Poster Session 3
Category: Antepartum Fetal Assessment
Poster Session 3
Abigail B. Clark, BS
University of Texas Southwestern Medical Center
University of Texas Southwestern Medical Center, Texas, United States
Allison Kurzeja, MD (she/her/hers)
MFM Fellow
University of Texas Southwestern Medical Center
Dallas, Texas, United States
Jessica D. Sisco, MD
Resident
University of Texas Southwestern Medical Center
Dallas, Texas, United States
Elaine L. Duryea, MD
Associate Professor
University of Texas Southwestern Medical Center
Dallas, Texas, United States
Emily H. Adhikari, MD (she/her/hers)
Associate Professor
University of Texas Southwestern Medical Center
Dallas, Texas, United States
Polly B. Cordova, CNM, DNP
Certified Nurse Midwife, Integrated Family Planning Opioid Project
Parkland Health
Dallas, Texas, United States
Jessica McNeil, CNM, DNP
Certified Nurse Midwife, Integrated Family Planning Opioid Project
Parkland Health
Dallas, Texas, United States
Amber Fisher
Parkland Health
Dallas, Texas, United States
Joshua Kern, MD
Assistant Professor, Department of Emergency Medicine
University of Texas Southwestern Medical Center
Dallas, Texas, United States
Nancy S. Onisko, DO
Assistant Professor of Emergency Medicine; Assistant Director of the Perinatal Intervention Program
University of Texas Southwestern Medical Center
Dallas, Texas, United States
Aldo Andino, MD
Assistant Professor of Emergency Medicine
University of Texas Southwestern Medical Center
Dallas, Texas, United States
Kurt Kleinschmidt, MD
Professor of Emergency Medicine, Director of Perinatal Intervention Program
University of Texas Southwestern Medical Center
Dallas, Texas, United States
C. Edward Wells, MD
University of Texas Southwestern Medical Center
Dallas, Texas, United States
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Anne M. Ambia, MD
Assistant Professor
University of Texas Southwestern Medical Center
Dallas, Texas, United States
To evaluate fetal heart rate tracing changes following induction of buprenorphine using a high-dose protocol for medication-assisted treatment (MAT) for opioid use disorder.
Study Design:
This is a retrospective cohort study of patients admitted with opioid use disorder (OUD) in pregnancy. Patients were included if they underwent a buprenorphine induction in the antepartum setting and were greater than 24-weeks' gestation. Fetal monitoring was reviewed for one hour following buprenorphine induction as well as any additional rescue doses. Tracings were independently reviewed and classified by three maternal fetal medicine physicians using the National Institute of Child Health and Human Development Criteria. Records were reviewed to assess subsequent antepartum and obstetrical management.
Results:
From September 2023 through May 2025, 25 buprenorphine inductions occurred after 24 weeks' gestation. Of these, 19 (76%) had fetal monitoring obtained. Two (8%) patients had two buprenorphine inductions after 24 weeks’ gestation and thus had multiple tracings obtained. There were no cases of precipitated withdrawal. Most tracings remained reassuring, with 16 (84%) with a Category I tracing, 3 (16%) with a Category II tracing, and 0 with a Category III tracing. Of those with Category II tracings, the findings were transient, with no patients requiring intrauterine resuscitation or need for delivery due to non-reassuring fetal status. Preterm contractions and arrested preterm labor complicated one induction at 36 weeks. Prelabor rupture of membranes occurred two days after one induction at 37 weeks, followed by repeat cesarean section. Two other patients underwent a scheduled delivery for usual obstetric indications during the same admission as the buprenorphine induction.
Conclusion:
Our findings provide reassuring data that high-dose buprenorphine inductions for medication-assisted treatment in pregnancy does not result in acute non-reassuring fetal heart rate patterns warranting emergent intervention. These preliminary findings support the acute safety of this induction protocol in the antepartum setting.