Nitric oxide donors for cervical ripening and induction of labour

Kelly, Anthony; Munson, Christopher; Minden, Lucy

doi:10.1002/14651858.cd006901.pub2

Cited by 81 publications

(14 citation statements)

References 56 publications

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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%

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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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Section: Results: Network and Pairwise Meta-analysismentioning

confidence: 99%

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

Section: Figurementioning

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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“…Although nitric oxide donors induce cervical ripening without inducing uterine contractions, 11 they do not hasten the onset of delivery or reduce the need for additional agents when used for induction of labour. 12,13 By contrast, in The Lancet Marta Jozwiak and colleagues 14 show that intracervical placement of a Foley catheter induces cervical ripening without inducing uterine contractions and is as successful as prostaglandin for induction of labour, according to the number of failed inductions and caesarean section rates.…”

Section: Intracervical Foley Catheter For Induction Of Labourmentioning

confidence: 99%

Foley catheter versus vaginal prostaglandin E2 gel for induction of labour at term (PROBAAT trial): an open-label, randomised controlled trial

et al. 2011

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“…Nineteen studies on sodium nitroprusside or glyceryl trinitrate, for cervical ripening and labor induction were reviewed and 10 were included in a metaanalysis. 25) Although the number of cases treated is relatively limited, there is to date no evidence of a benefit from NO-donors over placebo. On the other hand, maternal side effects like headaches are more frequent with NO-donors.…”

Section: )mentioning

confidence: 99%

Cervical maturation and labor induction

Carbonne

2014

Hypertens Res Pregnancy

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Nitric oxide donors for cervical ripening and induction of labour

Abstract: NO donors do not appear currently to be a useful tool in the process of induction of labour. More studies are required to examine how NO donors may work alongside established induction of labour protocols, especially those based in outpatient settings.

Cited by 81 publications

References 56 publications

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

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

Foley catheter versus vaginal prostaglandin E2 gel for induction of labour at term (PROBAAT trial): an open-label, randomised controlled trial

Cervical maturation and labor induction

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