Is dinoprostone safe? A report of three maternal deaths

Abstract

We report three maternal deaths which might be in possible association with the use of intravaginal dinoprostone for cervical ripening and induction of labor. All cases occurred at our institution between January 2006 and December 2007. Uterine atony and profuse bleeding followed by disseminated intravascular coagulation (DIC), characterized by severe hypofibrinogenemia developed shortly after delivery of the first two patients. The third patient developed respiratory symptoms in the active labor followed by hemodynamic changes manifested by tetanic uterine contractions and fetal heart rate decelerations. Cardiac arrest developed in all patients shortly after the occurrence of symptoms with no response to any medical intervention. The pharmacologic induction of labor with dinoprostone may be in association with increased risk of maternal death because of increased risk of postpartum DIC and amnionic fluid embolism. Further investigations seem to be needed.

The Effect of Parity on Labor Induction with Prostaglandin E2 Analogue (Dinoprostone): An Evaluation of 2090 Cases

“…There was no statistically significant difference between nulliparous and multiparous patients regarding maternal and fetal morbidity and mortality. Previously in 2006, we reported 3 maternal deaths [19] after labor induction with dinoprostone vaginal insert. In this report, we have discussed the increased probability of disseminated intravascular coagulation and amniotic fluid emboli in dinoprostone vaginal insert used patients for labor induction.…”

“…In our hospital, our induction of labor policy is to use dinoprostone for patients < 35 years old and low parity (≤2) due to possible relationship of maternal age (≥ 35 years old) and parity (≥ 3 deliveries) with maternal mortality that we have previously experienced and reported [19]. Gestational age was calculated from the LMP and confirmed by ultrasonography done in the first or early second trimester.…”