Title: Does Prostaglandin Use Affect Mode of Delivery in SGA vs Non-SGA Neonates?
Presenter: Alexis G Bridges, DO; University of Utah Department of Obstetrics and Gynecology, Intermountain Healthcare Department of Obstetrics and Gynecology
Contributors: Amanda A Allshouse, MS (University of Utah); Dana R Canfield, MD (University of Utah, Intermountain Healthcare); Bryan W Grover, BS (University of Utah); Shannon L Son, MD(University of Utah, Intermountain Healthcare); Brett D Einerson, MD (University of Utah, Intermountain Healthcare); Robert M Silver, MD (University of Utah, Intermountain Healthcare); David M Haas, MD, MS (Indiana University); William A Grobman, MD, MBA (Northwestern University)
Faculty Sponsor: Nathan R Blue, MD (University of Utah, Intermountain Healthcare)
Brief Description: Prostaglandin use during induction of labor in SGA neonates associated with higher rates of cesarean delivery compared to non-SGA neonates
Keywords/Main Subjects: Labor, delivery, SGA, cesarean delivery, prostaglandin use
Copyright: copyright Alexis G Bridges et. al. ©2020
Prostaglandin (PG)use for labor induction with small for gestational age (SGA) fetuses is controversial, and it remains uncertain if use increases cesarean delivery (CD). Our objective was to assess the difference in association between PG use during labor induction and mode of delivery between SGA and non-SGA neonates.
This is a secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be, a prospective observational cohort of 10,038 nulliparas. Women undergoing induction with non-anomalous fetuses in cephalic presentation were included. Women with > 2 cm cervical dilation or prior uterine scar were excluded. We assessed the difference in association of PG use with CD with SGA and non-SGA neonates. 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.
Among 2,353 women eligible. The PGs and CD association differed significantly (interaction p=0.018) for SGA vs non-SGA neonates, CD occurred more often in SGA neonates exposed to PGs than those not exposed (35% vs 22%, p=0.009), whereas PG use was not associated with CD among non-SGA neonates, (36% vs 36%, p=0.8). This interactive effect remained significant when adjusting for BMI, race/ethnicity, and cervical dilation on admission (Figure 1). Among SGA neonates, PG use was not associated with adverse neonatal outcomes or maternal hemorrhage, though did have a higher rate of chorioamnionitis (7.0 vs 2.1%, p=0.048, Figure 2).
PG use was associated with a higher rate of CD in SGA neonates but not non-SGA neonates.