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The Cochrane Database of Systematic... 2001This is one of a series of reviews of methods of cervical ripening and labour induction using standardised methodology. (Review)
Review
BACKGROUND
This is one of a series of reviews of methods of cervical ripening and labour induction using standardised methodology.
OBJECTIVES
To determine the effects of oral prostaglandin E2 for third trimester induction of labour.
SEARCH STRATEGY
The Cochrane Pregnancy and Childbirth Group trials register, the Cochrane Controlled Trials Register and bibliographies of relevant papers. Date of last search: December 2000.
SELECTION CRITERIA
The criteria for inclusion included the following: (1) clinical trials comparing oral prostaglandin E2 used for third trimester cervical ripening or labour induction with placebo/no treatment or other methods listed above it on a predefined list of labour induction methods; (2) random allocation to the treatment or control group; (3) adequate allocation concealment; (4) violations of allocated management not sufficient to materially affect conclusions; (5) clinically meaningful outcome measures reported; (6) data available for analysis according to the random allocation; (7) missing data insufficient to materially affect the conclusions.
DATA COLLECTION AND ANALYSIS
A strategy has been developed to deal with the large volume and complexity of trial data relating to labour induction. This involves a two-stage method of data extraction. The initial data extraction is done centrally, and incorporated into a series of primary reviews arranged by methods of induction of labour, following a standardised methodology. The data will then be extracted from the primary reviews into a series of secondary reviews, arranged by category of woman. To avoid duplication of data in the primary reviews, the labour induction methods have been listed in a specific order, from one to 25. Each primary review includes comparisons between one of the methods (from two to 25) with only those methods above it on the list.
MAIN RESULTS
There were 19 studies included in the review. Of these 15 included a comparison using either oral or intravenous oxytocin with or without amniotomy. The quality of studies reviewed was not high. Only seven studies had clearly described allocation concealment. Only two studies stated that providers and/or participants were blinded to treatment group. For the outcome of vaginal delivery not achieved within 24 hours, in the composite comparison of oral PGE2 versus all oxytocin treatments (oral and intravenous, with and without amniotomy), there was a trend favoring oxytocin treatments (relative risk (RR) 1.97, 95% confidence interval (CI) 0.86 to 4.48). For the outcome of cesarean section, in the comparison of PGE2 versus no treatment or placebo, PGE2 was favored (relative risk (RR) 0.54, 95% confidence interval (CI) 0.29,0.98). Otherwise, there were no significant differences between groups for this outcome. Oral prostaglandin was associated with vomiting across all comparison groups.
REVIEWER'S CONCLUSIONS
Oral prostaglandin consistently resulted in more frequent gastrointestinal side effects, in particular vomiting, compared with the other treatments included in this review. There were no clear advantages to oral prostaglandin over other methods of induction of labour.
Topics: Administration, Oral; Cervical Ripening; Dinoprostone; Female; Humans; Labor, Induced; Oxytocics; Pregnancy; Pregnancy Trimester, Third
PubMed: 11406075
DOI: 10.1002/14651858.CD003098 -
BMJ Open Oct 2018The use of herbal medicines for induction of labour (IOL) is common globally and yet its effects are not well understood. We assessed the efficacy and safety of herbal... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The use of herbal medicines for induction of labour (IOL) is common globally and yet its effects are not well understood. We assessed the efficacy and safety of herbal medicines for IOL.
DESIGN
Systematic review and meta-analysis of published literature.
DATA SOURCES
We searched in MEDLINE, AMED and CINAHL in April 2017, updated in June 2018.
ELIGIBILITY CRITERIA
We considered experimental and non-experimental studies that compared relevant pregnancy outcomes between users and non-user of herbal medicines for IOL.
DATA EXTRACTION AND SYNTHESIS
Data were extracted by two reviewers using a standardised form. A random-effects model was used to synthesise effects sizes and heterogeneity was explored through I statistic. The risk of bias was assessed using 'John Hopkins Nursing School Critical Appraisal Tool' and 'Cochrane Risk of Bias Tool'.
