Does Induction with Misoprostol Impact the Small for Gestational Age Neonate?
OBJECTIVE
To compare outcomes in small for gestational age neonates induced with misoprostol to other cervical ripening agents. We hypothesized that misoprostol use will demonstrate no significant difference in outcomes compared with alternative agents.


METHODS
Small for gestational age neonates (<10th percentile for gestational age) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) sponsored Consortium on Safe Labor database were analyzed. Neonates induced with misoprostol ± oxytocin (n = 451) were compared with neonates induced with prostaglandin E2 ± oxytocin and/or mechanical dilation ± oxytocin (n = 663). Primary outcomes included intrapartum fetal distress, cesarean section for fetal distress, cesarean section for any reason, neonatal intensive care unit admission, low 5-minute Apgar, and composite neonatal morbidity. Multiple logistic regression was used to calculate adjusted odds ratios (aORs). Data were analyzed using SAS.


RESULTS
Small for gestational age neonates induced with misoprostol ± oxytocin compared with alternative agents had decreased low 5-minute Apgar scores (aOR 0.27 [0.10-0.71]). No significant differences were demonstrated among very small for gestational age neonates (<5th percentile for gestational age).


CONCLUSIONS
Our results suggest that misoprostol does not increase risk of adverse outcomes in small for gestational age neonates; however, prospective studies are warranted to further assess optimal cervical ripening agents in this population.
Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin.
Megan E
ME
Foeller
Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin.
Meredith O
MO
Cruz
Department of Obstetrics and Gynecology, University of Illinois, Chicago, Illinois.
Michelle A
MA
Kominiarek
Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin.
Judith U
JU
Hibbard
D000328:Adult; D001034:Apgar Score; D002585:Cesarean Section / Q000706:statistics & numerical data; D004106:Dilatation; D015232:Dinoprostone; D005260:Female; D005316:Fetal Distress / Q000139:chemically induced; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D007363:Intensive Care Units, Neonatal; D007751:Labor, Induced / Q000009:adverse effects / Q000379:methods*; D016595:Misoprostol / Q000008:administration & dosage / Q000009:adverse effects; D010120:Oxytocics / Q000008:administration & dosage / Q000009:adverse effects; D010121:Oxytocin; D010343:Patient Admission / Q000706:statistics & numerical data; D011247:Pregnancy; D012189:Retrospective Studies; D055815:Young Adult
D010120:Oxytocics; D016595:Misoprostol; D010121:Oxytocin; D015232:Dinoprostone