Induction of Labour with Prostaglandins: Does Their Pro-Inflammatory Effect Mimic Chorioamnionitis After PROM?

Abstract

Purpose: Induction of labour (IOL) is commonly performed by administration of prostaglandin E (PGE). As pro-inflammatory agents, a known side-effect of PGE is maternal fever. This is problematic as it potentially mimics chorioamnionitis and may lead to unnecessary interventions such as administration of antibiotics or cesarean section. The aim of the study was therefore to investigate the effect of PGE on pregnancy outcomes.

Methods: Retrospective single-centre cohort study with inclusion of women ≥ 37 weeks of gestation who underwent IOL with PGE and subsequently developed PROM (Group 1) or women who presented with spontaneous PROM without contractions (Group 2). At the time of PROM, CRP and white blood count (WBC) were assessed. We compared rates of maternal fever, Triple I, mode of delivery, and administration of antibiotics between Group 1 and Group 2.

Results: A total of n = 850 women were included (Group 1: 200, Group 2: 650). CRP levels were higher in patients with more prolonged PGE administration (< 12 hours: 0.3 mg/dL vs. > 48 hours: 1.4 mg/dL, p = 0.002; r = 0.309; p < 0.001). WBCs were also higher after PGE administration (11.1 × 10 ⁹ /L vs. 9.5 × 10 ⁹ /L, p < 0.001). The logistic regression model revealed an association between IOL with PGE and antibiotics during labour. However, the rates of maternal fever and suspected Triple I did not differ significantly between the two groups, nor did the mode of delivery.

Conclusion: IOL with PGE increases maternal serum levels of CRP (time-dependently), as well as WBC. This might lead to overtreatment with antibiotics during labour. However, the diagnosis of maternal fever or rates of suspected Triple I were not affected in our cohort.