Predicting factors for success of vaginal delivery in preterm induction with prostaglandin E₂

Abstract

ObjectiveTo evaluate the efficacy and safety of prostaglandin (PG) E2 for preterm labor induction and to investigate the predictive factors for the success of vaginal delivery.MethodsA retrospective cohort study was performed in women (n=155) at 24+0 to 36+6 weeks of gestation who underwent induction of labor using a PGE2 vaginal pessary (10 mg, Propess) from January 2009 to December 2015. Success rates of vaginal delivery according to gestational age at induction and incidence of intrapartum complications such as tachysystole and nonreassuring fetal heart rate were investigated. Multivariable logistic regression analysis was performed to evaluate the predictive factors for success of labor induction.ResultsThe vaginal delivery rate was 57% (n=89) and the rate of cesarean delivery after induction was 43% (n=66). According to gestational age, labor induction was successful in 16.7%, 50.0%, and 62.8% of patients at 24 to 31, 32 to 33, and 34 to 36 weeks, showing a stepwise increase (P=0.006). There were 18 cases (11%) of fetal distress, 9 cases (5.8%) of tachysystole, and 6 cases (3.8%) of massive postpartum bleeding (>1,000 mL). After adjusting for confounding factors, multiparity (odds ratio [OR], 8.47; 95% confidence interval [CI], 3.10 to 23.14), younger maternal age (OR, 0.84; 95% CI, 0.75 to 0.94), advanced gestational age at induction (OR, 1.06; 95% CI, 1.02 to 1.09), rupture of membranes (OR, 11.83; 95% CI, 3.55 to 39.40), and the Bishop score change after removal of PGE2 (OR, 2.19; 95% CI, 1.0 to 4.8) were significant predictors of successful preterm vaginal delivery.ConclusionAn understanding of the principal predictive factors of successful preterm labor induction, as well as the safety of PGE2, will provide useful information when clinicians consult with preterm pregnant women requiring premature delivery.

Preterm Labor and Preterm-PROM at a Lower Gestational Age Are Associated with a Longer Latency-to-Delivery Even in Patients with the Same Intensity of Intra-Amniotic Inflammation: “Carroll-Model” Revisited

“…Secondly, in the context of term gestation, PGF2α concentrations in AF [26] and PTGS2 mRNA expression in amnion [27] abruptly increase before the onset of labor and continuously increase with advancing gestation from 38 weeks to 40 weeks. These findings correspond with the previous results as in the following: (1) Nielsen et al demonstrated that the prevalence of unfavorable Bishop scores (≤5) decreased with increasing GA until 41 weeks during term gestation, ultimately leading to an immediate labor and delivery [15]; and (2) Chow et al found that the levels of CX43 mRNA in myometrial tissue collected from women not in labor significantly increased between 37 and 40 weeks, with a further significant increase occurring during labor [28] It is well-known that preterm gestations with a lower GA have a significantly higher frequency of IAI in both PTL and preterm-PROM [4,6]. Moreover, we previously demonstrated the intensity of IAI continuously increases with decreasing GA during preterm gestation even in the context of the same severity of acute chorioamnionitis [29].…”

“…The frequency of term birth, preterm birth (PTB) (before 37 weeks), late PTB (between 34 and 37 weeks), and early PTB (before 34 weeks) account for about 90%, 10%, 7%, and 3% of all births, respectively [13]. Moreover, an earlier GA is known to make the induction of labor (IOL) more difficult to succeed in preterm [14] and even term pregnant women [15]. Therefore, one can expect that delivery is more difficult in pregnant women at an earlier GA.…”

“…Indeed, the levels of oxytocin receptor (OXTR) are known to be one of the contraction-associated proteins (CAPs) (i.e., connexin-43 [CX43], OXTR and prostaglandin [PG] receptors including PGE2EP1 and PGF2αFP) with the function of uterine myometrial activation [16], and are continuously increased with advancing GA in the human placenta [17], decidua [18], and myometrium [18,19]. Based on these findings [13][14][15][16][17][18][19], it is plausible PTL and preterm-PROM at a lower GA are associated with a longer latency to delivery. Indeed, our current study reaffirmed Carroll's finding reporting the time interval from preterm-PROM to delivery is longer at a lower GA at ROM [8] (Figure 3).…”

A Retrospective Comparative Study of the Effect of Controlled-Release Dinoprostone Vaginal Delivery System (Propess®) and Mechanical Methods for Cervical Ripening in Nulliparous Women in Late-Term Pregnancy

“…In this study, the success rate of vaginal delivery was approximately 70%; however, considering that the average rate of cesarean sections in Japan [ 10 , 11 ], including multiparous women, is approximately 19%-25%, the current result is considered not bad at all. In addition, recently, the risk of a cesarean section was reported to be elevated with the use of Propess® in nulliparous women, especially in cases without epidural analgesia during labor [ 12 ]. Although we do not perform epidural anesthesia during the use of Propess® according to the Japanese guidelines [ 8 ], we were relieved that the use of Propess® did not lead to an increase in cesarean sections.…”

Application effect of single balloon catheters in labor induction of pregnant women in late-term pregnancy and their influences on stress and inflammatory responses

“…Methods promoting cervical ripening include drugs such as oxytocin and prostaglandin preparations and mechanical methods such as water sac. Dinoprostone is a kind of prostaglandin E 2 preparation, which should be locally applied and can be slowly and continuously released, and it has been clinically proven safe and effective ( 2 ). The disadvantages include that it easily causes excessive uterine stimulation and frequent uterine contractions, thus increasing the probabilities of fetal distress in the uterus and amniotic fluid contamination ( 3 ).…”