Amniotomy plus intravenous oxytocin for induction of labour

Howarth, Graham; Botha, D. J.

doi:10.1002/14651858.cd003250

Cited by 138 publications

(52 citation statements)

References 52 publications

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“…Howarth GR and Botha DJ, in their Cochrane meta analysis review, stated that prostaglandin induction was not associated with an increased risk of postpartum haemorrhage as compared to that in controls [16]. Present study also revealed that prostaglandin induction (either through oral or vaginal route) was not associated with increased blood loss as compared to that in those who delivered spontaneously.…”

Section: Discussionsupporting

confidence: 46%

Comparison of Blood Loss in Induced Vs. Spontaneous Vaginal Delivery Using Specialized Blood Collection Bag

Hebbar

Rai

Mohan

2014

JCDR

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Section: Discussionsupporting

confidence: 46%

Comparison of Blood Loss in Induced Vs. Spontaneous Vaginal Delivery Using Specialized Blood Collection Bag

Hebbar

Rai

Mohan

2014

JCDR

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“…oxytocin,16,amniotomy;17,i.v. oxytocin with amniotomy;18,NO;19,mifepristone;20,oestrogens;21,corticosteroids;22,relaxin;23,hyaluronidase;24,Foley catheter;25,laminaria;26,27,membrane sweeping;28,29,i.v. prostaglandin;30,sexual intercourse;31,acupuncture;32,oral prostaglandins;33, buccal/sublingual misoprostol.…”

Section: Results: Network and Pairwise Meta-analysismentioning

confidence: 99%

“…There are advantages and disadvantages of high-or low-dose regimens; higher doses may lead to a shorter period to delivery, but may increase the risk of hyperstimulation, whereas lower doses may increase risk of infection if labour is prolonged. [24][25][26][27] Nitric oxide donors Nitric oxide (NO) is thought to be involved in cervical ripening, and in recent years NO donors [isosorbide mononitrate (ISMN), isosorbide dinitrate, nitroglycerin and sodium nitroprusside] have been used to promote cervical ripening. NO is administered as a vaginal tablet.…”

Section: Oxytocinmentioning

confidence: 99%

Which method is best for the induction of labour? A systematic review, network meta-analysis and cost-effectiveness analysis

Alfirević

Keeney

Dowswell

et al. 2016

Health Technol Assess

111

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BackgroundMore than 150,000 pregnant women in England and Wales have their labour induced each year. Multiple pharmacological, mechanical and complementary methods are available to induce labour.ObjectiveTo assess the relative effectiveness, safety and cost-effectiveness of labour induction methods and, data permitting, effects in different clinical subgroups.MethodsWe carried out a systematic review using Cochrane methods. The Cochrane Pregnancy and Childbirth Group’s Trials Register was searched (March 2014). This contains over 22,000 reports of controlled trials (published from 1923 onwards) retrieved from weekly searches of OVID MEDLINE (1966 to current); Cochrane Central Register of Controlled Trials (The Cochrane Library); EMBASE (1982 to current); Cumulative Index to Nursing and Allied Health Literature (1984 to current); ClinicalTrials.gov; the World Health Organization International Clinical Trials Registry Portal; and hand-searching of relevant conference proceedings and journals. We included randomised controlled trials examining interventions to induce labour compared with placebo, no treatment or other interventions in women eligible for third-trimester induction. We included outcomes relating to efficacy, safety and acceptability to women. In addition, for the economic analysis we searched the Database of Abstracts of Reviews of Effects, and Economic Evaluations Databases, NHS Economic Evaluation Database and the Health Technology Assessment database. We carried out a network meta-analysis (NMA) using all of the available evidence, both direct and indirect, to produce estimates of the relative effects of each treatment compared with others in a network. We developed a de novo decision tree model to estimate the cost-effectiveness of various methods. The costs included were the intervention and other hospital costs incurred (price year 2012–13). We reviewed the literature to identify preference-based utilities for the health-related outcomes in the model. We calculated incremental cost-effectiveness ratios, expected costs, utilities and net benefit. We represent uncertainty in the optimal intervention using cost-effectiveness acceptability curves.ResultsWe identified 1190 studies; 611 were eligible for inclusion. The interventions most likely to achieve vaginal delivery (VD) within 24 hours were intravenous oxytocin with amniotomy [posterior rank 2; 95% credible intervals (CrIs) 1 to 9] and higher-dose (≥ 50 µg) vaginal misoprostol (rank 3; 95% CrI 1 to 6). Compared with placebo, several treatments reduced the odds of caesarean section, but we observed considerable uncertainty in treatment rankings. For uterine hyperstimulation, double-balloon catheter had the highest probability of being among the best three treatments, whereas vaginal misoprostol (≥ 50 µg) was most likely to increase the odds of excessive uterine activity. For other safety outcomes there were insufficient data or there was too much uncertainty to identify which treatments performed ‘best’. Few studies collected information on women’s views. Owing to incomplete reporting of the VD within 24 hours outcome, the cost-effectiveness analysis could compare only 20 interventions. The analysis suggested that most interventions have similar utility and differ mainly in cost. With a caveat of considerable uncertainty, titrated (low-dose) misoprostol solution and buccal/sublingual misoprostol had the highest likelihood of being cost-effective.LimitationsThere was considerable uncertainty in findings and there were insufficient data for some planned subgroup analyses.ConclusionsOverall, misoprostol and oxytocin with amniotomy (for women with favourable cervix) is more successful than other agents in achieving VD within 24 hours. The ranking according to safety of different methods was less clear. The cost-effectiveness analysis suggested that titrated (low-dose) oral misoprostol solution resulted in the highest utility, whereas buccal/sublingual misoprostol had the lowest cost. There was a high degree of uncertainty as to the most cost-effective intervention.Future workFuture trials should be powered to detect a method that is more cost-effective than misoprostol solution and report outcomes included in this NMA.Study registrationThis study is registered as PROSPERO CRD42013005116.FundingThe National Institute for Health Research Health Technology Assessment programme.

