Delivery Mode among Patients with Oligohydramnios with or without Fetal Growth Restriction by Induction Method

Abstract

Objective This study aimed to evaluate the association of induction method on delivery mode in pregnancies complicated by oligohydramnios with and without fetal growth restriction (FGR).

Study Design This was a secondary analysis of a National Institutes of Health funded retrospective cohort study of singleton deliveries at a tertiary-care hospital between 2002 and 2013 with diabetes, mild hypertension, and/or FGR. Chart abstraction was performed by trained research nurses. Patients with a diagnosis of fetal oligohydramnios with and without FGR were identified. Our analytic cohort was further stratified into three groups per initial induction agent: prostaglandins (PGEs) alone, PGE plus mechanical ripening, or oxytocin only. Primary outcome was mode of delivery. Secondary outcomes included indications for cesarean delivery and neonatal morbidity.

Results Out of 4,929 patients in the original database, 546 subjects with fetal oligohydramnios were identified; of these, 270 were induced and included for analysis. Outcomes were compared between 171 patients who had fetuses with isolated oligohydramnios and 99 patients who had fetuses with oligohydramnios and FGR. There were no significant differences in demographic characteristics between the groups. Patients with fetuses with isolated oligohydramnios had similar rates of spontaneous vaginal delivery (SVD) when PGEs were used (n = 44/79, 55.7% PGE alone, n = 44/76, 57.9% PGE with mechanical ripening) and when they were not used (n = 5/13, 38.5% oxytocin alone; p = 0.43). Similarly, the majority of patients in both cohorts underwent SVD regardless of induction method (n = 30/44, 68.2% PGE alone, n = 30/44, 68.2% PGE with mechanical ripening, and n = 6/10, 60% oxytocin alone; p = 0.90). There was no significant difference in composite neonatal morbidity.

Conclusion In patients with fetuses with oligohydramnios with and without FGR, most patients delivered by SVD regardless of induction method. In this population, PGE use was associated with a high chance of SVD in patients with fetuses with suspected placental insufficiency regardless of the presence of absence of FGR.

Key Points

• The majority of fetuses with oligohydramnios with or without FGR deliver vaginally.

• The use of prostaglandins did not increase rates of cesarean for fetal distress in oligohydramnios.

• Prostaglandin use did not increase rate of neonatal intensive care unit admission among pregnancies with oligohydramnios.

Keywords

oligohydramnios - induction of labor - growth restriction - prostaglandins - delivery

Note

This article is presented as a poster at the Society for Maternal-Fetal Medicine's 42nd Annual Pregnancy Meeting, January 31 through February 5, 2022.

