Labor Outcomes of Obese Patients Undergoing Induction of Labor with Misoprostol compared to Dinoprostone

Abstract

Objective The aim of the article is to evaluate and compare labor outcomes in obese patients undergoing induction of labor (IOL) with misoprostol and dinoprostone.

Study Design This was a retrospective review of patients who delivered from February 1, 2008, to July 1, 2013 at our institution. All obese women who underwent IOL were identified. The rates of successful cervical ripening and cesarean delivery (CD) for patients who underwent IOL with misoprostol and dinoprostone were calculated and compared.

Results A total of 564 women met inclusion criteria; 297 (52.7%) were induced with misoprostol, and 267 (47.3%) were induced with dinoprostone. The misoprostol group had a higher successful cervical ripening rate (78.1 vs. 66.7%; odds ratio [OR], 1.79; 95% confidence interval [CI], 1.23–2.6; p = 0.002) and a lower CD rate (39.1 vs. 51.3%; OR, 0.61; 95% CI, 0.44–0.85; p = 0.003) than the dinoprostone group. This significance persisted in a multivariate model adjusting for parity, gestational age, birth weight, and indication for IOL. The rates of tachysystole, terbutaline use, postpartum hemorrhage, and infectious morbidity were comparable in both groups, as were Apgar scores, rates of neonatal intensive care unit admission, and meconium passage.

Conclusion In obese women undergoing IOL, misoprostol leads to a higher successful cervical ripening rate and a lower CD rate than dinoprostone, with a similar rate of peripartum complications and neonatal outcomes.

Keywords

obesity - induction of labor - cesarean delivery - misoprostol - dinoprostone

• References

• 1 Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity among adults: United States, 2011-2012. NCHS Data Brief 2013; 131 (131) 1-8
• 2 Weiss JL, Malone FD, Emig D , et al; FASTER Research Consortium. Obesity, obstetric complications and cesarean delivery rate—a population-based screening study. Am J Obstet Gynecol 2004; 190 (4) 1091-1097
• 3 Cedergren MI. Maternal morbid obesity and the risk of adverse pregnancy outcome. Obstet Gynecol 2004; 103 (2) 219-224
• 4 Vahratian A, Zhang J, Troendle JF, Savitz DA, Siega-Riz AM. Maternal prepregnancy overweight and obesity and the pattern of labor progression in term nulliparous women. Obstet Gynecol 2004; 104 (5 Pt 1) 943-951
• 5 Martin JA, Hamilton BE, Ventura SJ, Osterman MJK, Mathews TJ. Births: Final Data for 2011. National Vital Statistics Reports; vol 62 no 1. Hyattsville, MD: National Center for Health Statistics; 2013
• 6 ACOG Practice Bulletin No. 107: Induction of labor. Obstet Gynecol 2009; 114 (2 Pt 1) 386-397
• 7 Ramsey PS, Harris DY, Ogburn Jr PL, Heise RH, Magtibay PM, Ramin KD. Comparative efficacy and cost of the prostaglandin analogs dinoprostone and misoprostol as labor preinduction agents. Am J Obstet Gynecol 2003; 188 (2) 560-565
• 8 Dällenbach P, Boulvain M, Viardot C, Irion O. Oral misoprostol or vaginal dinoprostone for labor induction: a randomized controlled trial. Am J Obstet Gynecol 2003; 188 (1) 162-167
• 9 Prager M, Eneroth-Grimfors E, Edlund M, Marions L. A randomised controlled trial of intravaginal dinoprostone, intravaginal misoprostol and transcervical balloon catheter for labour induction. BJOG 2008; 115 (11) 1443-1450
• 10 Faucett AM, Daniels K, Lee HC, El-Sayed YY, Blumenfeld YJ. Oral misoprostol versus vaginal dinoprostone for labor induction in nulliparous women at term. J Perinatol 2014; 34 (2) 95-99
• 11 Abraham C, Meirowitz N, Kohn N. Labor induction for premature rupture of membranes using vaginal misoprostol versus dinoprostone vaginal insert. Am J Perinatol 2014; 31 (3) 181-186
• 12 Wolfe KB, Rossi RA, Warshak CR. The effect of maternal obesity on the rate of failed induction of labor. Am J Obstet Gynecol 2011; 205 (2) e1-e7
• 13 Martínez ME, Heddens D, Earnest DL , et al. Physical activity, body mass index, and prostaglandin E2 levels in rectal mucosa. J Natl Cancer Inst 1999; 91 (11) 950-953
• 14 Richelsen B. Prostaglandin E2 action and binding in human adipocytes: effects of sex, age, and obesity. Metabolism 1988; 37 (3) 268-275
• 15 Subbaramaiah K, Morris PG, Zhou XK , et al. Increased levels of COX-2 and prostaglandin E2 contribute to elevated aromatase expression in inflamed breast tissue of obese women. Cancer Discov 2012; 2 (4) 356-365
• 16 Clark EAS, Silver RM. Long-term maternal morbidity associated with repeat cesarean delivery. Am J Obstet Gynecol 2011; 205 (6, Suppl): S2-S10
• 17 Spong CY, Berghella V, Wenstrom KD, Mercer BM, Saade GR. Preventing the first cesarean delivery: summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, and American College of Obstetricians and Gynecologists Workshop. Obstet Gynecol 2012; 120 (5) 1181-1193
• 18 Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA 2012; 307 (5) 491-497