Intervention Review

Hyaluronidase for cervical ripening and induction of labour

  1. Josephine Kavanagh1,*,
  2. Anthony J Kelly2,
  3. Jane Thomas3

Editorial Group: Cochrane Pregnancy and Childbirth Group

Published Online: 7 OCT 2009

Assessed as up-to-date: 15 JUL 2009

DOI: 10.1002/14651858.CD003097.pub2

Database Title

Additional Information

How to Cite

Kavanagh J, Kelly AJ, Thomas J. Hyaluronidase for cervical ripening and induction of labour. Cochrane Database of Systematic Reviews 2006, Issue 2. Art. No.: CD003097. DOI: 10.1002/14651858.CD003097.pub2.

Author Information

  1. 1

    Social Science Research Unit, Evidence for Policy and Practice Information and Co-ordinating Centre, London, UK

  2. 2

    Brighton and Sussex University Hospitals NHS Trust, Department of Obstetrics and Gynaecology, Brighton, UK

  3. 3

    The University of Liverpool, C/o Cochrane Pregnancy and Childbirth Group, School of Reproductive and Developmental Medicine, Division of Perinatal and Reproductive Medicine, Liverpool, UK

*Josephine Kavanagh, Evidence for Policy and Practice Information and Co-ordinating Centre, Social Science Research Unit, Institute of Education, University of London, 18 Woburn Square, London, WC1H 0NR, UK. j.kavanagh@ioe.ac.uk.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 7 OCT 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Dilatation and effacement of the cervix are not only a result of uterine contractions, but are also dependant upon ripening processes within the cervix. The cervix is a fibrous organ composed principally of hyaluronic acid, collagen and proteoglycan. Hyaluronic acid increases markedly after the onset of labour. An increase in the level of hyaluronic acid is associated with an increase in tissue water content. Cervical ripening during labour is characterised by changes of the cervix and an increased water content. Cervical injection of hyaluronidase was postulated to increase cervical ripening. This is one of a series of reviews of methods of cervical ripening and labour induction using standardised methodology.

Objectives

To determine the effects of hyaluronidase for third trimester cervical ripening or induction of labour in comparison with other methods of induction of labour.

Search methods

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (July 2009) and bibliographies of relevant papers.

Selection criteria

Clinical trials of hyaluronidase for third trimester cervical ripening or labour induction.

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. We assessed trial quality. We contacted study authors for additional information. We collected adverse effects information from the trials.

Main results

One trial, with 168 women participating, was included in the review.

When compared with placebo for cervical ripening intracervical injections of hyaluronidase resulted in women receiving significantly fewer caesarean sections (18% versus 49%, relative risk (RR) 0.37, 95% confidence interval (CI) 0.22 to 0.61), less need for oxytocin augmentation (10% versus 47%, RR 0.20, 95% CI 0.10 to 0.41), and increased cervical favourability after 24 hours (60% versus 98%, RR 0.62, 95% CI 0.52 to 0.74). No side-effects for mother or baby were reported in this trial.

Authors' conclusions

Intracervical injections of hyaluronidase for cervical ripening appear beneficial. However, this is not common practice. In addition it is an invasive procedure that women may find unacceptable in the presence of less invasive methods.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Hyaluronidase for cervical ripening and induction of labour

Hyaluronidase injected into the cervix increased cervical favourability but its effect on induction of labour is unknown and its use is not recommended.

Sometimes it is considered beneficial to bring labour on artificially and there are many methods currently used. One method is an injection of hyaluronidase into the cervix. The review of trials found one study, which showed hyaluronidase was more effective than placebo, resulting in fewer caesarean sections, less oxytocin augmentation and greater cervical favourability. However, it is an invasive procedure that women may find unacceptable in the presence of less invasive methods of cervical ripening. Given this, the review authors do not recommend it for clinical practice.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

玻尿酸酉每(Hyaluronidase) 用於子宮頸成熟和引產

子宮頸管削除和子宮口擴張不只是因為子宮收縮的結果，也和子宮頸的成熟過程有關。子宮頸是由玻尿酸、膠原蛋白和蛋白多(酉每)(proteoglycan)等所組成的纖維狀器官。玻尿酸在產程開始後顯著增加，玻尿酸的增加程度與組織水含量有關。子宮頸成熟在生產的之特徵為子宮頸改變及水含量增加。子宮頸注射玻尿酸酉每(hyaluronidase)被視為可以增加子宮頸成熟。這是使用標準方法引產和子宮頸成熟方式的一系列回顧之一。

目標

確認hyaluronidase用於第3懷孕期子宮頸成熟或引產的效果，與其他引產方法比較。

搜尋策略

我們搜尋searched the Cochrane Pregnancy and Childbirth Group Trials Register (2006年1月)以及相關報告的參考文獻。

選擇標準

hyaluronidase用於第3懷孕期子宮頸成熟或引產的臨床試驗。

資料收集與分析

發展用以處理與引產有關的大量且複雜之試驗資料的一套策略。包括了資料摘錄的2階段方法。我們評估試驗品質，聯絡研究作者以獲取更多資訊。從試驗中蒐集副作用資料。

主要結論

1篇研究、試驗中有168名婦女參與。相較於安慰劑時，子宮頸內注射hyaluronidase而使子宮頸成熟，可使剖腹產比率顯著減少(18%相較於49%, RR為0.37, 95%CI為0.22–0.61)、比較不需要使用oxytocin(10%相較於47%, RR為0.20, 95% CI為0.10–0.41)、24小時後子宮頸適意度(favourability)增加(60%相較於98%, RR為0.62, 95% CI為0.52–0.74)。試驗中沒有母親或嬰兒的副作用報告。

作者結論

子宮頸內注射hyaluronidase以使子宮頸成熟似乎有幫助，不過，這非一般實務。此外，這是一種侵入性步驟，相較於非侵入性方式，婦女可能比較無法接受。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

Hyaluronidase 用於子宮頸成熟和引產。 子宮頸內注射Hyaluronidase增加子宮頸適意度，但是對於引產的效果尚未知，並不建議使用。有時候是考量對人工引產的幫助，現在有許多方法可使用，方法之一是子宮頸內注射Hyaluronidase。回顧試驗發現1篇研究，顯示hyaluronidase比安慰劑更有效，減少剖腹產、較少使用oxytocin、子宮頸適意度較佳。不過，它是一種侵犯入性方法，如果有非侵入性方式時，婦女就會比較無法接受。因此，回顧作者不建議將它作為臨床實務。

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