title: Labor induction with dinoprostone or oxytocine and postpartum disseminated intravascular coagulation: a hospital-based case-control study.
abstract: OBJECTIVE
  This study was undertaken to test the hypothesis of an association between pharmacologic agents used for labor induction, in particular dinoprostone, and postpartum disseminated intravascular coagulation (DIC).
  
  
  METHODS
  A retrospective hospital-based case-control study. Adjusted odds ratios (AOR) were calculated by a conditional logistic regression.
  
  
  RESULTS
  Forty valid cases of postpartum DIC were compared against 197 matched controls. Labor was induced in 17% of controls, and 56% of cases (AOR = 7.2; 95% CI: 2.1-24.6). The association was observed for both dinoprostone (AOR = 6.7; 95% CI: 1.7-26.5) and oxytocin (AOR = 8.4; 95% CI: 1.4-50.9). Other risk factors identified were as follows: a maternal age older than 34 years (AOR = 9.5; 95% CI: 2.4-37.7), complications during pregnancy (AOR = 5.5; 95% CI: 1.3-22.8), and a gestational age of over 40 weeks (AOR = 3.5; 95% CI: 1.1-11.1). Such factors were shown to also have an interaction with the induction of labor. Oxytocin augmentation showed a negative association (AOR = 0.1; 95% CI: 0.02-0.4). The absolute risk attributable to induction was estimated in 5 per 10,000 deliveries.
  
  
  CONCLUSIONS
  The pharmacologic induction of labor is associated with an increased risk of postpartum DIC, regardless the substance used. Although the absolute risk seems to be quite low, the obstetricians should not neglect it, in particular for the special risk groups identified.
authors.affiliation: Division of Pharmacoepidemiology and Pharmacovigilance, Agencia Española de Medicamentos y Productos Sanitarios, Madrid, Spain. fabajo@agemed.es
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: De Abajo
authors.forename: Carmen M
authors.initials: CM
authors.lastname: Meseguer
authors.forename: Guillermo
authors.initials: G
authors.lastname: Antiñolo
authors.forename: Luis A
authors.initials: LA
authors.lastname: García Rodríguez
authors.forename: Dolores
authors.initials: D
authors.lastname: Montero
authors.forename: Juan R
authors.initials: JR
authors.lastname: Castillo
authors.forename: Jaume
authors.initials: J
authors.lastname: Torelló
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D015232:Dinoprostone / Q000008:administration & dosage / Q000009:adverse effects*; D004211:Disseminated Intravascular Coagulation / Q000139:chemically induced / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D007751:Labor, Induced; D008423:Maternal Age; D008499:Medical Records; D008875:Middle Aged; D010120:Oxytocics / Q000008:administration & dosage / Q000009:adverse effects*; D010121:Oxytocin / Q000008:administration & dosage / Q000009:adverse effects*; D011247:Pregnancy; D011644:Puerperal Disorders / Q000139:chemically induced / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology
chemical_list: D010120:Oxytocics; D010121:Oxytocin; D015232:Dinoprostone