The risk of placental abruption when using prostaglandins for cervical ripening in women with preeclampsia: Comparing misoprostol versus dinoprostone

Objective. Recent data have raised concern about the safety of using misoprostol in women with preeclampsia. We wanted to evaluate the risk of placental abruption in women with preeclampsia undergoing cervical ripening with misoprostol compared to dinoprostone. Methods. We evaluated data on 403 preeclamptic women receiving either misoprostol (N = 235) or dinoprostone (N 168) at different regimens and delivering in two university hospitals in Switzerland (Geneva and Basel). The main outcome was the incidence of placental abruption in both groups using two definitions for placental abruption ("clinical" and "post hoc"). We performed univariable and multivariable analysis. Results. The overall incidence of placental abruption was 1.5% (six cases); 1.3% (3) in the misoprostol group versus 1.8% (3) in the dinoprostone group; p = 0.69). When using the post-hoc definition the incidence was higher in the latter group (1.3 versus 5.4%; p - 0.03). In multivariable analyses, the risk of placental abruption using the "post hoc" definition was associated with the use of dinoprostone. Conclusions. The use of misoprotol in preeclamptic women appears to be safe and is not associated with a higher risk of placental abruption when compared with other prostaglandins. Concerns about the use of misoprostol in the case of preeclampsia are not justified.