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Labor

Poster Session 4

(1161) Prostaglandin administration and cesarean for non-reassuring fetal status in preterm induction of labor

Wednesday, February 14, 2024
1:00 PM – 2:30 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

    Primary & Presenting Author(s)

  • Rachel A. W Taylor, MD

    Assistant Professor, Maternal-Fetal Medicine
    ECU Brody School of Medicine Department of Ob/Gyn, ECU Health
    Greenville, NC, United States

    • Coauthor(s)

  • David M. Stamilio, MD, MSCE

    Professor, Maternal and Fetal Medicine
    Wake Forest University School of Medicine
    Winston-Salem, NC, United States

Objective: The primary objective was to estimate the association between prostaglandin administration in preterm labor induction and cesarean for non-reassuring fetal status. An a priori secondary aim was to assess this association in the subgroup of preterm patients with fetal growth restriction (FGR).

Study Design: This was a retrospective cohort study using the NICHD Consortium for Safe Labor (CSL) database. Only patients undergoing preterm labor induction were included for analysis. The exposure was prostaglandin E as an induction agent. The primary outcome was cesarean performed for non-reassuring fetal status. Secondary outcomes included rate of cesarean for all indications as well as specified maternal and neonatal adverse outcomes. We used unadjusted and multivariable analyses to estimate the independent effect of prostaglandins on the primary outcome. Multiple imputation was performed to address missing data for maternal body mass index.

Results: Among 228,438 patients in the CSL cohort, 4789 patients underwent preterm labor induction and 833 (17%) of these received prostaglandins. After adjusting for confounding variables, rate of cesarean for non-reassuring fetal status was increased nearly 75% in the prostaglandin-exposed population and the cesarean rate for all indications more than doubled (Table 1). Prostaglandin-exposed patients had lower rates of chorioamnionitis (1.7% v. 4.0%, p < 0.0001). Neonates in the prostaglandin-exposed group had longer NICU admissions (22.65±21.71 days v. 17.16±22.16 days, p=0.0003) but lower rates of sepsis (4.0% v. 6.1%, p=0.017). In comparison to the total cohort, the FGR subcohort had increased risk for cesarean for non-reassuring fetal status but not for cesarean for other indications. 

Conclusion: Prostaglandin administration in preterm induction of labor is associated with increased rate of cesarean for non-reassuring fetal status as well as for cesarean overall. The association between prostaglandin use and cesarean for non-reassuring fetal status is amplified in preterm pregnancies complicated by FGR.