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Labor

Poster Session 2

(524) Factors Affecting Success of Vaginal Delivery in Nulliparous Patients Receiving Magnesium Sulfate During Labor Induction

Tuesday, February 13, 2024

3:30 PM – 5:00 PM

Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

Primary & Presenting Author(s)

Jenny Y. Mei, MD (she/her/hers)

Maternal-Fetal Medicine Fellow
University of California, Los Angeles
Los Angeles, CA, United States

Coauthor(s)

Daniel Lee, MD

OBGYN Resident
UCLA Medical Center
Los Angeles, CA, United States
MN

Masaru Negi, MD

Associate Professor
UCLA David Geffen School of Medicine
N Hollywood, CA, United States

Objective: Magnesium sulfate administration for preeclampsia with severe features during labor induction has been associated with increased risk of cesarean delivery (CD). We aim to evaluate associations with successful vaginal delivery (VD) in nulliparous patients undergoing labor induction while receiving magnesium sulfate.

Study Design: This was a secondary analysis from the Consortium on Safe Labor, a multicenter cohort study of 228,438 deliveries in 19 U.S. hospitals. The analysis included nulliparous women ≥ 18 years old with singleton gestation undergoing induction of labor for preeclampsia with severe features and receiving magnesium sulfate. Primary outcome was characteristics associated with successful VD. Secondary outcomes were maternal and neonatal outcomes. Chi-square and independent samples t-test were used to compare groups. The study was deemed IRB exempt #20-000360.

Results: Total 4,122 women met inclusion criteria, of whom 2256 (54.7%) had a successful VD. Patients who had a VD were more likely to have lower maternal age (p< 0.001) and BMI (p< 0.001), higher gestational age (p< 0.001), higher rate of public insurance (p=0.001), lower rate of anti-hypertensive medication usage (p< 0.001), and lower admission systolic blood pressure (p=0.049). Other factors associated with VD included having more than 3 contractions in 10 minutes on admission (p=0.002), higher Bishop’s score on admission (p< 0.001), cervical dilation greater than 0 or 1cm (p< 0.001), effacement greater than 50% (p< 0.001), and undergoing AROM (p=0.003) or Pitocin administration (p< 0.001). Successful VD was associated with shorter induction time (p< 0.001), higher 1-minute APGAR(p< 0.001), and lower rates of NICU admission (p< 0.001) and composite neonatal morbidity (p< 0.001).

Conclusion: Rates of cesarean delivery are high in patients undergoing induction of labor for severe preeclampsia and receiving magnesium sulfate. Various characteristics are associated with increased rate of successful VD. Appropriate care should be taken in expeditiously managing labor for this high risk patient cohort.