Oral misoprostol for induction of labour

Alfirević, Z̄arko; Weeks, Andrew

doi:10.1002/14651858.cd001338.pub2

Cited by 267 publications

(288 citation statements)

References 89 publications

Supporting

Mentioning

266

Contrasting

Unclassified

Order By: Relevance

“…Misoprostol is a PGE1 analogue and undergoes rapid deesterification to its active, free acid metabolites, its onset of action will be speedier than the local PG production via a cascade of synthetic processes that would be expected in Stripping. 18,19 Studies on misoprostol have demonstrated less need for oxytocin augmentation than there was with Stripping, similar to our findings. 19 This further enhances acceptability of Misoprostol, as women perceive their labour as more 'natural' with less intervention.…”

Section: Resultssupporting

confidence: 89%

See 1 more Smart Citation

Can Term Gestation Be Induced by Misoprostol on Opd Basis?

Javadekar¹,

Rokade²

2013

jemds

View full text Add to dashboard Cite

Stripping of membranes is wide used as OPD procedure for preripening and induction of labour. This study was planned to assess whether or not low single dose of vaginal misoprostol ( 25 mcg.) can be added to stripping in OPD and what is going to be the impact on the end result of labour induction. The study was applied in Datta Sugar mill Charitable Hospital, Shirol, Dist. Kolhapur. A total of eighty patients were taken for the study. They were divided in 2 equal teamsGroup A with solely stripping of membranes and Group B Stripping along with 25 mcg Misoprostol. Primary observations were delivery at intervals forty eight hours from the beginning of induction and route of delivery. Secondary observations were interval from induction to onset of labour (latency period), interval from begin of induction to delivery (duration of labour), want for oxytocin augmentation, labour complications, Apgar scores at one and five minutes. Both teams were similar at begin with respect to age, parity and between forty weeks and forty one weeks gestation. There was a considerably shorter induction to onset of labour interval within the B group. The period of labour was considerably shorter in B group. Overall, baby outcomes were similar and comparable within the 2 teams. The study gave following results and conclusionThe patients who received Stripping with vaginal 25mcg.Misoprostol showed 1. A shorter latency period, 2. Less need for oxytocin augmentation, 3. Shorter duration of labour in patients. The two induction strategies were similar with respect to baby outcomes. each were found safe as OPD strategies, though any assessment of the security profile with larger studies are required. More patients felt positive about the intervention in B group than in A group.

show abstract

Section: Resultssupporting

confidence: 89%

“…18,19 Studies on misoprostol have demonstrated less need for oxytocin augmentation than there was with Stripping, similar to our findings. 19 This further enhances acceptability of Misoprostol, as women perceive their labour as more 'natural' with less intervention.…”

Section: Resultssupporting

confidence: 89%

Can Term Gestation Be Induced by Misoprostol on Opd Basis?

Javadekar¹,

Rokade²

2013

jemds

View full text Add to dashboard Cite

show abstract

“…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%

“…oxytocin;15,i.v. oxytocin with amniotomy;16,NO;17,mifepristone;18,Foley catheter;19,laminaria;20,21, buccal/sublingual misoprostol. The size of each node is proportional to the number of randomised participants (sample size).…”

Section: Figurementioning

confidence: 99%

See 1 more Smart Citation

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

Self Cite

106

View full text Add to dashboard Cite

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.

show abstract