RESULTS
A total of 1421 papers were identified through the searches, but only 10 were retained after eligibility and risk of bias assessments. The users of herbal medicine for IOL were significantly more likely to give birth within 24 hours than non-users (Risk Ratio (RR) 4.48; 95% CI 1.75 to 11.44). No significant difference in the incidence of caesarean section (RR 1.19; 95% CI 0.76 to 1.86), assisted vaginal delivery (RR 0.73; 95% CI 0.47 to 1.14), haemorrhage (RR 0.84; 95% CI 0.44 to 1.60), meconium-stained liquor (RR 1.20; 95% CI 0.65 to 2.23) and admission to nursery (RR 1.08; 95% CI 0.49 to 2.38) was found between users and non-users of herbal medicines for IOL.
CONCLUSIONS
The findings suggest that herbal medicines for IOL are effective, but there is inconclusive evidence of safety due to lack of good quality data. Thus, the use of herbal medicines for IOL should be avoided until safety issues are clarified. More studies are recommended to establish the safety of herbal medicines.
Topics: Cesarean Section; Female; Herbal Medicine; Humans; Labor, Induced; Oxytocics; Plant Extracts; Plants, Medicinal; Pregnancy; Pregnancy Outcome
PubMed: 30337313
DOI: 10.1136/bmjopen-2018-022499 -
South African Medical Journal =... Dec 2023Postpartum haemorrhage is the leading cause of preventable maternal mortality in South Africa. In a significant breakthrough in the management of PPH, the E-MOTIVE trial...
Postpartum haemorrhage is the leading cause of preventable maternal mortality in South Africa. In a significant breakthrough in the management of PPH, the E-MOTIVE trial found that a multifaceted health service intervention reduced severe PPH after vaginal delivery by 60% in 78 hospitals in Nigeria, Kenya, Tanzania and SA. The E-MOTIVE approach comprises objective blood loss measurement monitored every 15 minutes during the first hour after delivery to detect PPH early and trigger a bundle of first-line treatments, including massaging the uterus, oxytocin infusion, tranexamic acid infusion, intravenous crystalloid fluids, examination for the cause, emptying the bladder and, if necessary, escalation of care. E-MOTIVE was integrated into the existing Essential Steps in Managing Obstetric Emergencies algorithm. Certain research-related elements of the trial setting cannot be replicated in routine practice. Therefore, we need to develop local strategies to ensure the essential clinical elements of the intervention are implemented. Potential strategies include incorporating the E-MOTIVE principles into national guidelines, ongoing training strategies and ensuring all facilities are equipped with necessary medication, equipment and delegations. This breakthrough intervention provides hope for women in SA, and requires a purposeful, co-ordinated implementation strategy on a national scale to reach all levels of the health service.
Topics: Female; Humans; Pregnancy; Delivery, Obstetric; Oxytocics; Oxytocin; Postpartum Hemorrhage; South Africa; Clinical Trials as Topic
PubMed: 38525626
DOI: 10.7196/SAMJ.2023.v113i12.1164 -
Trials Apr 2011Prospective meta-analysis (PMA) is a collaborative research design in which individual sites perform randomized controlled trials (RCTs) and pool the data for... (Meta-Analysis)
Meta-Analysis Randomized Controlled Trial
BACKGROUND
Prospective meta-analysis (PMA) is a collaborative research design in which individual sites perform randomized controlled trials (RCTs) and pool the data for meta-analysis. Members of the PMA collaboration agree upon specific research interventions and outcome measures, ideally before initiation but at least prior to any individual trial publishing results. This allows for uniform reporting of primary and secondary outcomes. With this approach, heterogeneity among trials contributing data for the final meta-analysis is minimized while each site maintains the freedom to design a specific trial. This paper describes the process of creating a PMA collaboration to evaluate the impact of misoprostol on ease of intrauterine device (IUD) insertion in nulliparous women.
