Intervention Review

Breast stimulation 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: 20 JAN 2010

Assessed as up-to-date: 14 SEP 2009

DOI: 10.1002/14651858.CD003392.pub2

Database Title

Additional Information

How to Cite

Kavanagh J, Kelly AJ, Thomas J. Breast stimulation for cervical ripening and induction of labour. Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No.: CD003392. DOI: 10.1002/14651858.CD003392.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: 20 JAN 2010

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Abstract

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

Background

Breast stimulation has been suggested as a means of inducing labour. It is a non-medical intervention allowing women greater control over the induction process. This is one of a series of reviews of methods of cervical ripening and labour induction using a standardised methodology.

Objectives

To determine the effectiveness of breast stimulation for third trimester cervical ripening or induction of labour in comparison with placebo/no intervention or other methods of induction of labour.

Search methods

The Cochrane Pregnancy and Childbirth Group's Trials Register (15 September 2009) and bibliographies of relevant papers.

Selection criteria

Clinical trials of breast stimulation 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.

Main results

Six trials (719 women) were included.

Analysis of trials comparing breast stimulation with no intervention found a significant reduction in the number of women not in labour at 72 hours (62.7% versus 93.6%, relative risk (RR) 0.67, 95% confidence interval (CI) 0.60 to 0.74). This result was not significant in women with an unfavourable cervix. A major reduction in the rate of postpartum haemorrhage was reported (0.7% versus 6%, RR 0.16, 95% CI 0.03 to 0.87). No significant difference was detected in the caesarean section rate (9% versus 10%, RR 0.90, 95% CI 0.38 to 2.12) or rates of meconium staining. There were no instances of uterine hyperstimulation. Three perinatal deaths were reported (1.8% versus 0%, RR 8.17, 95% CI 0.45 to 147.77).

When comparing breast stimulation with oxytocin alone the analysis found no difference in caesarean section rates (28% versus 47%, RR 0.60, 95% CI 0.31 to 1.18). No difference was detected in the number of women not in labour after 72 hours (58.8% versus 25%, RR 2.35, 95% CI 1.00 to 5.54) or rates of meconium staining. There were four perinatal deaths (17.6% versus 5%, RR 3.53, 95% CI 0.40 to 30.88).

Authors' conclusions

Breast stimulation appears beneficial in relation to the number of women not in labour after 72 hours, and reduced postpartum haemorrhage rates. Until safety issues have been fully evaluated it should not be used in high-risk women. Further research is required to evaluate its safety, and should seek data on postpartum haemorrhage rates, number of women not in labour at 72 hours and maternal satisfaction.

 

Plain language summary

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

Breast stimulation for cervical ripening and induction of labour

Breast stimulation appears beneficial in relation to the number of women not in labour after 72 hours, and reduced postpartum haemorrhage rates.

Breast stimulation causes the womb to contract, though the mechanism remains unclear. It may increase levels of the hormone oxytocin, which stimulates contractions. It is a non-medical method allowing the woman greater control over the process of attempting to induce labour. The review of six trials (719 women) found insufficient research to evaluate the safety of breast stimulation in a high-risk population and until safety issues have been fully evaluated, it should not be considered for use in this group.

 

摘要

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

背景

乳房刺激以協助子宮頸成熟和引產

乳房刺激被視為一種引產的方法，它是一種可以讓婦女自我控制引產過程的非藥物方法，這是有關子宮頸成熟和標準引產方法的一系列回顧之一。

目標

確認進行乳房刺激對於懷孕第3期子宮頸成熟或引產的效果，和安慰劑/無介入方式或其他引產方法進行比較。

搜尋策略

搜尋Cochrane Pregnancy和Childbirth Group's Trials Register (2009年9月15日)和相關報告的參考文獻。

選擇標準

乳房刺激對於懷孕第3期之子宮頸成熟或引產的臨床試驗。

資料收集與分析

發展一套策略以處理和引產有關的大量且複雜的試驗資料，包括一套二階段資料摘錄方法。

主要結論

納入6篇試驗(719名婦女)。比較乳房刺激和無介入組的分析發現，72小時未生產的婦女人數顯著減少(62.7% 相較於93.6% R為0.67, 95% CI為0.60 – 0.74)。子宮頸情況不適宜之婦女的結果不明顯。報告指出產後出血率減少許多(0.7% 相較於6%, RR為0.16, 95% CI為0.03 – 0.87)。剖腹產比率(9% 相較於10% R為0.90, 95% CI為0.38 – 2.12)或羊水胎便染色(meconium staining)沒有顯著差異。沒有發生子宮過度刺激案例。出生前後死亡報告有3例(1.8% 相較於0% R為8.17, 95% CI為0.45 – 147.77)。比較乳房刺激和單用oxytocin時，分析發現剖腹產比率沒有差異(28% 相較於47% R為0.60, 95% CI為0.31 – 1.18)，72小時後未生產之婦女數(58.8% 相較於25% R為2.35, 95% CI為1.00 – 5.54)或羊水胎便染色比率都沒有差異。出生前後死亡報告有4例(17.6% 相較於5% R為3.53, 95% CI為0.40 – 30.88)。

作者結論

乳房刺激對於72小時未生產的婦女人數似乎有幫助，也減少產後出血比率。除非完整評估安全方面議題，它不應用於高風險孕婦。需要後續研究評估它的安全性，尋找有關產後出血率、72小時未生產的婦女人數和母親的滿意度等資料。

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

乳房刺激以協助子宮頸成熟和引產：乳房刺激對於72小時未生產的婦女人數似乎有幫助，也減少產後出血比率。乳房刺激可引起子宮收縮，不過機轉還不清楚。它可以增加oxytocin值、可刺激子宮收縮，它是一種可以讓婦女自我控制引產過程的非藥物方法。回顧發現，有關高風險族群採用乳房刺激的安全性的研究不足，除非完整評估安全方面議題，它不應用於高風險孕婦。

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