Advertisement
JOGC

Observational Study of Neonatal Safety for Outpatient Labour Induction Priming with Dinoprostone Vaginal Insert

Published:March 28, 2017DOI:https://doi.org/10.1016/j.jogc.2017.01.003

      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

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Obstetrics and Gynaecology Canada
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Wing D.A.
        • Sheibani L.
        Pharmacotherapy options for labor induction.
        Expert Opin Pharmcother. 2015; 16: 1657-1668
        • Chen W.
        • Xue J.
        • Peprah M.K.
        • et al.
        A systematic review and network meta-analysis comparing the use of Foley catheters, misoprostol, and dinoprostone for cervical ripening in the induction of labour.
        BJOG. 2016; 123: 346-354
        • Calbera I.B.
        • Quinones J.N.
        • Durie D.
        • et al.
        Use of intracervical balloons and chorioamnionitis in term premature rupture of membranes.
        J Matern Fetal Neonatal Med. 2016; 29: 967-971
        • McMaster K.
        • Sanchez-Ramos L.
        • Kaunitz A.M.
        Evaluation of a transcervical Foley catheter as a source of infection: a systematic review and meta-analysis.
        Obstet Gynecol. 2015; 126: 539-551
        • Thomas J.
        • Faircloth A.
        • Kavanagh J.
        • et al.
        Vaginal prostaglandin (PGE2 and PGF2a) for induction of labour at term.
        Cochrane Database Syst Rev. 2014; 6: CD003101
        • Rayburn W.F.
        • Wapner R.J.
        • Barss V.A.
        • et al.
        An intravaginal controlled-release prostaglandin E2 pessary for cervical ripening and initiation of labor at term.
        Obstet Gynecol. 1992; 79: 374-379
        • Witter F.R.
        • Rocco L.E.
        • Johnson T.R.
        A randomized trial of prostaglandin E2 in a controlled-release vaginal pessary for cervical ripening at term.
        Am J Obstet Gynecol. 1992; 166 ([see comment]): 830-834
        • Witter F.R.
        • Mercer B.M.
        Improved intravaginal controlled-release prostaglandin E2 insert for cervical ripening at term. The Prostaglandin E2 insert Study Group.
        J Matern Fetal Med. 1996; 5: 64-69
        • Salvador S.C.
        • Simpson M.L.
        • Cundiff G.W.
        Dinoprostone vaginal insert for labour induction: a comparison of outpatient and inpatient settings.
        J Obstet Gynaecol Can. 2009; 31: 1028-1034
        • Farmer K.C.
        • Schwartz W.J.
        • Rayburn W.
        • et al.
        A cost-minimization analysis of intracervical prostaglandin E, for cervical ripening in an outpatient versus inpatient setting.
        Clin Therap. 1996; 18: 747-756
        • Kelly A.J.
        • Alfirevic Z.
        • Ghosh A.
        Outpatient versus inpatient induction of labour for improving birth outcomes.
        Cochrane Database Syst Rev. 2013; : CD007372
        • Rauf Z.
        • Alfirevic Z.
        Outpatient approaches to elective induction of labor: past, present, and future.
        Clin Obstet Gynecol. 2014; 57: 391-400
        • Gulmezoglu A.M.
        • Crowther C.A.
        • Middleton P.
        • et al.
        Induction of labour for improving birth outcomes for women at or beyond term.
        Cochrane Database Syst Rev. 2012; : CD004945
        • Sahibzadi Hingoro S.A.
        • Rizwan N.
        • Qazi R.A.
        Maternal outcome of early intervention in women with prom at term (37 weeks or more).
        J Pak Med Assoc. 2016; 66: 334-336
        • Austin K.
        • Chambers G.M.
        • de Abreu Lourenco R.
        • et al.
        Cost-effectiveness of term induction of labour using inpatient prostaglandin gel versus outpatient Foley catheter.
        Aust NZ J Obstet Gynaecol. 2015; 55: 440-445
        • Adelson P.L.
        • Wedlock G.R.
        • Wilkinson C.S.
        • et al.
        A cost analysis of inpatient compared with outpatient prostaglandin E2 cervical priming for induction of labour: results from the OPRA trial.
        Aust Health Rev. 2013; 37: 467-473
        • Wilkinson C.
        • Bryce R.
        • Adelson P.
        • et al.
        A randomised controlled trial of outpatient compared with inpatient cervical ripening with prostaglandin E₂ (OPRA study).
        BJOG. 2015; 122: 94-104
        • Howard K.
        • Gerard K.
        • Adelson P.
        • et al.
        Women's preferences for inpatient and outpatient priming for labour induction: a discrete choice experiment.
        BMC Health Serv Res. 2014; 14: 330
        • Turnbull D.
        • Adelson P.
        • Oster C.
        • et al.
        Psychosocial outcomes of a randomized controlled trial of outpatient cervical priming for induction of labor.
        Birth. 2013; 40: 7-80