METHODS
After the principal investigator developed a preliminary PMA protocol, he identified potential collaborating investigators at other sites. One site already had a trial underway and another site was in the planning stages of a trial meeting PMA requirements. Investigators at six sites joined the PMA collaborative. Each site committed to enroll subjects to meet a pre-determined total sample size. A final common research plan and site responsibilities were developed and agreed upon through email and face-to-face meetings. Each site committed to contribute individual patient data to the PMA collaboration, and these data will be analyzed and prepared as a multi-site publication. Individual sites retain the ability to analyze and publish their site's independent findings.
RESULTS
All six sites have obtained Institutional Review Board approval and each has obtained individual funding to meet the needs of that site's study. Sites have shared resources including study protocols and consents to decrease costs and improve study flow. This PMA protocol is registered with the Cochrane Collaboration and data will be analyzed according to Cochrane standards for meta-analysis.
CONCLUSIONS
PMA is a novel research method that improves meta-analysis by including several study sites, establishing uniform reporting of specific outcomes, and yet allowing some independence on the part of individual sites with respect to the conduct of research. The inclusion of several sites increases statistical power to address important clinical questions. Compared to multi-center trials, PMA methodology encourages collaboration, aids in the development of new investigators, decreases study costs, and decreases time to publication.
TRIAL REGISTRATION
ClinicalTrials.gov: NCT00613366, NCT00886834, NCT01001897, NCT01147497 and NCT01307111.
Topics: Cooperative Behavior; Evidence-Based Medicine; Family Planning Services; Female; Humans; Interinstitutional Relations; Intrauterine Devices; Misoprostol; Oxytocics; Parity; Pregnancy; Prospective Studies; Research Design; Treatment Outcome; United States
PubMed: 21527040
DOI: 10.1186/1745-6215-12-104 -
Journal of Ayub Medical College,... 2019Oligohydramnios, defined as an amniotic fluid index (AFI) of less than the 5th percentile (at term ≤5 cm, or at per-term ≤8.0 cm), has an incidence of 8.5-15.5%. It...
BACKGROUND
Oligohydramnios, defined as an amniotic fluid index (AFI) of less than the 5th percentile (at term ≤5 cm, or at per-term ≤8.0 cm), has an incidence of 8.5-15.5%. It is associated with an increased perinatal morbidity and mortality. The objective of this study was to explore whether induction with misoprostol can safely be offered to patients with reduced amniotic fluid index and that vaginal delivery can be achieved without major adverse effects.
METHODS
All women at term who gave consent to be part of the study and required labour induction were recruited. Total 120 women were included in study. They had a per-induction ultrasound to calculate amniotic fluid index (AFI). Based on AFI., the patients were divided into two groups: group 1, had AFI ≤5 cm and was oligohydramnios group. The other was group 2 with normal amniotic fluid, i.e., AFI >5 cm. Both these groups then underwent labour induction with misoprostol (cytotec-Pfizer) 50microgram. The dose was repeated 6 hourly for a maximum of three doses. The outcomes studied were number of tablets used, induction to labour interval, induction to the delivery interval and method of delivery. The foetal outcomes were meconium staining, Apgar score, NICU admission and advance neonatal resuscitation.
RESULTS
In maternal parameters, it was observed that there was a significant difference in induction to delivery interval only and in foetal parameters it was observed that in group 1, there was statistical significance in meconium staining, Apgar score and NICU admission.
CONCLUSIONS
Induction with misoprostol and vaginal delivery can safely be offered to women with oligohydramnios at term.
