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

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.