The influence of various induction methods on adverse outcomes in small for gestational age neonates: A secondary analysis of the PROBAAT 1 and 2 trials

de Vaan, Marieke D.T.; Croll, Dorothée M.R.; Verhoeven, Corine J.M.; de Boer, Marjon A.; Jozwiak, Marta; ten Eikelder, Mieke L.G.; Mol, Ben Willem; Bloemenkamp, Kitty W.M.; de Heus, Roel

Abstract

Objective: To evaluate the safety aspects of different induction methods in pregnancies with small-for-gestational-age neonates. Study design: This was a secondary analysis of two previously reported multicenter, randomized controlled trials conducted in the Netherlands. In the original trials, women were randomized to either a 30 cc Foley catheter, vaginal prostaglandin E2 (PROBAAT-1) or oral misoprostol (PROBAAT-2). A total of 425 patients with a term, singleton pregnancy in cephalic presentation with an indication for labor induction and a small-for-gestational-age neonate were included in this secondary analysis. Our primary outcome was a composed adverse neonatal outcome of Apgar score < 7 after 5 min and/or a pH in the umbilical artery < 7.05 and/or NICU admission. Secondary outcomes were mode of birth, operative birth for fetal distress and pH < 7.10 in the umbilical artery. For these outcome measures, multivariate as well as bivariate analyses were performed. Results: An adverse neonatal outcome occurred in 4.7 % (10/214) induction with a Foley catheter, versus 12.8 % (19/149) after misoprostol (RR 0.36; 95 % CI 0.17–0.76) and 4.7 % (3/64) after Prostaglandin E2 (RR 0.98; 95 %CI 0.28–3.51). For individual components of the composed outcome of adverse events, a difference was found between a Foley catheter and misoprostol for Apgar score < 7 at 5 min (0.5 % versus 3.4; RR 0.14; 95 %CI 0.02–1.16) and NICU admission (1.9 % versus 6.1 %; RR 0.31; 0.10–0.97). No differences were found for mode of birth. Conclusions: For women who gave birth to a small-for-gestational-age neonate, a Foley catheter is probably a safer induction method compared to oral misoprostol.

• Journal Article Type: Article
• Acceptance Date: Jan 3, 2023
• Online Publication Date: Jan 5, 2023
• Publication Date: 2023-03
• Deposit Date: Jun 8, 2023
• Publicly Available Date: Jun 8, 2023
• Journal: European Journal of Obstetrics and Gynecology and Reproductive Biology
• Print ISSN: 0301-2115
• Electronic ISSN: 1872-7654
• Publisher: Elsevier BV
• Peer Reviewed: Peer Reviewed
• Volume: 282
• Pages: 89-93
• DOI: https://doi.org/10.1016/j.ejogrb.2023.01.003
• Keywords: Prostaglandin, Foley catheter, Balloon, Cervical ripening, Induction of labor, SGA, PGE1, Misoprostol, FGR, PGE2
• Public URL: https://nottingham-repository.worktribe.com/output/17372818
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S0301211523000039?via%3Dihub
• Additional Information: This article is maintained by: Elsevier; Article Title: The influence of various induction methods on adverse outcomes in small for gestational age neonates: A secondary analysis of the PROBAAT 1 and 2 trials; Journal Title: European Journal of Obstetrics & Gynecology and Reproductive Biology; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/j.ejogrb.2023.01.003; Content Type: article; Copyright: © 2023 The Authors. Published by Elsevier B.V.