Maternal and neonatal outcomes following induction of labor for fetal growth restriction: Extra-amniotic balloon versus prostaglandins

Abstract

Objective: To compare perinatal outcomes in pregnancies with fetal growth restriction (FGR) undergoing induction of labor by extra-amniotic balloon (EAB) versus prostaglandin E2 (PGE2). Methods: A retrospective cohort study of women with singleton pregnancies and FGR, undergoing induction at term via EAB, PGE2, or both, at a single medical center (2014–2017). Primary outcome was rate of cesarean deliveries (CDs). Secondary outcomes included composite maternal and neonatal outcomes. Results: Overall, 266 women met the inclusion criteria. Among them, 131 (49.2%) underwent induction by PGE2, 116 (43.6%) by EAB, and 19 (7.14%) by both methods. No differences were noted in baseline characteristics. Rate of CD (17.24% vs. 6.11% vs. 10.53%, P = 0.022) and maternal composite outcome (18.97% vs. 6.11% vs. 10.53%, P < 0.01) were higher among women who underwent induction by EAB compared with PGE2 or both. No difference was noted between groups in neonatal outcomes. In a multivariable logistic regression, rates of cesarean delivery and composite maternal outcome were no longer higher in the EAB group (adjusted odds ratio [aOR] 1.68, 95% confidence interval [CI] 0.68–4.16, P = 0.260; and aOR 1.94, 95% CI 0.84–4.45, P = 0.120, respectively). Conclusion: EAB and PGE2 have comparable maternal and neonatal outcomes when used for induction of labor due to FGR.