(819) Safety of prostaglandins in the peripartum period in case of sickle cell disease

To assess the tolerance of peripartum prostaglandin use in women with sickle cell disease (SCD).



Study Design: A retrospective cohort study in 10 centers in France. Among all women with SCD (S/S, S/C or S/β-thalassemia), we compared pregnancies with and without exposure to prostaglandins, overall and specifically according to whether prostaglandins were used for labor induction or for post-partum hemorrhage (PPH). The main outcome was the occurrence of acute SCD complications, defined as any vaso-occlusive crisis (VOC) or thromboembolic event, within 7 days after delivery.

Results:

Prostaglandins were used in 114/411 pregnancies (27.7%). In 106/411 (25.8%), prostaglandins were used to induce labor, with PGE2 (dinoprostone gel or pessary) for 95 patients and misoprostol for 11 patients. The incidence of PPH 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 acute complications 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 VOC (7.0% vs 7.8%, respectively; p = 0.78) or other secondary outcomes. Among patients undergoing labor induction, acute complications occurred in 12/106 (11.6%) exposed to prostaglandins vs 6/77 (7.6%) unexposed (p=0.46). Among patients with PPH, rates were respectively 2/11 (18.2%) vs 9/49 (18.4%; p=0.99).


Conclusion:

The use of prostaglandins in patients with SCD for labor induction or for PPH appeared safe, within the limitations of a retrospective study.