P11.08: Mifepristone is an effective ripening agent in postdates primips with cervical length ≥ 2.5 cm, but mode of delivery correlates with birthweight: a randomised, placebo controlled double blind study

Thakur, Vidya; Dorman, E. B.; Sanu, L.; Harrington, Kevin

doi:10.1002/uog.2514

Cited by 4 publications

(4 citation statements)

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“…We identified 72 reports, representing 55 separate studies (some trials were reported in more than one published paper). We have included 28 studies in the review, excluded 25, and two studies are awaiting further assessment (Ascher-Walsh 2000; Thakur 2005; see Characteristics of studies awaiting classification tables).…”

Section: Resultsmentioning

confidence: 99%

“…Procedure was repeated after three days if labour did not start until 42 weeksOutcomesInterval to delivery, CS, Induction at 42 weeks, hyperstimulation, Apgar scoresNotesThis study was reported in a brief abstract and the data was described as “preliminary”. We attempted to contact authors for further information (8th September 2009) Thakur 2005…”

Section: Characteristics Of Included Studies [Ordered By Study Id]mentioning

confidence: 99%

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Different methods for the induction of labour in outpatient settings

Dowswell¹,

Kelly²,

Livio³

et al. 2010

Cochrane Database of Systematic Reviews

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Background Induction of labour is carried out for a variety of indications and using a range of pharmacological, mechanical and other methods. For women at low risk, some methods of induction of labour may be suitable for use in outpatient settings. Objectives To examine pharmacological and mechanical interventions to induce labour in outpatient settings in terms of feasibility, effectiveness, maternal satisfaction, healthcare costs and, where information is available, safety. The review complements existing reviews on labour induction examining effectiveness and safety. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (December 2009) and reference lists of retrieved studies. Selection criteria We included randomised controlled trials examining outpatient cervical ripening or induction of labour with pharmacological agents or mechanical methods. Data collection and analysis Two authors independently extracted data and assessed eligible papers for risk of bias. We checked all data after entry into review manager software. Main results We included 28 studies with 2616 women examining different methods of induction of labour where women received treatment at home or were sent home after initial treatment and monitoring in hospital. Studies examined vaginal and intracervical PGE2, vaginal and oral misoprostol, isosorbide mononitrate, mifepristone, oestrogens, and acupuncture. Overall, the results demonstrate that outpatient induction of labour is feasible and that important adverse events are rare. There was no strong evidence that agents used to induce labour in outpatient settings had an impact (positive or negative) on maternal or neonatal health. There was some evidence that, compared to placebo or no treatment, induction agents reduced the need for further interventions to induce labour, and shortened the interval from intervention to birth. We were unable to pool results on outcomes relating to progress in labour as studies tended to measure a very broad range of outcomes. There was no evidence that induction agents increased interventions in labour such as operative deliveries. Only two studies provided information on women’s views about the induction process, and overall there was very little information on the costs to health service providers of different methods of labour induction in outpatient settings. Authors’ conclusions Induction of labour in outpatient settings appears feasible. We do not have sufficient evidence to know which induction methods are preferred by women, or the interventions that are most effective and safe to use in outpatient settings.

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Section: Resultsmentioning

confidence: 99%

Section: Characteristics Of Included Studies [Ordered By Study Id]mentioning

confidence: 99%

Different methods for the induction of labour in outpatient settings

Dowswell¹,

Kelly²,

Livio³

et al. 2010

Cochrane Database of Systematic Reviews

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“…Ages 20-35; primigravid women with singleton pregnancies and cephalic presentation Interventions Mifepristone 50 mg orally 12 hourly up a maximum dose of 200 mg. Control group women had no initial treatment, but were observed in hospital for 2 days. Women who were not in labour after 48 hours were given either oxytocin (50% either group) or vaginal prostaglandin (50% both groups) Outcomes Clinical, endocrine. Notes Risk of bias Item Authors’ judgement Description Allocation concealment? Unclear B - Unclear Thakur 2005…”

Section: Characteristics Of Studiesmentioning

confidence: 99%

“…Six new trials identified. Five have been included (Berkane 2005; Lelaidier 1994; Thakur 2005; Wing 2000; Wing 2005) and one excluded (Jiang 1997). Another report of Frydman 1992 has been added.…”

Section: Characteristics Of Studiesmentioning

confidence: 99%

Mifepristone for induction of labour

Hapangama

Neilson

2009

Cochrane Database of Systematic Reviews

106

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Background The steroid hormone, progesterone, inhibits contractions of the pregnant uterus at all gestations. Antiprogestins (including mifepristone) have been developed to antagonise the action of progesterone, and have a recognised role in medical termination of early or mid-trimester pregnancy. Animal studies have suggested that mifepristone may also have a role in inducing labour in late pregnancy. Objectives To determine the effects of mifepristone for third trimester cervical ripening or induction of labour. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register and reference lists of relevant papers (May 2009). Selection criteria Clinical trials comparing mifepristone used for third trimester cervical ripening or labour induction with placebo/no treatment or other labour induction methods. Data collection and analysis 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. For this update, two review authors independently assessed trial quality and extracted data. Main results Ten trials (1108 women) are included. Compared to placebo, mifepristone treated women were more likely to be in labour or to have a favourable cervix at 48 hours (risk ratio (RR) 2.41, 95% confidence intervals (CI) 1.70 to 3.42) and this effect persisted at 96 hours (RR 3.40, 95% CI 1.96 to 5.92). They were less likely to need augmentation with oxytocin (RR 0.80, 95% CI 0.66 to 0.97). Mifepristone treated women were less likely to undergo caesarean section (RR 0.74, 95% CI 0.60 to 0.92) but more likely to have an instrumental delivery (RR 1.43, 95% CI 1.04 to 1.96). Women receiving mifepristone were less likely to undergo a caesarean section as a result of failure to induce labour (RR 0.40, 95% CI 0.20 to 0.80). There is insufficient evidence to support a particular dose but a single dose of 200 mg mifepristone appears to be the lowest effective dose for cervical ripening (increased likelihood of cervical ripening at 72 hours (RR 2.13, 95% CI 1.15 to 3.97). Abnormal fetal heart rate patterns were more common after mifepristone treatment (RR 1.85, 95% CI 1.17 to 2.93), but there was no evidence of differences in other neonatal outcomes. There is insufficient information on the occurrence of uterine rupture/dehiscence in the reviewed studies. Authors’ conclusions There is insufficient information available from clinical trials to support the use of mifepristone to induce labour. However, the studies suggest that mifepristone is better than placebo in reducing the likelihood of caesarean sections being performed for failed induction of labour; therefore, this may justify future trials comparing mifepristone with the routine cervical ripening agents currently in use. There is little information on effects on the baby.

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