The use of prostaglandin E1 in peripartum patients with asthma

Megan Rooney Thompson, Craig Towers, Bobby Howard, Mark Hennessy, Lynlee Wolfe, Callie Heitzman

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective Prostaglandin E1 (PGE1) is commonly used in obstetric practice for labor induction and cervical ripening and in treating postpartum hemorrhage; however, its use in pregnant asthmatic patients has not been studied to date. The package insert states there is an unknown causal side effect for dyspnea and bronchospasm. Other pharmacological publications have stated that bronchoconstriction may occur with the use of PGE1. The study objective was to examine peripartum pregnant asthmatic patients who received prostaglandin E1. Study Design Every patient who was administered PGE1 from January 2010 through December 2013 was prospectively recorded. The charts were retrospectively reviewed. Peripartum patients with asthma were identified and further analyzed for any evidence of an asthma exacerbation following administration of the drug. Results A total of 234 of 2629 patients (8.9%) who received PGE1 were identified as having asthma. None of the patients had any evidence of an asthma exacerbation (0 of 234; 95% confidence interval, 0-0.017). Of the 234 patients, 104 (44%) had active asthma and were receiving daily medication, and the remaining 130 patients had a medical history of asthma for which they used an inhaler on an as-needed basis. A total of 98 patients (42%) received greater than 400 μg of total dose. A post hoc statistical assessment was performed, and the study was sufficiently powered to detect any clinically meaningful increase in asthma exacerbation with PGE1 usage, if such a risk existed. Conclusion Based on the 95% confidence interval of these data, the maximum risk for an asthma exacerbation following the use of prostaglandin E1 is less than 2%. Although all medications administered to asthmatic patients in the peripartum period should be carefully selected, this information supports the use of prostaglandin E1 in obstetric patients with asthma, if clinically indicated.

Original languageEnglish (US)
Pages (from-to)392.e1-392.e3
JournalAmerican Journal of Obstetrics and Gynecology
Volume212
Issue number3
DOIs
StatePublished - Mar 1 2015

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Peripartum Period
Alprostadil
Asthma
Obstetric Labor
Cervical Ripening
Confidence Intervals
Induced Labor
Product Labeling
Postpartum Hemorrhage
Bronchial Spasm
Bronchoconstriction
Nebulizers and Vaporizers
Dyspnea
Obstetrics
Publications

All Science Journal Classification (ASJC) codes

  • Obstetrics and Gynecology

Cite this

The use of prostaglandin E1 in peripartum patients with asthma. / Rooney Thompson, Megan; Towers, Craig; Howard, Bobby; Hennessy, Mark; Wolfe, Lynlee; Heitzman, Callie.

In: American Journal of Obstetrics and Gynecology, Vol. 212, No. 3, 01.03.2015, p. 392.e1-392.e3.

Research output: Contribution to journalArticle

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title = "The use of prostaglandin E1 in peripartum patients with asthma",
abstract = "Objective Prostaglandin E1 (PGE1) is commonly used in obstetric practice for labor induction and cervical ripening and in treating postpartum hemorrhage; however, its use in pregnant asthmatic patients has not been studied to date. The package insert states there is an unknown causal side effect for dyspnea and bronchospasm. Other pharmacological publications have stated that bronchoconstriction may occur with the use of PGE1. The study objective was to examine peripartum pregnant asthmatic patients who received prostaglandin E1. Study Design Every patient who was administered PGE1 from January 2010 through December 2013 was prospectively recorded. The charts were retrospectively reviewed. Peripartum patients with asthma were identified and further analyzed for any evidence of an asthma exacerbation following administration of the drug. Results A total of 234 of 2629 patients (8.9{\%}) who received PGE1 were identified as having asthma. None of the patients had any evidence of an asthma exacerbation (0 of 234; 95{\%} confidence interval, 0-0.017). Of the 234 patients, 104 (44{\%}) had active asthma and were receiving daily medication, and the remaining 130 patients had a medical history of asthma for which they used an inhaler on an as-needed basis. A total of 98 patients (42{\%}) received greater than 400 μg of total dose. A post hoc statistical assessment was performed, and the study was sufficiently powered to detect any clinically meaningful increase in asthma exacerbation with PGE1 usage, if such a risk existed. Conclusion Based on the 95{\%} confidence interval of these data, the maximum risk for an asthma exacerbation following the use of prostaglandin E1 is less than 2{\%}. Although all medications administered to asthmatic patients in the peripartum period should be carefully selected, this information supports the use of prostaglandin E1 in obstetric patients with asthma, if clinically indicated.",
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N2 - Objective Prostaglandin E1 (PGE1) is commonly used in obstetric practice for labor induction and cervical ripening and in treating postpartum hemorrhage; however, its use in pregnant asthmatic patients has not been studied to date. The package insert states there is an unknown causal side effect for dyspnea and bronchospasm. Other pharmacological publications have stated that bronchoconstriction may occur with the use of PGE1. The study objective was to examine peripartum pregnant asthmatic patients who received prostaglandin E1. Study Design Every patient who was administered PGE1 from January 2010 through December 2013 was prospectively recorded. The charts were retrospectively reviewed. Peripartum patients with asthma were identified and further analyzed for any evidence of an asthma exacerbation following administration of the drug. Results A total of 234 of 2629 patients (8.9%) who received PGE1 were identified as having asthma. None of the patients had any evidence of an asthma exacerbation (0 of 234; 95% confidence interval, 0-0.017). Of the 234 patients, 104 (44%) had active asthma and were receiving daily medication, and the remaining 130 patients had a medical history of asthma for which they used an inhaler on an as-needed basis. A total of 98 patients (42%) received greater than 400 μg of total dose. A post hoc statistical assessment was performed, and the study was sufficiently powered to detect any clinically meaningful increase in asthma exacerbation with PGE1 usage, if such a risk existed. Conclusion Based on the 95% confidence interval of these data, the maximum risk for an asthma exacerbation following the use of prostaglandin E1 is less than 2%. Although all medications administered to asthmatic patients in the peripartum period should be carefully selected, this information supports the use of prostaglandin E1 in obstetric patients with asthma, if clinically indicated.

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