Association of Prostaglandin Use for Cervical Ripening with Mode of Delivery in Small for Gestational Age versus Non–Small for Gestational Age Neonates

Alexis G. Bridges; Amanda A. Allshouse; Dana R. Canfield; Bryan W. Grover; Shannon L. Son; Brett D. Einerson; Robert M. Silver; David M. Haas; William A. Grobman; Hyagriv N. Simhan; Robert C. Day; Nathan R. Blue

doi:10.1055/a-1906-8919

American Journal of Perinatology, Table of Contents

Am J Perinatol 2024; 41(S 01): e456-e464
DOI: 10.1055/a-1906-8919

Original Article

Association of Prostaglandin Use for Cervical Ripening with Mode of Delivery in Small for Gestational Age versus Non–Small for Gestational Age Neonates

Authors

Alexis G. Bridges

¹Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah

²Department of Obstetrics and Gynecology, Intermountain Healthcare, Salt Lake City, Utah
Amanda A. Allshouse

¹Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
Dana R. Canfield

¹Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah

²Department of Obstetrics and Gynecology, Intermountain Healthcare, Salt Lake City, Utah
Bryan W. Grover

³University of Utah School of Medicine, Salt Lake City, Utah
Shannon L. Son

¹Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah

²Department of Obstetrics and Gynecology, Intermountain Healthcare, Salt Lake City, Utah
Brett D. Einerson

¹Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah

²Department of Obstetrics and Gynecology, Intermountain Healthcare, Salt Lake City, Utah
Robert M. Silver

¹Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah

²Department of Obstetrics and Gynecology, Intermountain Healthcare, Salt Lake City, Utah
David M. Haas

⁴Department of Obstetrics and Gynecology, Indiana University, Indianapolis, Indiana
William A. Grobman

⁵Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
Hyagriv N. Simhan

⁶Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania
Robert C. Day

⁷Department of Obstetrics and Gynecology, University of California–Irvine, Irvine, California
Nathan R. Blue

¹Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah

²Department of Obstetrics and Gynecology, Intermountain Healthcare, Salt Lake City, Utah

Abstract

Objective Prostaglandins (PGs) use for cervical ripening with small for gestational age (SGA) fetuses is controversial since it remains uncertain if use increases the chance of cesarean delivery (CD). We aimed to assess the association between PG use for cervical ripening and mode of delivery between SGA and appropriate for gestational age (AGA) neonates.

Study Design Secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b), a prospective observational cohort study of 10,038 nulliparas. We included women undergoing induction with nonanomalous fetuses in the cephalic presentation. Women with >2 cm cervical dilation or prior uterine scar were excluded. We assessed the association of PG use with CD among women with SGA and AGA neonates. SGA was defined as birth weight <10th percentile for gestational age and sex. Multivariable logistic regression was used to adjust for potential confounders and test for interaction. Secondary outcomes included adverse neonatal outcomes, indication for CD, maternal hemorrhage, and chorioamnionitis.

Results Among 2,353 women eligible, PGs were used in 54.8%, SGA occurred in 15.1%, and 35.0% had CD. The association between PG use and CD differed significantly (interaction p = 0.018) for SGA versus AGA neonates; CD occurred more often in SGA neonates exposed to PGs than not (35 vs. 22%, p = 0.009). PG use was not associated with CD among AGA neonates (36 vs. 36%, p = 0.8). This effect remained significant when adjusting for body mass index, race/ethnicity, and cervical dilation. Among SGA neonates, CD for “nonreassuring fetal status” was similar between PG groups. Among SGA neonates, PG use was not associated with adverse neonatal outcomes or postpartum hemorrhage but had a higher rate of chorioamnionitis (7.0 vs. 2.1%, p = 0.048).

Conclusion PG use was associated with a higher rate of CD in SGA but not AGA neonates; however, further studies are needed before PG use is discouraged with SGA neonates.

Key Points

PGs are commonly used for cervical ripening.
PG use was associated with increased risk of cesarean delivery in SGA neonates.
PG use was not associated with adverse neonatal outcomes.

Keywords

labor Induction - prostaglandins - small for gestational age - fetal growth restriction - cesarean delivery

Full Text

References

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