Use of oxytocin and misoprostol for induction or ... - POPPHI

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Figure 2.1a Identification and inclusion process for literature searches Databases searched: PubMed; Embase; CINAHL Plus; Scopus; Cochrane database References identified (excluding duplicates): 962 References remaining after review of abstracts: 278 References meeting inclusion/exclusion criteria after full review of article: 140 Reference providing rates, trends or indications: 43 References providing data on misoprostol for induction/augmentation: 7 References specifically on elective inductions: 12 References providing data on maternal/perinatal outcomes: 24 References specifically on low resource settings: 36 Meta-analyses identified and reviewed in the Cochrane library: 18 Objectives #5 and 6: Recommendations resulting from data compiled in this review are proposed; gaps in knowledge are summarized and needs for further research are discussed. 3. Results This section presents results corresponding to each of the objectives listed in section 1.1. Additionally, issues related to the use of induction and augmentation in LRS which emerged as a result of the literature review are listed and discussed in section 3.6. 3.1 Definitions 19
Table 3.1a provides definitions for the terms induction and augmentation of labor and cervical ripening. These definitions are taken from the clinical guidelines and policy statements listed in Section 2.1. No variation in definitions was identified in these documents. Additional related terms are defined in Appendix A. It should be noted that some mechanical, or non-pharmacological methods, are listed among the obstetric interventions to induce labor in all of these guidelines. It should also be noted that the terms induction and augmentation of labor and cervical ripening are often used interchangeably in the literature, despite important differences in their definitions, indications and outcomes. For example, cervical ripening which involves the use of mechanical or prostaglandin methods to prepare the cervix for induction often results in spontaneous onset of labor, and is then erroneously referred to as induction; oxytocin induction is often accompanied by artificial rupture of the membranes (ARM), though use of this non-pharmacological method may or may not be mentioned in the literature; use of uterotonic drugs for induction and then subsequent augmentation is often not distinguished and is referred to simply as induction. The use of these terms in this paper will refer to their specific, technical definitions to the extent possible. Table 3.1a Definitions of terms relating to induction and augmentation of labor Term Induction of labor Definition An obstetrical intervention to stimulate uterine contractions before spontaneous onset of labor, with or without ruptured membranes (18, 23). It commonly includes two steps: cervical ripening by prostaglandins or mechanical methods and stimulation of contractions by use of oxytocin (21). Methods are individual to each case depending on the readiness of the cervix for dilation(18). The term is usually restricted to pregnancies at gestations greater than the legal definition of fetal viability (ie. 24 weeks in UK) (18). The goals of induction of labor are to prevent anticipated poor outcomes associated with continuation of pregnancy, effect uterine activity sufficient for cervical change and fetal descent without causing uterine hyper-stimulation or fetal compromise and to allow as natural a birth experience as safely possible (19). Augmentation of labor Cervical ripening Stimulation of the uterus during labor to increase the frequency, duration and strength of contractions(21) when spontaneous contractions are considered inadequate because of lack of progressive cervical dilatation and fetal descent (23). Mechanical or prostaglandin methods of preparing the cervix for induction which may or may not result in spontaneous labor. These methods cause the cervix to soften, shorten and become ready for dilation in response to uterine contractions (22). The use of oxytocin to ripen the cervix is not effective (19, 22). 20
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Page 7 and 8: Acronyms ACOG AMRN AMTSL CS EFM FDA
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Page 57 and 58: documented rates of elective induct
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81. Roberts CL, Algert CS, Douglas
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105. Nigam A, Singh VK, Dubay P, Pa
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