Labor Induction in Late-Onset Fetal Growth Restriction: Foley Balloon versus Vaginal Dinoprostone

Villalaín, Cecilia; Herraı̀z, Ignacio; Quezada, M.S.; Arriaga, Paula Gómez; Simón, Elisa; Gómez-Montes, Enery; Galindo, Alberto

doi:10.1159/000491784

Cited by 21 publications

(18 citation statements)

References 24 publications

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“…This was a multicenter, retrospective cohort study involving 5 referral centers in Italy and Spain (Chieti, Madrid, Valencia, Naples, and Modena) between January 2017 and January 2020. A part of the present cohort has been previously reported in another study from one of the participating centers [10]. All consecutive pregnancies fulfilling all the inclusion criteria and none of the exclusion criteria were included in the study.…”

Section: Methodsmentioning

confidence: 99%

Comparison between Cerebroplacental Ratio and Umbilicocerebral Ratio in Predicting Adverse Perinatal Outcome in Pregnancies Complicated by Late Fetal Growth Restriction: A Multicenter, Retrospective Study

et al. 2021

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Introduction: The role of cerebroplacental ratio (CPR) or umbilicocerebral ratio (UCR) to predict adverse intrapartum and perinatal outcomes in pregnancies complicated by late fetal growth restriction (FGR) remains controversial. Methods: This was a multicenter, retrospective cohort study involving 5 referral centers in Italy and Spain, including singleton pregnancies complicated by late FGR, as defined by Delphi consensus criteria, with a scan 1 week prior to delivery. The primary objective was to compare the diagnostic accuracy of the CPR and UCR for the prediction of a composite adverse outcome, defined as the presence of either an adverse intrapartum outcome (need for operative delivery/cesarean section for suspected fetal distress) or an adverse perinatal outcome (intrauterine death, Apgar score <7 at 5 min, arterial pH <7.1, base excess of >−11 mEq/mL, or neonatal intensive care unit admission). Results: Median CPR absolute values (1.11 vs. 1.22, p = 0.018) and centiles (3 vs. 4, p = 0.028) were lower in pregnancies with a composite adverse outcome than in those without it. Median UCR absolute values (0.89 vs. 0.82, p = 0.018) and centiles (97 vs. 96, p = 0.028) were higher. However, the area under the curve, 95% confidence interval for predicting the composite adverse outcome showed a poor predictive value: 0.580 (0.512–0.646) for the raw absolute values of CPR and UCR, and 0.575 (0.507–0.642) for CPR and UCR centiles adjusted for gestational age. The use of dichotomized values (CPR <1, UCR >1 or CPR <5th centile, UCR >95th centile) did not improve the diagnostic accuracy. Conclusion: The CPR and UCR measured in the week prior delivery are of low predictive value to assess adverse intrapartum and perinatal outcomes in pregnancies with late FGR.

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Section: Methodsmentioning

confidence: 99%

Comparison between Cerebroplacental Ratio and Umbilicocerebral Ratio in Predicting Adverse Perinatal Outcome in Pregnancies Complicated by Late Fetal Growth Restriction: A Multicenter, Retrospective Study

et al. 2021

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“…A part of the present cohort was reported previously in another study from one of the participating centers. 8 Inclusion criteria were pregnancies complicated by late FGR (gestational age ≥32 weeks of gestation at diagnosis), as defined by the recently proposed Delphi consensus criteria, including 9 :…”

Section: Study Design and Participantsmentioning

confidence: 99%

“…The large sample size and the data coming from all referral centers for the surveillance and management of FGR, inclusion of true cases of late FGR as defined by the Delphi consensus criteria 8 and TA B L E 3 Logistic regression predicting composite adverse intrapartum outcome a , uterine tachysystole or cesarean section/operative delivery for non-reassuring fetal status (NRFS) multitude of outcomes explored represent the main strengths of this study. The retrospective, non-randomized design represents the main weakness of the present study, mostly because two interventions are compared.…”

Section: Ta B L E 2 Primary and Secondary Outcomesmentioning

confidence: 99%

“…1,5,17 Villalain et al reported a lower risk for uterine tachysystole (4.2% vs. 16.9%) and CD (15.5% vs. 37.7%) in IOL with Foley balloon than with IOL with dinoprostone in late FGR fetuses;8 the authors reported in their logistic regression model that the use of a Foley balloon was the only modifiable risk factor which led to a higher chance of vaginal delivery. Conversely, Duro-Gomez et al did not find any difference between prostaglandins and mechanical methods concerning the risk of CD, uterine tachysystole, NRFS or neonatal adverse events, although the authors did not include fetuses with abnormal Dopplers 13.…”

