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.

Keywords: asthma in pregnancy; cervical ripening; postpartum hemorrhage; prostaglandin E(1).