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“…Postnatal blood loss may be increased by both induction of labour with amniotomy and intravenous oxytocin, 8 The Cochrane review comparing active and expectant third stage management includes 5 studies involving 6486 women. 11 Results of meta-analyses show that AMTSL reduces rates of severe blood loss, blood transfusions and anaemia in the 6 postnatal period but causes a number of harms including vomiting, increased diastolic blood pressure, increased after-birth pains and a decrease in baby's birthweight.…”

Section: Active Management Of the Third Stage Of Labourmentioning

confidence: 99%

Intervention or interference? The need for expectant care throughout normal labour

Begley

2014

Sexual & Reproductive Healthcare

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Intervention or interference? The need for expectant care throughout normal labour IntroductionAlthough healthcare professionals talk about the "stages" of labour, this is a medical label, not a definition that women recognise. To them, and in physiology, labour is a continuum, a state of being that changes, develops and transforms women into mothers, both physically and emotionally. One cannot, therefore, focus on intervening or modifying care in any part of pregnancy and labour without looking at its effects on all other aspects. Any action we take has consequences far beyond the intended effect on that particular 'stage' of labour, so any intervention we introduce (either medico-technical or more 'natural') must be for a good reason, based on sound research evidence and resulting in more good than harm, otherwise it is just interference.The objective of this paper is to describe and evaluate some common medicotechnical interventions in normal pregnancy or labour and critique their usefulness in terms of overall effects on women and neonates. There are many interventions used in modern maternity care, but three are chosen for special focus: induction of labour, episiotomy and active management of the third stage of labour (including early clamping of the cord). These three have been chosen for particular discussion as they are the most invasive of procedures conducted in the first (or pre-labour), second and third stages of labour, respectively. Method 3A comprehensive review of the literature was undertaken to seek evidence of the benefits and adverse effects of three routine interventions. PubMed and the Cochrane databases were searched using the three interventions as search terms.Reviews and randomised trial results were given priority. The findings are presented firstly as background information on each intervention, and then as focused information on how to avoid using the intervention as interference.

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Amniotomy plus intravenous oxytocin for induction of labour

Abstract: Bakos 1987 {published data only} Bakos O, Backstrom T. Induction of labor: a prospective, randomized study into amniotomy and oxytocin as induction methods in a total unselected population.

Cited by 138 publications

References 52 publications

Comparison of Blood Loss in Induced Vs. Spontaneous Vaginal Delivery Using Specialized Blood Collection Bag

Comparison of Blood Loss in Induced Vs. Spontaneous Vaginal Delivery Using Specialized Blood Collection Bag

Which method is best for the induction of labour? A systematic review, network meta-analysis and cost-effectiveness analysis

Intervention or interference? The need for expectant care throughout normal labour

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