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confidence: 99%

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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

Mascio

Villalaín

Rizzo

et al. 2021

Acta Obstet Gynecol Scand

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Introduction The aim of this study was to compare vaginal dinoprostone and mechanical methods for induction of labor (IOL) in pregnancies complicated by late fetal growth restriction. Material and methods Multicenter, retrospective, cohort study involving six referral centers in Italy and Spain. Inclusion criteria were pregnancies complicated by late fetal growth restriction as defined by Delphi consensus criteria. The primary outcome was the occurrence of uterine tachysystole; secondary outcomes were either cesarean delivery or operative vaginal delivery for non‐reassuring fetal status, a composite score of adverse neonatal outcome and admission to neonatal intensive care unit (NICU). Univariate and multivariate logistic regression analysis was used to analyze the data. Results A total of 571 pregnancies complicated by late fetal growth restriction undergoing IOL (391 with dinoprostone and 180 with mechanical methods) were included in the analysis. The incidence of uterine tachysystole (19.2% vs. 5.6%; p = 0.001) was higher in women undergoing IOL with dinoprostone than in those undergoing IOL with mechanical methods. Similarly, the incidence of cesarean delivery or operative delivery for non‐reassuring fetal status (25.6% vs. 17.2%; p = 0.027), composite adverse neonatal outcome (26.1% vs. 16.7%; p = 0.013) and NICU admission (16.9% vs. 5.6%; p < 0.001) was higher in women undergoing IOL with dinoprostone than in those undergoing IOL with mechanical methods. At logistic regression analysis, IOL with mechanical methods was associated with a significantly lower risk of uterine tachysystole (odds ratio 0.26, 95% confidence interval 0.13‐0.54; p < 0.001). Conclusions In pregnancies complicated by late fetal growth restriction, IOL with mechanical methods is associated with a lower risk of uterine tachysystole, cesarean delivery or operative delivery for non‐reassuring fetal status, and adverse neonatal outcome compared with pharmacological methods.

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“…There is scarce evidence on which is the best approach for cervical ripening in this scenario. Recently, our group has found that the Foley balloon could be an optimal method due to its lower association with uterine tachysystole when compared to prostaglandins [11]. Nevertheless, we hypothesize that, besides the method used, there may be other factors affecting the outcome of the induction process in this particular group of fetuses.…”

Section: Introductionmentioning

confidence: 87%

Prognostic Factors of Successful Cervical Ripening and Labor Induction in Late-Onset Fetal Growth Restriction

et al. 2019

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Objective: The aim of this work was to identify independent risk factors influencing the achievement of vaginal delivery among women undergoing labor induction for late-onset fetal growth restriction (FGR). Methods: This was a retrospective cohort study of 201 singleton pregnancies with late-onset FGR (diagnosed > 32 + 0 weeks) that required labor induction with cervical ripening from 37 + 0 weeks, either with dinoprostone (from 2014 to 2015) or Foley balloon (from 2016 to 2018). Independent factors for successful vaginal delivery were identified. A prediction model of vaginal delivery with the identified factors was made using logistic regression and bootstrapping with 1,000 re-samples performed for bias correction. Results: Perinatal results were more favorable in the vaginal delivery group, with significantly lower neonatal admission rates (4.0 vs. 13.7%) and lower composite neonatal morbidity (4.0 vs. 15.7%). The labor induction method (Foley balloon), higher cerebro-pla-cental ratio, lower pre-gestational BMI, and absence of preeclampsia were identified as independent factors associated to vaginal delivery. The area under the curve of the model was of 0.75 (95% CI 0.70-0.79). Conclusions: The use of a Foley balloon is the only modifiable risk factor to improve the chances of vaginal delivery when attempting induction of labor in singleton pregnancies with late-onset FGR.

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Labor Induction in Late-Onset Fetal Growth Restriction: Foley Balloon versus Vaginal Dinoprostone

Cited by 21 publications

References 24 publications

Comparison between Cerebroplacental Ratio and Umbilicocerebral Ratio in Predicting Adverse Perinatal Outcome in Pregnancies Complicated by Late Fetal Growth Restriction: A Multicenter, Retrospective Study

Comparison between Cerebroplacental Ratio and Umbilicocerebral Ratio in Predicting Adverse Perinatal Outcome in Pregnancies Complicated by Late Fetal Growth Restriction: A Multicenter, Retrospective Study

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

Prognostic Factors of Successful Cervical Ripening and Labor Induction in Late-Onset Fetal Growth Restriction

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