Abstract
To compare maternal and neonatal outcomes in women with suspected intra-uterine growth restriction (IUGR) undergoing induction of labor by extra-amniotic balloon (EAB) versus prostaglandin E2 (PGE2). A retrospective cohort study of women with singleton pregnancies with suspected IUGR and normal amniotic fluid volume undergoing induction at term (37-42 weeks), via EAB, PGE2 or both, at a single university affiliated medical center (2014-2017). Suspected IUGR was defined as estimated fetal weight below the 10th percentile for gestational age (GA) or an abdominal circumference below the 10th percentile for GA. We excluded pregnancies with multiple gestations, known fetal anomalies and elective cesarean delivery (CD). Primary outcome was rate of CD. Composite maternal outcome included: CD, post-partum hemorrhage (PPH) and blood products transfusion. Composite neonatal outcome included: neonatal intensive care unit (NICU) admission, transient tachypnea of the newborn (TTN), 5-minute apgar score< 7 and jaundice requiring phototherapy. We compared maternal and neonatal outcomes between groups. Overall, 266 women met inclusion criteria. 131 (49.2%) underwent induction by PGE2, 116 (43.6%) by EAB, and 19 (7.14%) by both methods. No differences were noted in maternal age, GA at delivery, nulliparity or BMI (p >0.05). There was a significantly higher rate of CD in the group induced by EAB compared to PGE2 or both (17.24% vs 6.11% vs 10.53%, p=0.02), (Table 1). Moreover, maternal composite outcome was higher in the EAB group (18.97% vs 6.11% vs 10.53%, p< 0.01). Groups were comparable regarding neonatal outcome (p >0.05) (table 2). Using multivariate logistic regression, after adjusting for potential confounders, rates of CD and composite maternal outcome were no longer higher in the EAB group (aOR 1.68, 95%CI 0.68-4.16, p=0.26; and aOR 1.94, 95%CI 0.84-4.45, p=0.12, respectively). Method of induction in suspected IUGR does not influence the rate of maternal or neonatal adverse outcome.View Large Image Figure ViewerDownload Hi-res image Download (PPT)
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