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Publications

Journal Article Epublish

PubMed: 42596950 DOI: 10.1002/pmf2.70014

Safety of prostaglandins in the peripartum period in case of sickle-cell disease: A multicenter cohort study.

Pregnancy (Hoboken) 1(5):e70014

Authors: Mayi Gnofam, Jeanne Sibiude, Louis Affo, Frédéric Galacteros, Edouard Lecarpentier, Florence Wang, Marine Driessen, Olivier Graesslin, Gylna Loko, Giovanna Cannas, Stéphane Bounan, Hervé Fernandez, Véronique Debarge, Caroline Makowski, Laurent Mandelbrot

Affiliations

  • Department of Obstetrics and Gynecology Assistance Publique-Hôpitaux de Paris Hôpital Louis Mourier, and FHU PREMA Colombes France.
  • Université Paris Cité Paris France.
  • Inserm IAME Paris France.
  • Department of Internal Medicine Assistance Publique-Hôpitaux de Paris Hôpital Louis Mourier Colombes France.
  • Department of Internal Medicine Assistance Publique-Hôpitaux de Paris Red Cell Genetic Disease Unit GHU Henri Mondor U-PEC, Paris, France.
  • Department of Obstetrics and Gynecology Centre Hospitalier Intercommunal Créteil Université Paris-Est Créteil, IMRB INSERM U955 Créteil France.
  • Department of Obstetrics and Gynecology Assistance Publique-Hôpitaux de Paris Hôpital Louis Mourier, and FHU PREMA Colombes France. Université Paris Cité Paris France.
  • Department of Obstetrics and Gynecology Assistance Publique-Hôpitaux de Paris Hôpital Necker AP-HP Paris France.
  • Department of Obstetrics and Gynecology Hôpital Maison Blanche Reims France.
  • Sickle Cell Disease Reference Center Hôpital La Meynard Martinique Fort-de-France France.
  • Sickle Cell Disease Reference Center Hôpital E. Herriot HCL Lyon France.
  • Department of Obstetrics and Gynecology Hôpital Delafontaine Saint Denis France.
  • Department of Obstetrics and Gynecology Assistance Publique-Hôpitaux de Paris Hôpital Bicêtre Le Kremlin Bicêtre France.
  • Department of Obstetrics and Gynecology Centre Hospitalier Universitaire de Lille Lille France.
  • Department of Internal Medicine Centre Hospitalier Universitaire Grenoble Alpes Grenoble France.

Abstract

INTRODUCTION

Pregnancies with sickle-cell disease are at high risk of maternal, obstetrical, and fetal complications, for which prostaglandins are often indicated to induce labor or to treat postpartum hemorrhage. There is concern that prostaglandin use may increase the risk of vaso-occlusion, but to date no clinical study has yet assessed this risk. Our objective was to assess the safety of prostaglandins during delivery and postpartum in women with sickle-cell disease.

METHOD

A retrospective multicenter cohort study in 10 tertiary university-affiliated centers in France, including all women with sickle-cell disease (S/S, S/C, or S/β-thalassemia) delivering in the centers.

METHODS

We compared pregnancies with and without exposure to prostaglandins, overall and specifically according to whether prostaglandins were used for labor induction or for postpartum hemorrhage. The main outcome was the occurrence of vaso-occlusive crisis and/or thromboembolism, within 7 days after delivery. Secondary outcomes were vaso-occlusive crises requiring intravenous morphine and/or intensive care admission.

RESULTS

Prostaglandins were used in 114/411 pregnancies (27.7%). In 106/411 (25.8%), they were used to induce labor, with Prostaglandin E2 (dinoprostone gel or pessary) for 95 patients and misoprostol for 11 patients. The incidence of postpartum hemorrhage was 60/411 (14.6%), and 11 cases required second-line therapy with prostaglandins; sulprostone was used as per French practice guidelines. The incidence of vaso-occlusive crises and/or venous thromboembolism in the postpartum did not differ between patients exposed and not exposed to prostaglandins (14/114 (12.2%) vs. 34/293 (11.6%), respectively; p = 0.87), nor did the incidence of severe vaso-occlusive crises requiring morphine and/or intensive care unit hospitalization (7.0% vs. 7.8%, respectively; p = 0.78). Among patients undergoing labor induction, acute complications occurred in 12/106 (11.6%) exposed to prostaglandins versus 6/77 (7.6%) unexposed (p = 0.46). Among patients with postpartum hemorrhage, rates were respectively 2/11 (18.2%) versus 9/49 (18.4%; p = 0.99).

CONCLUSION

The use of prostaglandins in patients with sickle-cell disease for labor induction or for postpartum hemorrhage appeared safe, within the limitations of a retrospective study.

MeSH

Labor, Induced, Cells, Pregnancy, Thromboembolism, Safety, Hemorrhage, Morphine, Anemia, Sickle Cell, Incidence, Cohort Studies, Prostaglandins, Postpartum Hemorrhage, Peripartum Period, Misoprostol, Postpartum Period, Dinoprostone, Vaso-Occlusive Crises