Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

A New Approach in the Induction of Labor with Misoprostol Vaginal Insert in High-Risk Pregnancy Obese Women

Version 1 : Received: 24 November 2020 / Approved: 25 November 2020 / Online: 25 November 2020 (16:41:16 CET)

How to cite: Varlas, V.N.; Bostan, G.; Nasui, B.A.; Bacalbasa, N.; Pop, A.L. A New Approach in the Induction of Labor with Misoprostol Vaginal Insert in High-Risk Pregnancy Obese Women. Preprints 2020, 2020110653 (doi: 10.20944/preprints202011.0653.v1). Varlas, V.N.; Bostan, G.; Nasui, B.A.; Bacalbasa, N.; Pop, A.L. A New Approach in the Induction of Labor with Misoprostol Vaginal Insert in High-Risk Pregnancy Obese Women. Preprints 2020, 2020110653 (doi: 10.20944/preprints202011.0653.v1).

Abstract

Background and objectives: Induction of labor (IOL) is an event that occurs in up to one-quarter of pregnancies; less is known about the outcomes and safety of IOL in obese pregnant woman; no data is available on misoprostol vaginal insert (MVI) IOL in high-risk pregnancy obese women. Objectives: (1) to evaluate the rate of successful IOL with 200 μg MVI in obese (Body Mass Index - BMI over 30 kg/m2) high-risk pregnant women: late-term pregnancy, hypertension or diabetes, compared to obese non-high-risk ones; (2) to evaluate the safety profile of MVI in high-risk pregnancy obese patients. Study design: We conducted a cross-sectional study in "Filantropia" Clinical Hospital, Bucharest, Romania, from June 2017 to September 2019 (28 months). From a total of 11,096 registered live births, IOL was performed in 206 obese patients; 74 obese high-risk pregnant patients matched the inclusion criteria; of these, 33.8% pregnancies (n=25) were late-term (41 – 41+6 weeks), 43.2% (n=32) had associated pathologies (hypertension and diabetes); labor induction was guided using a standardized protocol. We evaluated the maternal and gestational age, parity, fetal tachysystole, hyper-stimulation, initial cervical status, time from induction to delivery, drug side effects, mode of delivery, and neonatal outcomes. Results: (a) The overall successful labor induction rate, evaluated by the vaginal delivery rate, was 71.6% (n=53), spontaneously or instrumentally assisted; 28.4% (n=21) births were unsuccessful MVI IOL, converted into caesareans. (b) No significant differences were found regarding the maternal outcomes; in terms of perinatal outcomes of safety, four cases of high-risk pregnancies vaginally delivered were associated with neonatal intensive care unit (NICU) admissions and a one-minute Apgar score under seven (5.4%). Most cases with adverse effects of misoprostol have been managed conservatively, except for three emergency C-section cases. Conclusions: Misoprostol vaginal insert is a safe choice in IOL in obese high-risk pregnancies with good maternal and perinatal outcomes.

Subject Areas

misoprostol; induction of labor; high-risk pregnancy; obesity; diabetes; hypertension; perinatal outcome

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