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Clinical and Experimental Obstetrics & Gynecology  2020, Vol. 47 Issue (3): 329-334    DOI: 10.31083/j.ceog.2020.03.5322
Original Research Previous articles | Next articles
The association between repeated doses of vaginal PGE2 (Dinoprostone, Prostin®) and both maternal and neonatal outcomes among women in the north of Jordan
A.M. Sindiani1, *(), H.M. Rawashdeh1, E.H. Alshdaifat1, 2, O.F. Altal1, H. Yaseen1, A.A. Alhowary3
1Department of Obstetrics and Gynecology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
2Department of Obstetrics and Gynecology, Faculty of Medicine, Yarmouk University, Irbid, Jordan
3Department of Anaesthesia, Jordan University of Science and Technology, Irbid, Jordan
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Abstract  

Objective: To evaluate the association between repeated doses of vaginal PGE2 and the maternal and neonatal outcomes for primigravid and multiparous women. Study design: A retrospective descriptive study was conducted at a teaching university hospital in Jordan. The study involved 885 women with singleton live fetuses; these women had been admitted to the labor ward for an induction of labor by vaginal PGE2 (Dinoprostone, Prostin?) for different indications from January 2015 to December 2016. The women were classified according to parity into two main groups, namely, primigravid and multiparous. In the primigravid group, the women who had received two or fewer doses of a vaginal PGE2 tablet (3 mg Dinoprostone) were compared with those who had received a PGE2 tablet three times. In the multiparous group, the women who had received one or two doses of half the usual vaginal PGE2 tablet (1.5 mg Dinoprostone) were compared with those who had received the same dose three times. The main outcomes studied were the cesarean section rate and the APGAR score. Results: There was a statistically significant association, namely, X2 (1) = 13.96, P = 0.001, between the repeated doses of PGE2 and the mode of delivery. This indicates that primigravid women who received more than two doses of PGE2 were more likely to have a cesarean section (65.5%, n = 57 out of 87) compared with primigravid women who received two or fewer doses of PGE2 (42.9%, n = 132 out of 308). There was no significant association between repeated doses of PGE2 insertion and admission either to the nursery or the neonatal intensive care unit (NICU) X2 (1) = 2.11, P = 0.14. Moreover, the results also showed that there was no significant association between repeated doses of PGE2 insertion and the APGAR score X2 (1) = 0.06, P = 0.88. For multiparous women, there was no statistically significant association X2 (1) = 2.15, P = 0.14 between repeated doses of PGE2 insertion and the mode of delivery. Conclusion: In both groups of primigravid and multiparous women, the third dose of vaginal PGE2 was not associated with a significant increase in maternal or neonatal morbidity. In the primigravid group, despite the third dose of PGE2 being associated with a higher rate of cesarean section in comparison with two or fewer doses of it, nearly a third of the women nevertheless achieved vaginal delivery. In the multiparous group, the third dose of PGE2 was not associated with a higher rate of cesarean sections.

Key words:  Induction      Labor      PGE2      Cesarean section     
Submitted:  12 July 2019      Accepted:  30 October 2019      Published:  15 June 2020     
Fund: 
49/116/2018/Jordan University of Science and Technology/King Abdullah University Hospital
*Corresponding Author(s):  AMER MAHMOUD SINDIANI     E-mail:  amsindiani0@just.edu.jo

Cite this article: 

A.M. Sindiani, H.M. Rawashdeh, E.H. Alshdaifat, O.F. Altal, H. Yaseen, A.A. Alhowary. The association between repeated doses of vaginal PGE2 (Dinoprostone, Prostin®) and both maternal and neonatal outcomes among women in the north of Jordan. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(3): 329-334.

URL: 

https://ceog.imrpress.com/EN/10.31083/j.ceog.2020.03.5322     OR     https://ceog.imrpress.com/EN/Y2020/V47/I3/329

Table 1  — Sample characteristics for primigravid and multiparous women (N = 885)
The whole sample (N = 885) Primigravid women 45% (n = 395) Multiparous women 55% (n = 490)
Age M (SD) 28.19 (5.37) 25.66 (3.90) 32.20 (5.53)
Age range 15-48 years 15-42 years 15-48 years
Mode of delivery N %
Vaginal delivery N % 623 (71%) 193 (49%) 430 (88%)
Cesarean section N % 242 (27%) 189 (48%) 53 (11%)
Instrumental delivery N % 20 (2%) 13 (3%) 7 (1%)
Table 2  — Indications for the induction of labor among primigravid and multiparous women (N = 885)
Indications for induction N Percentage %
1-Postdate (41 weeks or more of gestation) 337 38.1
2-Premature rupture of membranes (PROM) 149 16.80
3-Reduced amniotic fluid index 130 14.70
4-Suspected fetal compromise 103 11.60
5-Hypertensive disorders 89 10.10
6-Preterm premature rupture of membranes (P-PROM) 25 2.80
7- A good-size baby in both diabetic and non-diabetic mothers 17 1.90
8-Maternal request 11 1.20
9-Stillbirth 9 1.00
10-Cholestasis in pregnancy 7 0.80
11-Advanced maternal age 4 0.50
12-Thrombophilic disorders 4 0.50
Table 3  — A chi-square to examine the association between repeated insertion of vaginal PGE2 (3 mg of Dinoprostone, one Prostin? tablet) and both maternal and neonatal outcomes among primigravid women (N = 395)
Vaginal PGE2 Insertion p value
Maternal and neonatal outcomes Two or fewer More than two
Mode of delivery 0.001*
Vaginal delivery N % 176 (57.1%) 30 (34.5%)
Cesarean section delivery N % 132 (42.9%) 57 (65.5%)
Admission after delivery 0.14
Nursery 232 (75.3%) 72 (82.8%)
NICU 76 (24.7%) 15 (17.2%)
APGAR score 0.80
6 and less 36.7 (11.7%) 11 (12.6%)
7 and more 272 (88.3%) 76 (87.4%)
Table 4  — A chi-square to examine the association between the repeated insertion of vaginal PGE2 (1.5 mg of Dinoprostone, half Prostin? tablet) and both maternal and neonatal outcomes among multiparous women (N = 490)
Vaginal PGE2 Insertion p value
Maternal and neonatal outcomes Two or less More than two
Mode of delivery 0.14
Vaginal delivery N % 392 (89.9%) 45 (83.3%)
Cesarean section delivery N % 44 (10.1%) 9 (16.7%)
Admission after delivery 0.002*
Nursery 359 (82.3%) 35 (64.8%)
NICU 77 (17.7%) 19 (35.2%)
APGAR score 0.001*
6 and less 34 (7.8%) 13 (24.1%)
7 and more 402 (92.2%) 41 (75.9%)
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