Publication History

Received: 24 May 2022

Accepted: 01 November 2022

Accepted Manuscript online:
08 November 2022

Article published online:
30 December 2022

• References

• 1 Unterscheider J, Daly S, Geary MP. et al. Optimizing the definition of intrauterine growth restriction: the multicenter prospective PORTO study. Am J Obstet Gynecol 2013; 208 (04) 290.e1-290.e6
• 2 Martins JG, Biggio JR, Abuhamad A. Society for Maternal-Fetal Medicine (SMFM). Electronic address: [e-mail]. Society for Maternal-Fetal Medicine Consult Series #52: diagnosis and management of fetal growth restriction: (Replaces Clinical Guideline Number 3, April 2012). Am J Obstet Gynecol 2020; 223 (04) B2-B17
• 3 Brzezinski-Sinai NA, Stavsky M, Rafaeli-Yehudai T. et al. Induction of labor in cases of late preterm isolated oligohydramnios: is it justified?. J Matern Fetal Neonatal Med 2019; 32 (14) 2271-2279
• 4 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 (03) 241.e1-241.e6
• 5 Chamberlain PF, Manning FA, Morrison I, Harman CR, Lange IR. Ultrasound evaluation of amniotic fluid volume. I. The relationship of marginal and decreased amniotic fluid volumes to perinatal outcome. Am J Obstet Gynecol 1984; 150 (03) 245-249
• 6 Locatelli A, Vergani P, Toso L, Verderio M, Pezzullo JC, Ghidini A. Perinatal outcome associated with oligohydramnios in uncomplicated term pregnancies. Arch Gynecol Obstet 2004; 269 (02) 130-133
• 7 Phelan JP, Platt LD, Yeh SY, Broussard P, Paul RH. The role of ultrasound assessment of amniotic fluid volume in the management of the postdate pregnancy. Am J Obstet Gynecol 1985; 151 (03) 304-308
• 8 Kansu-Celik H, Gun-Eryılmaz O, Dogan NU. et al. Prostaglandin E2 induction of labor and cervical ripening for term isolated oligohydramnios in pregnant women with Bishop score ≤ 5. J Chin Med Assoc 2017; 80 (03) 169-172
• 9 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 (03) 139-143
• 10 Venturini P, Contu G, Mazza V, Facchinetti F. Induction of labor in women with oligohydramnios. J Matern Fetal Neonatal Med 2005; 17 (02) 129-132
• 11 Stefos T, Mouzakioti E, Sotiriadis A, Andronikou S, Adamidis K, Lolis D. Use of prostaglandin E2 for cervical ripening in pregnancies with oligohydramnios. Gynecol Obstet Invest 2000; 50 (03) 158-161
• 12 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
• 13 Al-Hafez L, Bicocca MJ, Chauhan SP, Berghella V. Prostaglandins for induction in pregnancies with fetal growth restriction. Am J Obstet Gynecol MFM 2022; 4 (02) 100538
• 14 Di Mascio D, Villalain C, Rizzo G. et al; induCtion of labOr in Late fetaL Growth rEstriction (COLLEGE) Study Group. Maternal and neonatal outcomes of pregnancies complicated by late fetal growth restriction undergoing induction of labor with dinoprostone compared with cervical balloon: a retrospective, international study. Acta Obstet Gynecol Scand 2021; 100 (07) 1313-1321
• 15 Ben-Haroush A, Yogev Y, Glickman H, Kaplan B, Hod M, Bar J. Mode of delivery in pregnancies with suspected fetal growth restriction following induction of labor with vaginal prostaglandin E2. Acta Obstet Gynecol Scand 2004; 83 (01) 52-57
• 16 Familiari A, Khalil A, Rizzo G. et al. Adverse intrapartum outcome in pregnancies complicated by small for gestational age and late fetal growth restriction undergoing induction of labor with dinoprostone, misoprostol or mechanical methods: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2020; 252: 455-467
• 17 Villalain C, Herraiz I, Quezada MS. et al. Labor induction in late-onset fetal growth restriction: Foley balloon versus vaginal dinoprostone. Fetal Diagn Ther 2019; 46 (01) 67-74
• 18 Horowitz KM, Feldman D. Fetal growth restriction: risk factors for unplanned primary cesarean delivery. J Matern Fetal Neonatal Med 2015; 28 (18) 2131-2134
• 19 Chavakula PR, Benjamin SJ, Abraham A, Londhe V, Jeyaseelan V, Mathews JE. Misoprostol versus Foley catheter insertion for induction of labor in pregnancies affected by fetal growth restriction. Int J Gynaecol Obstet 2015; 129 (02) 152-155
• 20 Savitz DA, Danilack VA, Cochancela J, Hughes BL, Rouse DJ, Gutmann R. Health outcomes associated with clinician-initiated delivery for hypertensive disorders at 34–38 weeks' gestation. Epidemiology 2022; 33 (02) 260-268
• 21 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 (04) 1166-1170
• 22 Kawakita T, Grantz KL, Landy HJ, Huang CC, Kominiarek MA. Induction of labor in women with oligohydramnios: misoprostol compared with prostaglandin E2. Am J Perinatol 2017; 34 (02) 204-210