Timing of cesarean delivery for fetal heart rate abnormalities in hypertensive pregnancies induced with oral misoprostol or Foley catheter: Secondary analysis of a randomized clinical trial.

Autor: Londero AP; Obstetrics and Gynecology Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy.; Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health (DiNOGMI), University of Genoa, Genoa, Italy., Fichera A; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy., Orabona R; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy., Cagnacci A; Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health (DiNOGMI), University of Genoa, Genoa, Italy.; Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale San Martino, Genoa, Italy., Prefumo F; Obstetrics and Gynecology Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy.
Jazyk: angličtina
Zdroj: International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics [Int J Gynaecol Obstet] 2024 Jul; Vol. 166 (1), pp. 373-380. Date of Electronic Publication: 2024 Jan 17.
DOI: 10.1002/ijgo.15375
Abstrakt: Objective: The study aims to assess how oral misoprostol for cervical ripening affects the time of cesarean delivery (CD) for fetal heart rate (FHR) abnormalities in pre-eclampsia patients. Secondary goals include determining the role of uterine hyperstimulation, comparing misoprostol with Foley catheter, and identifying risk factors for FHR abnormalities associated with CD.
Methods: A previously published randomized clinical trial was subjected to a secondary analysis (NCT01801410). We conducted a time-dependent analysis, stratifying the population based on the final mode of induction used (low-dose oral misoprostol vs Foley catheter).
Results: There was no CD for FHR abnormalities within 2 h of starting misoprostol. At 5 h, the cumulative incidence of CD for FHR abnormalities in the misoprostol group was 2.10%, while it was 1.00% in the Foley group (P = 0.565). After 25 h, the CD risk for FHR abnormalities remained constant in both groups at 21.00% (95% confidence interval [CI] 15.00%-28.00%). Within 5 h of misoprostol induction, the risk of uterine hyperstimulation was similar in both groups (0.33% in misoprostol vs 0.34% in Foley group, P = 0.161). The risk of CD for FHR abnormalities was unaffected by newborn weight centiles.
Conclusion: There was no significant difference in CD risk for FHR abnormalities between misoprostol and Foley catheter induction. Nonetheless, the cumulative incidence of CD for FHR abnormalities increased faster in the misoprostol group, indicating that FHR monitoring timing should be tailored to the induction method.
(© 2024 International Federation of Gynecology and Obstetrics.)
Databáze: MEDLINE
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