Safety of misoprostol vaginal insert for labor induction using standard vs. adjusted retrieval criteria: a comparative cohort study

Aleke Brandstetter 1 , 2 , Moritz Döbert 1 , 2 , Peter Schwaerzler 1 , Timm Fabian Döbert 3 , 4 , Hendrik Hasselbeck 3  and Wolfgang Henrich 2 , 5
  • 1 Department of Obstetrics and Gynecology, Asklepios Clinic Barmbek, Hamburg, Germany
  • 2 Department of Obstetrics, Universitätsmedizin Charité, Berlin, Germany
  • 3 Asklepios Pro-Research, Hamburg, Germany
  • 4 Department of Biological Sciences, University of Alberta, Edmonton, Alberta, Canada
  • 5 Department of Obstetrics and Gynecology, Charité University Hospital Berlin, Charitéplatz 1, 10117 Berlin, Germany
Aleke Brandstetter
  • Department of Obstetrics and Gynecology, Asklepios Clinic Barmbek, Hamburg, Germany
  • Department of Obstetrics, Universitätsmedizin Charité, Berlin, Germany
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, Moritz Döbert
  • Department of Obstetrics and Gynecology, Asklepios Clinic Barmbek, Hamburg, Germany
  • Department of Obstetrics, Universitätsmedizin Charité, Berlin, Germany
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, Peter Schwaerzler
  • Department of Obstetrics and Gynecology, Asklepios Clinic Barmbek, Hamburg, Germany
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, Timm Fabian Döbert
  • Asklepios Pro-Research, Hamburg, Germany
  • Department of Biological Sciences, University of Alberta, Edmonton, Alberta, Canada
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, Hendrik Hasselbeck and Wolfgang Henrich
  • Corresponding author
  • Department of Obstetrics, Universitätsmedizin Charité, Berlin, Germany
  • Department of Obstetrics and Gynecology, Charité University Hospital Berlin, Charitéplatz 1, 10117 Berlin, Germany
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Abstract

Objective

To compare the safety of misoprostol vaginal insert (MVI) for labor induction using standard and adjusted criteria.

Methods

This was a single-center, comparative cohort study of 138 pregnant women ≥37/0 weeks undergoing labor induction with MVI using standard (69 women; administration for up to 24 h; MVI-24) or adjusted (69 women; administration for up to 10 h; MVI-10) criteria in a tertiary academic center in Germany. The main maternal safety outcomes were the rate of tachysystole and rate of tachysystole requiring tocolysis. Neonatal safety assessments included Apgar score at 5 min and postpartum arterial fetal pH.

Results

Uterine tachysystole occurred in more women in the MVI-24 group compared with the MVI-10 group [47.8% vs. 25.5%; P = 0.001; relative risk (RR) 2.36 (95% confidence interval [CI]: 1.39–4.00)] and as did uterine tachysystole requiring tocolysis [MVI-24: 26.1% vs. MVI-10: 11.6%; P = 0.049; RR 2.25 (95% CI: 1.05–4.83)]. The mean 5-min Apgar scores were 9.64 for the MVI-24 group and 9.87 for the MVI-10 (P = 0.016). Low postpartum umbilical arterial pH values occurred more often in the MVI-24 compared with the MVI-10 group (pH 7.10–7.19: 26.1% vs. 20.3% and pH <7.10: 4.4% vs. 0.0%, respectively).

Conclusion

Adjusted retrieval criteria for MVI of up to 10 h exposure instead of the standard 24 h reduced uterine tachysystole and improved the neonatal outcome.

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