , pediatrics , abortion , environmental health , biology , genetics
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.