Abstract
Objectives
To evaluate the safety of outpatient induction with dinoprostone insert in low-risk
labour inductions for premature rupture of membranes or postdates gestation.
Methods
This retrospective cohort study compared outpatient labour induction priming with
inpatient induction in terms of neonatal safety, mode of delivery, and obstetrical
parameters. The sample included all inductions for premature rupture of membranes
or postdate gestation. The analysis used logistic regression. The statistical power
of the sample was 80% to detect a difference of 5.6% for the composite neonatal safety
outcome (5-minute Apgar score <7 and NICU admission for >12 hours or transfer to a
level III nursery).
Results
Compared with the inpatient cohort (n = 568), the outpatient cohort (n = 611) included
more postdate gestations (93% vs. 67%) with less cervical dilatation (0.5 cm vs. 1.0
cm) and larger infants (3705 g vs. 3551 g). There were no differences in measures
of neonatal safety or mode of delivery. The outpatient cohort required more dinoprostone
inserts (1.59 vs. 1.23) and were less likely to deliver within 24 hours (OR 0.24,
95% CI 0.17 to 0.34) but were also less likely to deliver by CS (OR 0.71, 95% CI 0.54
to 0.95), after adjusting for obstetrical parameters.
Conclusion
An outpatient model of labour induction using dinoprostone inserts is feasible and
safe.
Résumé
Objectifs
Évaluer l’innocuité du recours aux insertions vaginales de dinoprostone pour induire
un déclenchement artificiel du travail en cas de rupture prématurée des membranes
ou de grossesse après terme chez des patientes externes dans un contexte de faible
risque.
Méthodologie
Cette étude de cohorte rétrospective a comparé le déclenchement artificiel du travail
chez des patientes externes et des patientes hospitalisées sur le plan de l’innocuité
néonatale, du mode d’accouchement et des paramètres obstétriques. Ont été inclus dans
l’échantillon tous les déclenchements attribuables à une rupture prématurée des membranes
ou à une grossesse après terme. Une analyse de régression logique a été utilisée.
L’étude avait une efficacité statistique de 80 % et a permis de détecter un écart
de 5,6 % dans les résultats combinés relatifs à l’innocuité néonatale (indice d’Apgar
à 5 minutes <7 et admission à l’UNSI pendant >12 heures ou transfert vers une pouponnière
de niveau 3).
Résultats
Comparativement à la cohorte de patientes hospitalisées (n = 568), la cohorte de patientes
externes (n = 611) a été associée à un plus grand nombre de grossesses après terme
(93 % c. 67 %), à une dilatation cervicale plus faible (0,5 cm c. 1,0 cm) et à des
bébés plus lourds (3 705 g c. 3 551 g). Aucune différence n’a été observée sur le
plan de l’innocuité néonatale et du mode d’accouchement. Les patientes externes ont
eu besoin d’un plus grand nombre d’insertions vaginales de dinoprostone (1,59 c. 1,23)
et étaient moins susceptibles d’accoucher en moins de 24 heures (RC : 0,24; IC à 95
% : 0,17–0,34), mais aussi d’accoucher par césarienne (RC : 0,71; IC à 95 % : 0,54–0,95),
après un ajustement pour tenir compte des paramètres obstétriques.
Conclusion
Un modèle de déclenchement artificiel du travail chez les patientes externes au moyen
d’insertions vaginales de dinoprostone est réalisable et sûr.
Key Words
Abbreviation:
PROM (premature rupture of membranes)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: March 28, 2017
Accepted:
January 6,
2017
Received:
November 10,
2016
Footnotes
Competing interests: None declared.
Identification
Copyright
© 2017 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