Topics: Female; Humans; Labor, Induced; Misoprostol; Oligohydramnios; Oxytocics; Pregnancy; Pregnancy Outcome
PubMed: 31535516
DOI: No ID Found -
The Pan African Medical Journal 2018Uterine rupture in patients with healthy uterus during the 2 and 3 trimester of pregnancy is a rare and severe obstetric complication involving maternal and fetal vital... (Review)
Review
Uterine rupture in patients with healthy uterus during the 2 and 3 trimester of pregnancy is a rare and severe obstetric complication involving maternal and fetal vital prognosis as well as obstetrical outcome of patients in the absence of diagnosis and early treatment. It mainly occurs in women who have had scarred uterus and it is anecdotal in those with healthy uterus. We report the case of a primiparous patient with unscarred uterus who had had uterine rupture during labour induction with misoprostol for fetal death in utero (FDIU) due to intrauterine growth retardation (IGR) and severe oligohydramnios at 31 weeks of amenorrhea (WA). This study and the literature review highlights the importance of administrating misoprostol for labour induction with extreme caution as well as the clinical features, the risk factors, the diagnostic method and the therapeutic treatment of this rare but potentially serious condition.
Topics: Female; Fetal Death; Humans; Labor, Induced; Misoprostol; Oxytocics; Pregnancy; Pregnancy Trimester, Third; Uterine Rupture
PubMed: 31447981
DOI: 10.11604/pamj.2018.31.223.12906 -
Science Advances May 2019Oxytocin is used in approximately half of all births in the United States during labor induction and/or augmentation. However, the effects of maternal oxytocin...
Oxytocin is used in approximately half of all births in the United States during labor induction and/or augmentation. However, the effects of maternal oxytocin administration on offspring development have not been fully characterized. Here, we used the socially monogamous prairie vole to examine the hypothesis that oxytocin exposure at birth can have long-term developmental consequences. Maternally administered oxytocin increased methylation of the oxytocin receptor () in the fetal brain. As adults, oxytocin-exposed voles were more gregarious, with increased alloparental caregiving toward pups and increased close social contact with other adults. Cross-fostering indicated that these effects were the result of direct action on the offspring, rather than indirect effects via postnatal changes in maternal behavior. Male oxytocin-exposed offspring had increased oxytocin receptor density and expression in the brain as adults. These results show that long-term effects of perinatal oxytocin may be mediated by an epigenetic mechanism.
Topics: Animals; Animals, Newborn; Arvicolinae; Behavior, Animal; Brain; Epigenesis, Genetic; Female; Male; Methylation; Oxytocics; Oxytocin; Parturition; Pregnancy; Receptors, Oxytocin; Social Behavior
PubMed: 31049395
DOI: 10.1126/sciadv.aav2244 -
Einstein (Sao Paulo, Brazil) 2020To characterize the use of the drug misoprostol for treatment of postpartum hemorrhage in pregnant women. (Observational Study)
Observational Study
OBJECTIVE
To characterize the use of the drug misoprostol for treatment of postpartum hemorrhage in pregnant women.
METHODS
A descriptive observational study was carried out with secondary data from pregnant women who used misoprostol to treat postpartum hemorrhage in a reference public maternity, from July 2015 to June 2017. Clinical and sociodemographic profiles of pregnant women, how misoprostol was used and success rate in controling postpartum hemorrhage were characterized.
RESULTS
A total of 717 prescriptions of misoprostol were identified. Of these, 10% were for treatment of postpartum hemorrhage. The majority of pregnant women were young adults, married, with complete high school education, white, residing in urban areas, multiparous (68.1%) and 25% had previous cesarean sections. The mean gestational age was 39 weeks and 51.4% had a cesarean section. There was prophylactic use of oxytocin in 47.2% of women. Treatment of postpartum hemorrhage was successful in 84.7% of women. Of these, 79.2% also used oxytocin and 54.2% methylergonovine. Only 13.5% of pregnant women had less than five prenatal visits, and the main cause of postpartum hemorrhage was uterine atony. There were 13 complications after hemorrhage, 15.3% required blood transfusion and there was one case of maternal death.
