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

More documents

Recommendations

Info

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. 47
Sweeping of the membranes was compared to cervical ripening by prostaglandins, oxytocin and no treatment in the review. The risk of Cesarean section is similar between the groups with a RR of 0.90 (0.70 – 1.15). For women who received routine sweeping of the membranes at term, there was a shorter duration of pregnancy and reduced frequency of post dates, a common indication for medical induction (to 41 weeks RR 0.59; 0.46 – 0.74) (to 42 weeks RR = 0.28; 0.15 – 0.5). The risk of requiring a formal method of labor induction was reduced by 14 percent across all available studies among women with sweeping of the membranes. Thus, in women who are in the early stages of developing an indication for IOL, sweeping of the membranes is likely to reduce the need for formal methods of induction. Importantly, this review showed no evidence of a difference in risk of maternal or neonatal infection rates although the procedure is uncomfortable, causes normal blood stained mucous and irregular contractions or irritable uterus for the time immediately following the procedure. Following an informed choice discussion, some women may prefer to endure this discomfort to avoid medical induction (108). Artificial rupture of the membranes (ARM) is a method of induction or augmentation only possible with a ripe cervix already partially dilated, ie. a primiparous woman already in labor needing augmentation or a multiparous woman with a very ready cervix for induction or augmentation (23). The effectiveness of ARM was evaluated in a Cochrane review based on 14 studies which compared labors with ARM to those without (110). The results showed no statistically significant differences in the mean length of first stage of labor, in maternal satisfaction, in the risk of a low Apgar score at five minutes or in the risk of Cesarean section. The authors conclude that ARM can not be recommended routinely to hasten labor or improve outcomes but could be offered on an informed choice basis (110). This is of particular importance to LRS where HIV/AIDS is highly prevalent, as the membranes should remain intact as long as possible in order to reduce maternal to fetal transmission of the virus (111). 48
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 and 34: Table 3.4c: The percent distributio
Page 35 and 36: studies that assessed this outcome.
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: use in LRS, particularly given the
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

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

Create successful ePaper yourself

Delete template?

Save as template?