| 20010802-8* Amniotomy plus intravenous oxytocin for
induction of labour (Cochrane Review). (Date of most recent substantive
update: 25 May 2001) - In: The Cochrane
Library. Oxford: Update Software , issue 2, 2003 Howarth
GR; Botha DJ - (2003) |
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Background:
Induction of labour is a common obstetric intervention. Amniotomy alone
for induction of labour is reviewed separately and oxytocin alone for
induction of labour is being prepared for inclusion in The Cochrane
Library. This review will address the use of the combination of these two
methods for induction of labour in the third trimester. This is one of a
series of reviews of methods of cervical ripening and labour induction
using standardised methodology. Objectives: To determine, from the best
available evidence, the efficacy and safety of amniotomy and intravenous
oxytocin for third trimester induction of labour. Search strategy: The
Cochrane Pregnancy and Childbirth Group Trials Register, the Cochrane
Controlled Trials Register and reference lists of articles were searched.
Date of last search: May 2001. Selection criteria: The criteria for
inclusion included the following: (1) clinical trials comparing amniotomy
plus intravenous oxytocin used for third trimester cervical ripening or
labour induction with placebo/no treatment or other methods listed above
it on a predefined list of labour induction methods; (2) random allocation
to the treatment or control group; (3) adequate allocation concealment;
(4) violations of allocated management not sufficient to materially affect
conclusions; (5) clinically meaningful outcome measures reported; (6) data
available for analysis according to the random allocation; (7) missing
data insufficient to materially affect the conclusions. Data collection
and analysis: Trial quality assessment and data extraction were done by
both reviewers. A strategy was developed to deal with the large volume and
complexity of trial data relating to labour induction. This involved a
two-stage method of data extraction. The initial data extraction was done
centrally, and incorporated into a series of primary reviews arranged by
methods of induction of labour, following a standardised methodology. The
data is to be extracted from the primary reviews into a series of
secondary reviews, arranged by category of woman. Main results: Seventeen
trials involving 2566 women were included. Amniotomy and intravenous
oxytocin were found to result in fewer women being undelivered vaginally
at 24 hours than amniotomy alone (relative risk (RR) 0.03, 95% confidence
intervals (CI) 0.001-0.49). This finding was based on the results of a
single study of 100 women. As regards secondary results amniotomy and
intravenous oxytocin resulted in significantly fewer instrumental vaginal
deliveries than placebo (RR 0.18, CI 0.05-0.58). Amniotomy and intravenous
oxytocin resulted in more postpartum haemorrhage than vaginal
prostaglandins (RR 5.5, CI 1.26-24.07). Significantly more women were also
dissatisfied with amniotomy and intravenous oxytocin when compared with
vaginal prostaglandins, RR 53, CI 3.32-846.51. Reviewers'
conclusions: Data on the effectiveness and safety of amniotomy and
intravenous oxytocin are lacking. No recommendations for clinical practice
can be made on the basis of this review. Amniotomy and intravenous
oxytocin is a combination of two methods of induction of labour and both
methods are utilised in clinical practice. If their use is to be continued
it is important to compare the effectiveness and safety of these methods,
and to define under which clinical circumstances one may be preferable to
another. (Author)
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