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

treatment and was not statistically significant (0.64-1.26)(109). However, given that
mechanical methods do not bring about immediate onset of labor, one could argue that
vaginal delivery within 24 hours may not be the most appropriate outcome indicator. Six
studies found no significant differences in the risk of Cesarean (relative risk: 1.00; 0.76-
1.30). No cases of severe neonatal or maternal morbidity were reported.
Mechanical methods compared against three different prostaglandins showed either
increased risks of vaginal delivery not within 24 hours or no significant difference in risk;
no significant differences in the risk of Cesarean; and substantially decreased risks of
hyper-stimulation of the uterus with fetal heart changes (for example: the relative risk for
mechanical methods compared against PGE 2 was 0.14 (0.04-0.53); against intracervical
PGE 2: 0.21 (0.04-1.20);and against misprostol: 0.41 (0.20-0.87). Vaginal delivery not
within 24 hours and hyper-stimulation of the uterus with fetal heart changes were not
assessed for mechanical methods compared against oxytocin. Mechanical methods were
shown to reduce the risk of Cesarean section relative to oxytocin (relative risk: 0.55;
0.33-0.91). Use of extra-amniotic infusion was not found to be beneficial for any of the
outcomes studied. The author concludes that evidence is insufficient to determine the
effectiveness of mechanical methods for achieving vaginal delivery within 24 hours but
that the risk to mother and baby is low. They recommend larger studies which assess a
broader set of outcomes, including maternal satisfaction and economic outcomes.
Sweeping of the membranes was examined in a 2005 Cochrane review by Boulvain as
well (108). Sweeping of the membranes, also commonly referred to as stripping of the
membranes, is done to decrease the duration of pregnancy or to avoid formal induction of
labor with oxytocin, prostaglandins or ARM. Sweeping of the membranes is a simple
technique that can be done on an out-patient basis. It involves inserting the examiner’s
finger into the cervical os during a vaginal exam and detaching the membranes from the
lower segment of the uterus with a circular movement of the finger. This separation of
tissues results in the production of natural prostaglandins which may lead to cervical
ripening or the initiation of labor. The cervix may also be massaged to encourage
softening during the procedure.
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