Impact of Prostaglandin Administration on Cesarean Delivery Rates

IF 2.3 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the National Medical Association Pub Date : 2025-09-01 DOI:10.1016/j.jnma.2025.08.048

Brooke Malone BS, MS, Kelly Muller BS, Angelina Lam BS, Daniel Novak PhD, Brenda Ross-Shelton MD

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引用次数: 0

Abstract

Introduction

Induction of labor (IOL) is a common obstetric procedure that has significantly increased in recent years, reaching a rate of 27.1% in the United States in 2020. IOL stimulates labor onset using mechanical or pharmacological methods, with prostaglandin analogues like misoprostol and dinoprostone commonly used for cervical ripening. These drugs aim to achieve vaginal delivery, but there is a lack of predictive models to determine successful induction. This study investigates whether prostaglandin analogues reduce cesarean section rates in singleton. Our hypothesis is that prostaglandin analogues lead to less cesarean deliveries in patients with singleton uncomplicated pregnancies, with the null hypothesis being that the drugs do not lead to any differences.

Methods

This retrospective cohort study utilized the TriNetX platform, a global network of electronic health records, to compare the likelihood of cesarean section in patients receiving misoprostol or dinoprostone within 24 hours of induction. Patients were identified using CPT and procedure codes for vaginal delivery, full-term, uncomplicated pregnancies, and drug exposure records for misoprostol (RxNorm 42331) and dinoprostone (RxNorm 3748).

Inclusion criteria included females aged 18-45 who received misoprostol or dinoprostone within three days of delivery and had delivery outcomes documented within the same hospitalization. Exclusion criteria were pre existing uterine anomalies, prior cesarean section, multiple gestations, or pregnancy complications like preeclampsia and gestational diabetes. Propensity score matching (PSM) was used to balance covariates such as maternal age, BMI, race, and comorbidities (e.g., hypertension, diabetes). The primary outcome was cesarean section delivery.

Results

After propensity score matching, two cohorts were created: 364,291 patients who received prostaglandin analogs and 364,291 controls. The group receiving prostaglandin analogues had a slightly higher likelihood of cesarean section (1.105%) compared to the control group (0.848%) (OR = 0.765, p<0.0001).

Conclusion

This study suggests that prostaglandin analog administration is associated with an increased likelihood of cesarean delivery. While the findings align with some studies, they also contrast with others in the existing literature. These conflicting results underscore the need for further research to optimize labor induction strategies and improve maternal and fetal outcomes.

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前列腺素对剖宫产率的影响

引产（IOL）是一种常见的产科手术，近年来显著增加，到2020年在美国达到27.1%。人工晶状体通过机械或药理学方法刺激产程开始，前列腺素类似物如米索前列醇和迪诺前列酮通常用于宫颈成熟。这些药物旨在实现阴道分娩，但缺乏预测模型来确定成功的诱导。本研究探讨前列腺素类似物是否能降低单胎剖宫产率。我们的假设是前列腺素类似物可以减少单胎无并发症妊娠患者的剖宫产，零假设是药物不会导致任何差异。方法本回顾性队列研究利用TriNetX平台（全球电子健康记录网络），比较诱导后24小时内使用米索前列醇或迪诺前列酮的患者剖宫产的可能性。使用CPT和阴道分娩、足月、无并发症妊娠的程序代码以及米索前列醇（RxNorm 42331）和迪诺前列酮（RxNorm 3748）的药物暴露记录来确定患者。纳入标准包括18-45岁的女性，在分娩3天内接受米索前列醇或迪诺前列酮治疗，并在同一住院期间记录分娩结果。排除标准为既往子宫异常、既往剖宫产、多胎妊娠或妊娠并发症如先兆子痫和妊娠糖尿病。倾向评分匹配（PSM）用于平衡协变量，如母亲年龄、BMI、种族和合并症（如高血压、糖尿病）。主要结局为剖宫产。结果倾向评分匹配后，创建了两个队列：364291名接受前列腺素类似物治疗的患者和364291名对照组。前列腺素类似物组剖宫产的可能性（1.105%）略高于对照组（0.848%）（OR = 0.765,p<0.0001）。结论前列腺素类似物的使用与剖宫产的可能性增加有关。虽然这些发现与一些研究相一致，但它们也与现有文献中的其他研究形成了对比。这些相互矛盾的结果强调了进一步研究优化引产策略和改善母婴结局的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the National Medical Association 医学-医学：内科

CiteScore

4.80

自引率

3.00%

发文量

139

审稿时长

98 days

期刊介绍： Journal of the National Medical Association, the official journal of the National Medical Association, is a peer-reviewed publication whose purpose is to address medical care disparities of persons of African descent. The Journal of the National Medical Association is focused on specialized clinical research activities related to the health problems of African Americans and other minority groups. Special emphasis is placed on the application of medical science to improve the healthcare of underserved populations both in the United States and abroad. The Journal has the following objectives: (1) to expand the base of original peer-reviewed literature and the quality of that research on the topic of minority health; (2) to provide greater dissemination of this research; (3) to offer appropriate and timely recognition of the significant contributions of physicians who serve these populations; and (4) to promote engagement by member and non-member physicians in the overall goals and objectives of the National Medical Association.