CONCLUSION
Misoprostol showed to be effective and safe for treating postpartum hemorrhage.
Topics: Adult; Cross-Sectional Studies; Female; Gestational Age; Humans; Methylergonovine; Misoprostol; Oxytocics; Oxytocin; Postpartum Hemorrhage; Pregnancy; Young Adult
PubMed: 31721897
DOI: 10.31744/einstein_journal/2020AO5029 -
BMC Pregnancy and Childbirth Apr 2022Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality worldwide. Midwives play a key role in the initial management of PPH. Uterotonic...
BACKGROUND
Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality worldwide. Midwives play a key role in the initial management of PPH. Uterotonic agents are widely used in its prevention and treatment, with oxytocin the first-line agent. Nonetheless, a standardized guideline for optimal dose and rate of administration has not been clearly defined. The aim of this study was to investigate French midwives' practices regarding first-line oxytocin treatment and the factors influencing its delayed administration.
METHODS
This multicenter study was based on clinical vignettes of PPH management collected using an anonymous online questionnaire. A random sample of midwives from 145 maternity units in France from 15 randomly selected perinatal networks were invited to participate by email. The Previously validated case vignettes described two different scenarios of severe PPH. Vignette 1 described a typical immediate, severe PPH, and vignette 2 a less typical case of severe but gradual PPH They were constructed in three successive steps and included multiple-choice questions proposing several types of clinical practice options at each stage. For each vignette separately, we analyzed the lack of prompt oxytocin administration and the factors contributing to them, that is, characteristics of the midwives and organizational features of maternity units. Bivariate analysis and multivariable logistic regression analysis were applied.
RESULTS
In all, 450 midwives from 87 maternity units provided complete responses. Lack of promptness was observed in 21.6% of responses (N = 97) in Vignette 1 and in 13.8% (N = 62) in Vignette 2 (p < .05). After multivariate analysis, the risk of delay was lower among with midwives working in university maternity hospitals (ORa 0.47, 95% 0.21, 0.97) and in units with 1500 to 2500 births per year (ORa 0.49, 95% CI 0.26, 0.90) for Vignette 1. We also noticed that delay increased with the midwives' years of experience (per 10-year period) (ORa 1.30, 95% CI 1.01, 1.69).
CONCLUSIONS
This study using clinical vignettes showed delays in oxytocin administration for first-line treatment of PPH. Because delay in treatment is a major cause of preventable maternal morbidity in PPH, these findings suggest that continuing training of midwives should be considered, especially in small maternity units.
Topics: Drug Therapy, Combination; Female; Humans; Midwifery; Oxytocics; Oxytocin; Postpartum Hemorrhage; Pregnancy; Surveys and Questionnaires
PubMed: 35461215
DOI: 10.1186/s12884-022-04648-5 -
Women's Health (London, England) Jan 2014Labor induction and cervical ripening are widely utilized and new methods are constantly being investigated. Prostaglandins have been shown to be effective labor... (Review)
Review
Labor induction and cervical ripening are widely utilized and new methods are constantly being investigated. Prostaglandins have been shown to be effective labor induction agents and, in particular, were compared with other prostaglandin preparations; vaginal misoprostol used off-label was associated with reduced failure to achieve vaginal delivery. The challenge is to provide this medication with the correct dosing for this indication and with the ability to discontinue the medication if needed, all while ensuring essential maternal and neonatal safety. The misoprostol vaginal insert initiates cervical ripening using a delivery system that controls misoprostol release and can be rapidly removed. This article reviews the development, safety and efficacy of the misoprostol vaginal insert for induction of labor and cervical ripening, and will focus on vaginally administered prostaglandins.
Topics: Administration, Intravaginal; Cervical Ripening; Dose-Response Relationship, Drug; Female; Humans; Labor, Induced; Misoprostol; Oxytocics; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, Third; Uterine Contraction
PubMed: 24328596
DOI: 10.2217/whe.13.49