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Methods of term labour induction for women with a previous caesarean section

  1. Marta Jozwiak1,*,
  2. Jodie M Dodd2

Editorial Group: Cochrane Pregnancy and Childbirth Group

Published Online: 28 MAR 2013

Assessed as up-to-date: 5 SEP 2012

DOI: 10.1002/14651858.CD009792.pub2


How to Cite

Jozwiak M, Dodd JM. Methods of term labour induction for women with a previous caesarean section. Cochrane Database of Systematic Reviews 2013, Issue 3. Art. No.: CD009792. DOI: 10.1002/14651858.CD009792.pub2.

Author Information

  1. 1

    Leiden University Medical Center, