Is dinoprostone safe? A report of three maternal deaths

We report three maternal deaths which might be in possible association with the use of intravaginal dinoprostone for cervical ripening and induction of labor. All cases occurred at our institution between January 2006 and December 2007. Uterine atony and profuse bleeding followed by disseminated intravascular coagulation (DIC), characterized by severe hypofibrinogenemia developed shortly after delivery of the first two patients. The third patient developed respiratory symptoms in the active labor followed by hemodynamic changes manifested by tetanic uterine contractions and fetal heart rate decelerations. Cardiac arrest developed in all patients shortly after the occurrence of symptoms with no response to any medical intervention. The pharmacologic induction of labor with dinoprostone may be in association with increased risk of maternal death because of increased risk of postpartum DIC and amnionic fluid embolism. Further investigations seem to be needed.