Induction of Labor in Women with Oligohydramnios: Misoprostol Compared with Prostaglandin E2

Abstract

Objective To compare perinatal outcomes in women with oligohydramnios and an unfavorable cervix undergoing labor induction with misoprostol to prostaglandin E2.

Study Design We conducted a secondary analysis of women with oligohydramnios undergoing labor induction in the Consortium on Safe Labor study (2002–2008). Oligohydramnios was recorded in the medical chart. We evaluated perinatal outcomes. We limited the analysis to women with an unfavorable cervix defined by simplified Bishop score ≤ 4. Misoprostol was compared with prostaglandin E2. Women could have received oxytocin, underwent mechanical dilation, or had artificial rupture of membranes, but women who underwent induction with both misoprostol and prostaglandin E2 were excluded. We calculated adjusted odds ratios with 95% confidence intervals, controlling for maternal age, maternal body mass index (kg/m²), parity, and mechanical dilation.

Results Among women with oligohydramnios and an unfavorable cervix who underwent induction of labor, 141 (39.4%) received misoprostol and 217 (60.6%) received prostaglandin E2. There were no significant differences in cesarean delivery, chorioamnionitis, postpartum hemorrhage, transfusion, neonatal intensive care unit (NICU) admission, NICU stay > 72 hours, mechanical ventilation, and neonatal sepsis.

Conclusion In women with oligohydramnios and an unfavorable cervix, induction of labor with misoprostol was comparable to prostaglandin E2.

Keywords

cesarean delivery - induction - misoprostol - oligohydramnios - prostaglandin E2

Note

This research was presented, in part, at the Society for Gynecologic Investigation Annual Meeting, 2013 as “Misoprostol for labor induction in pregnancies with oligohydramnios: what's the risk?” Orlando, FL.

• References

• 1 Divon MY, Marks AD, Henderson CE. Longitudinal measurement of amniotic fluid index in postterm pregnancies and its association with fetal outcome. Am J Obstet Gynecol 1995; 172 (1 Pt 1): 142-146
• 2 Casey BM, McIntire DD, Bloom SL , et al. Pregnancy outcomes after antepartum diagnosis of oligohydramnios at or beyond 34 weeks' gestation. Am J Obstet Gynecol 2000; 182 (4) 909-912
• 3 American College of Obstetricians and Gynecologists. ACOG committee opinion no. 560: medically indicated late-preterm and early-term deliveries. Obstet Gynecol 2013; 121 (4) 908-910
• 4 ACOG Committee on Practice Bulletins -- Obstetrics. ACOG Practice Bulletin No. 107: induction of labor. Obstet Gynecol 2009; 114 (2 Pt 1): 386-397
• 5 Wang W, Zheng J, Fu J , et al. Which is the safer method of labor induction for oligohydramnios women? Transcervical double balloon catheter or dinoprostone vaginal insert. J Matern Fetal Neonatal Med 2014; 27 (17) 1805-1808
• 6 Shechter-Maor G, Haran G, Sadeh-Mestechkin D, Ganor-Paz Y, Fejgin MD, Biron-Shental T. Intra-vaginal prostaglandin E2 versus double-balloon catheter for labor induction in term oligohydramnios. J Perinatol 2015; 35 (2) 95-98
• 7 Hofmeyr GJ, Gülmezoglu AM, Pileggi C. Vaginal misoprostol for cervical ripening and induction of labour. Cochrane Database Syst Rev 2010; (10) CD000941
• 8 Manzanares S, Carrillo MP, González-Perán E, Puertas A, Montoya F. Isolated oligohydramnios in term pregnancy as an indication for induction of labor. J Matern Fetal Neonatal Med 2007; 20 (3) 221-224
• 9 Melamed N, Pardo J, Milstein R, Chen R, Hod M, Yogev Y. Perinatal outcome in pregnancies complicated by isolated oligohydramnios diagnosed before 37 weeks of gestation. Am J Obstet Gynecol 2011; 205 (3) 241.e1-241.e6
• 10 Zhang J, Troendle J, Reddy UM , et al; Consortium on Safe Labor. Contemporary cesarean delivery practice in the United States. Am J Obstet Gynecol 2010; 203 (4) 326.e1-326.e10
• 11 Laughon SK, Zhang J, Troendle J, Sun L, Reddy UM. Using a simplified Bishop score to predict vaginal delivery. Obstet Gynecol 2011; 117 (4) 805-811
• 12 Dede FS, Haberal A, Dede H, Sivaslioglu A, Arslanpence I. Misoprostol for cervical ripening and labor induction in pregnancies with oligohydramnios. Gynecol Obstet Invest 2004; 57 (3) 139-143
• 13 Larson JD, Rayburn WF, Turnbull GL, Schwartz WJ, Stanley JR, Christensen HD. Effects of intracervical prostaglandin E2 on fetal heart rate and uterine activity patterns in the presence of oligohydramnios. Am J Obstet Gynecol 1995; 173 (4) 1166-1170
• 14 Cırık DA, Taşkın EA, Karcaaltıncaba D, Dai Ö. Study of uterine and fetal hemodynamics in response to labor induction with dinoprostone in prolonged pregnancies with normal amniotic fluid and oligohydramnios. J Matern Fetal Neonatal Med 2014; 27 (7) 691-695
• 15 Venturini P, Contu G, Mazza V, Facchinetti F. Induction of labor in women with oligohydramnios. J Matern Fetal Neonatal Med 2005; 17 (2) 129-132
• 16 Ferguson JE II, Head BH, Frank FH , et al. Misoprostol versus low-dose oxytocin for cervical ripening: a prospective, randomized, double-masked trial. Am J Obstet Gynecol 2002; 187 (2) 273-279 , discussion 279–280
• 17 Mozurkewich E, Horrocks J, Daley S , et al; MisoPROM study. The MisoPROM study: a multicenter randomized comparison of oral misoprostol and oxytocin for premature rupture of membranes at term. Am J Obstet Gynecol 2003; 189 (4) 1026-1030
• 18 Sanchez-Ramos L, Kaunitz AM, Delke I. Labor induction with 25 microg versus 50 microg intravaginal misoprostol: a systematic review. Obstet Gynecol 2002; 99 (1) 145-151