FPIN's Clinical Inquiries
Prostaglandins to Induce Labor in Women with Asthma
Am Fam Physician. 2014 Sep 15;90(6):415.
Does the use of prostaglandins to induce labor increase the risk of maternal bronchospasm in patients with asthma?
There is little evidence evaluating whether prostaglandins used to induce labor increase the risk of bronchospasm in patients with asthma. The use of dinoprostone to induce labor is not associated with asthma exacerbations or reduced oxygen saturation in patients with active asthma or a history of asthma. (Strength of Recommendation: C, based on a retrospective cohort study.)
Approximately 4% to 8% of pregnancies are complicated by asthma, and prostaglandins are often used to induce labor (225 cases per 1,000 live births).1,2 However, there are no prospective studies evaluating the use of prostaglandins in pregnant women with asthma.
A small 12-year retrospective cohort study (n = 189) found no change in asthma symptoms in pregnant patients with active asthma or a history of asthma who received dinoprostone for labor induction.3 There was no increase in the primary outcomes of clinical asthma exacerbation (described as any respiratory symptoms or the need for new bronchodilator medications), and no decrease in pulse oximetry measurements after prostaglandin exposure. An older study on the intravenous use of dinoprostone for pregnancy termination found an uncommon paradoxical increase in airway resistance with nonobstetric dosing.4 No studies have evaluated whether there is an association between bronchospasm and the use of misoprostol for induction of labor.
Recommendations from Others
Consensus recommendations from the National Asthma Education and Prevention Program support the use of misoprostol and dinoprostone for cervical ripening in pregnancy and for the management of postpartum hemorrhage.5 They warn that methylergonovine and carboprost may cause bronchospasm. The package insert for dinoprostone recommends caution when used in patients with a history of childhood asthma, even if there have not been exacerbations during adulthood. The package insert for misoprostol lists bronchospasm as an uncommon adverse event.
The opinions and assertions contained herein are the private views of the authors and do not not reflect the official policy of Brooke Army Medical Center, the U.S. Army or U.S. Air Force Medical Departments, or the U.S. Army or U.S. Air Force at large.
REFERENCESshow all references
1. Dombrowski MP. Asthma and pregnancy [published correction appears in Obstet Gynecol. 2006;108(6):1556]. Obstet Gynecol. 2006;108(3 pt 1):667–681....
2. ACOG practice bulletin no. 107: induction of labor. Obstet Gynecol. 2009;114(2 pt 1):386–397.
3. Towers CV, et al. The use of prostaglandin E2 in pregnant patients with asthma. Am J Obstet Gynecol. 2004;190(6):1777–1780.
4. Smith AP. The effects of intravenous infusion of graded doses of prostaglandins F2 and E2 on lung resistance in patients undergoing termination of pregnancy. Clin Sci. 1973;44(1):17–25.
5. Asthma and Pregnancy Report. National Asthma Education and Prevention Program (NAEPP) Report of the Working Group on Asthma and Pregnancy: Management of Asthma During Pregnancy. Bethesda, Md.: U.S. Dept. of Health and Human Services, et al.;1993:42.
Clinical Inquiries provides answers to questions submitted by practicing family physicians to the Family Physicians Inquiries Network (FPIN). Members of the network select questions based on their relevance to family medicine. Answers are drawn from an approved set of evidence-based resources and undergo peer review. The strength of recommendations and the level of evidence for individual studies are rated using criteria developed by the Evidence-Based Medicine Working Group (http://www.cebm.net/?o=1025).
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