Outcomes reported in trials of methods for the induction of labour

Medley, Nancy; Alfirević, Z̄arko; Caldwell, Deborah M; Dias, Sofia; Dowswell, Therese; Keeney, Edna; Jones, Leanne; Navaratnam, Kate; Welton, Nicky J

doi:10.1186/1745-6215-16-s1-p4

Cited by 4 publications

(15 citation statements)

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“…In view of the difficulty in demonstrating which is the best method of cervical ripening in terms of effectiveness and safety, women's satisfaction should be evaluated further. This outcome is reported very rarely, in only 5% of the trials of induction of labour . Such information could help professionals in choosing ripening methods and improving the counselling they provide to women.…”

Section: Commentmentioning

confidence: 99%

Comparison of effectiveness and safety of cervical ripening methods for induction of labour: A population‐based study using coarsened exact matching

Blanc-Petitjean

Carbonne

Deneux‐Tharaux

et al. 2019

Paediatric Perinatal Epid

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Background There is no consensus about the ideal cervical ripening method to use for induction of labour. Objective To compare in current practice the effectiveness and safety of four cervical ripening methods. Methods We performed a matched comparative study using data from the MEDIP prospective population‐based cohort conducted during one month in 2015 in all maternity units of seven French perinatal networks (3042 consecutive women with a live fetus and induction of labour). We analysed 1671 women with singleton cephalic fetus, unscarred uterus, and bishop score <7. Dinoprostone vaginal pessary (reference) was compared to dinoprostone vaginal gel, misoprostol vaginal tablet, and balloon catheter. Effectiveness outcomes were the need for more than one induction agent, oxytocin use, failure to achieve vaginal delivery within 24 hours (VD < 24 hours), and caesarean delivery. Safety outcomes were meconium‐stained amniotic fluid, uterine hyperstimulation, NICU admission, and post‐partum haemorrhage. Coarsened exact matching was used to balance confounders among the groups. Outcomes were compared using multivariable logistic regression models. Results Compared to the dinoprostone pessary (N = 1142, 68.3%), dinoprostone gel (N = 335, 20.1%) was associated with less failure to achieve VD < 24 hours (adjusted OR 0.66, 95% CI 0.47, 0.91). Misoprostol (N = 103, 6.2%) was associated with less need of more than one induction agent (aOR 0.56, 95% CI 0.34, 0.92) and less oxytocin use (aOR 0.60, 95% CI 0.37, 0.99). The balloon catheter (N = 91, 5.4%) was associated with more failure to achieve VD < 24 hours (aOR 2.62, 95% CI 1.37, 5.01), more caesarean delivery (aOR 1.84, 95% CI 1.09, 3.08), and less meconium‐stained amniotic fluid (aOR 0.12, 95% CI 0.02, 0.70). Uterine hyperstimulation rates seemed lower with the balloon catheter (1.2% vs 4.2% for the pessary). Conclusions In current practice, no cervical ripening method appears clearly superior to the others considering all effectiveness and safety outcomes.

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Section: Commentmentioning

confidence: 99%

Comparison of effectiveness and safety of cervical ripening methods for induction of labour: A population‐based study using coarsened exact matching

Blanc-Petitjean

Carbonne

Deneux‐Tharaux

et al. 2019

Paediatric Perinatal Epid

View full text Add to dashboard Cite

show abstract

“…Our COS captured outcomes that are commonly reported, such as ‘time from induction of labour to delivery’ (reported in >50% of trials), but also outcomes which are less commonly reported, such as ‘maternal satisfaction’ (reported in 5% of trials) and ‘maternal death’ (reported in 12% of trials).…”

Section: Discussionmentioning

confidence: 99%

“…Regarding ‘mode of delivery’, researchers might want to differentiate between vaginal delivery, instrumental delivery, and caesarean section. Trials on induction of labour almost always report on caesarean section and about half report instrumental delivery rates . The participants of the Delphi process and consensus meeting reached a consensus that this should be minimally reported.…”

Section: Discussionmentioning

confidence: 99%

“…The participants of the consensus meeting were satisfied with all the offspring outcomes. ‘Apgar score <7 at 5 minutes’ is nearly always reported in trials of induction of labour . Stakeholders suggested that this outcome might be useful in low‐resource settings and should be included in that case.…”

Section: Discussionmentioning

confidence: 99%

“…Although none of the cost‐orientated outcome measures is included in our COS, these should be considered in the case of a randomised trial comparing cost‐effectiveness of different agents. Currently, only 10% of trials report costs …”

Section: Discussionmentioning

confidence: 99%

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