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

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labor. The odds of Cesarean section following elective induction in these studies ranged from 1.54 (1.26-1.84) to 3.30 (2.9-3.7). The one study reporting relative risks showed a relative risk of Cesarean of 1.52 (1.37-1.70) (83) and others analyzed the association using different methods (84-87). Where reported, the factors controlled for in these studies included: parity, gestational age, maternal age, cervical ripeness, birth weight, epidural use and qualification of provider. Methods of induction included oxytocin or a combination of artificial rupture of membranes (ARM) and oxytocin. Table 3.4d Odds ratios or relative risk and 95% confidence intervals for Cesarean section following elective induction of labor versus spontaneous onset in low risk women in developed countries Author, publication date Country Study design Adjusted odds ratio, relative risk 95% confidence interval Seyb S, Berka R et al , 1998 (76) USA Prospective, cohort study Prysak M, and Castronova F, USA Retrospective, 1998 (75) case/control study Maslow A. and Sweeny A, 2000 USA Retrospective, (88) Boulvain M, Marcoux S, et al., 2001 (82) Sheiner E, Levy A, et al., 2002 (89) Cammu H, Martens G, et al., 2002 (83) Johnson D, Davis N, et al., 2003 (90) Crane J, and Young D., 2003 (91) Canada Israel Belgium USA Canada cohort study Retrospective, descriptive study Retrospective, descriptive study Prospective, case/control study Prospective, case /control study Retrospective, descriptive study Glantz CJ, 2005 (71) USA Retrospective, descriptive OR = 1.89 1.12-3.18 OR = 1.81 1.07-3.08 OR = 2.40 1.20-4.90 OR = 2.14 1.6-3.6 OR = 3.30 2.9-3.7 RR = 1.52 1.37-1.70 OR = 1.77 1.46-2.11 OR = 1.04 0.87-1.24 OR = 1.52 1.26-1.84 Rates and risks of various adverse neonatal outcomes associated with elective induction versus spontaneous labor from six studies in four developed countries (Japan, Belgium, US and Canada) are compiled and presented in Table 3.4e. There were no statistically significant differences in the rates or risks of an Apgar score less than seven at five minutes associated with elective induction relative to spontaneous labor in any of the four 33
studies that assessed this outcome. Only two of the six studies assessed rates or risks of a cord blood Ph of less than 7.1, with both reporting no significant differences between elective induction and spontaneous labor (82, 92). Only one of five studies reported a significant increase in the risk of admission to the NICU associated with elective induction versus spontaneous labor; this study from Belgium reported a slightly increased but significant risk of 1.14 (1.03, 1.25) (83). All three studies which assessed the rates or risk of meconium staining found elective induction to be protective relative to spontaneous labor (71, 92, 93). Of the three studies which assessed the rates or risk of asphyxia, only one study reported a significantly increased risk of asphyxia associated with elective induction relative to spontaneous labor; in this US study, the risk of asphyxia was 1.52 (1.2,1.93)(71) Thus, although a only small number of studies were identified, these results do not suggest elevated risks of adverse neonatal outcomes associated with elective induction relative to spontaneous labor in developed countries. Perinatal outcomes associated with induction with misoprostol Two meta-analysis by Alfirevic and Weeks (35) of oral misoprostol and Hofmeyr and Gulmezoglu (94)include perinatal outcomes of misoprostol induction relative to other methods. Each found that compared with vaginal or intra-cervical dinoprostone, oxytocin and higher dose misoprostol, low dose misoprostol (50 ug orally or 25ug vaginally every four hours) does not appear to increase adverse fetal outcomes. Increase in the risk of uterine hyper-stimulation with oral misoprostol (RR = 1.63; 1.09-2.44) shown at higher doses, was not associated with any adverse fetal outcomes (35) and was reduced with lower doses, although available studies on lower doses were limited. Both oral and vaginal misoprostol were associated with increased meconium staining relative to other methods of induction. It was suggested by the authors that this may be an action of the misoprostol directly on the gut of the fetus as it is higher with ruptured membranes. Nevertheless, this increased meconium is not associated with poor outcomes of the neonate (40). The authors point out that many previous studies have used relatively high doses of misoprostol with more perinatal consequences compared to the latest studies using low dose misoprostol which show very similar outcomes to vaginal prostaglandin E2 (30). 34
Page 1 and 2: Use of oxytocin and misoprostol for
Page 3 and 4: data from lower level and private f
Page 5 and 6: the literature provides us with ver
Page 7 and 8: Acronyms ACOG AMRN AMTSL CS EFM FDA
Page 9 and 10: List of Tables Table 1.1a Published
Page 11 and 12: 1. Introduction Low and middle inco
Page 13 and 14: Comment Setting Country Source and
Page 15 and 16: 4) To summarize current rates, tren
Page 17 and 18: eview given its focus on the use of
Page 19 and 20: Category Inclusion Exclusion Ration
Page 21 and 22: Table 3.1a provides definitions for
Page 23 and 24: Prerequisite clinical conditions fo
Page 25 and 26: practitioner’s discretion as outl
Page 27 and 28: Table 3.3c WHO recommendations for
Page 29 and 30: Table 3.4a National induction rates
Page 31 and 32: variable induction rates in Washing
Page 33: Table 3.4c: The percent distributio
Page 37 and 38: 3.5 Rates, Trends, Indications and
Page 39 and 40: Tables 3.5b presents rates of induc
Page 41 and 42: Table 3.5d Hospital-specific rates
Page 43 and 44: adverse outcomes of induction becau
Page 45 and 46: this is not associated with increas
Page 47 and 48: use in LRS, particularly given the
Page 49 and 50: Sweeping of the membranes was compa
Page 51 and 52: concern regarding its use for early
Page 53 and 54: Misoprostol is now available in som
Page 55 and 56: Figure 3.6 c World map showing glob
Page 57 and 58: documented rates of elective induct
Page 59 and 60: In general, definitions, descriptio
Page 61 and 62: An evidence-based safe and effectiv
Page 63 and 64: Appendix A: Glossary of common term
Page 65 and 66: References 1. World Health Organiza
Page 67 and 68: 28. Beebe LA, Rayburn WF, Beaty CM,
Page 69 and 70: 55. Maternity statistics, england:
Page 71 and 72: 81. Roberts CL, Algert CS, Douglas
Page 73: 105. Nigam A, Singh VK, Dubay P, Pa

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