title: Racial/Ethnic Differences in Labor Outcomes with Prostaglandin Vaginal Inserts.
abstract: OBJECTIVE
  The aim of this study is to compare labor outcomes across race/ethnicity in women undergoing prostaglandin labor induction.
  
  
  METHODS
  Secondary analysis of misoprostol vaginal insert (MVI) trial, a double-blind, randomized, control trial of 1,308 patients comparing sustained release vaginal inserts containing dinoprostone 10 mg and misoprostol 50 mcg (MVI 50) or 100 mcg (MVI 100).
  
  
  RESULTS
  Achievement of active labor and induction failures were similar across race/ethnicity. Cesareans were performed less frequently in whites (29 %) and Hispanics (24.5 %) compared to blacks (32.7 %) (adjusted odds ratio (aOR) 0.87, 95 % confidence interval (CI) 0.47-0.97, p = 0.03 and aOR 0.86, 95 % CI 0.44-0.97, p = 0.03, respectively). When compared to blacks, whites were less likely to undergo cesarean for non-reassuring fetal heart rate tracing (aOR 0.41, 95 % CI 0.25-0.66, p = 0.0003), as were Hispanics (aOR 0.38, 95 % CI 0.22-0.65, p = 0.0004). Postpartum hemorrhage occurred more frequently in Hispanics (8.8 %) versus blacks (4.1 %) and whites (OR 2.27, 95 % CI 0.23-0.82, p = 0.02 and OR 3.69, 95 % CI 0.14-0.51, p < 0.0001, respectively). Birth weights of black infants were lower than whites (p < 0.0001) and Hispanics (p = 0.0003). Neonatal outcomes did not differ between groups.
  
  
  CONCLUSIONS
  Differences in labor induction outcomes with prostaglandin labor induction exist based on race/ethnicity. Blacks delivered smaller babies, were more likely to undergo cesarean, and have cesareans performed for non-reassuring fetal heart tracing compared to other groups. Hispanics were more likely to experience postpartum hemorrhage compared to the other races.
authors: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California Irvine Medical Center, Orange, CA, 92868, USA. meganls@uci.edu.|Department of Obstetrics and Gynecology, Memorial Care Center for Women at Miller Children's Hospital, Long Beach Memorial Medical Center, Long Beach, CA, 90806, USA. meganls@uci.edu.
authors: Megan L
authors: ML
authors: Stephenson
authors: Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, 75235, USA.
authors: J Seth
authors: JS
authors: Hawkins
authors: Department of Obstetrics and Gynecology, Kaiser Permanente Orange County, Irvine, CA, 92618, USA.
authors: Leo
authors: L
authors: Pevzner
authors: Independent Consultant, Phoenixville, PA, 19460, USA.
authors: Barbara L
authors: BL
authors: Powers
authors: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California Irvine Medical Center, Orange, CA, 92868, USA.|Department of Obstetrics and Gynecology, Memorial Care Center for Women at Miller Children's Hospital, Long Beach Memorial Medical Center, Long Beach, CA, 90806, USA.
authors: Deborah A
authors: DA
authors: Wing
mesh_terms: D000282:Administration, Intravaginal; D000328:Adult; D044383:Black People / Q000706:statistics & numerical data*; D002585:Cesarean Section / Q000706:statistics & numerical data; D015232:Dinoprostone / Q000008:administration & dosage; D004311:Double-Blind Method; D005260:Female; D054624:Health Status Disparities; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D007751:Labor, Induced / Q000379:methods*; D016595:Misoprostol / Q000008:administration & dosage; D007744:Obstetric Labor Complications / Q000208:ethnology; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000208:ethnology*; D011453:Prostaglandins / Q000008:administration & dosage*; D044465:White People / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D011453:Prostaglandins; D016595:Misoprostol; D015232:Dinoprostone
keywords: Cesarean; Disparity; Labor induction; Race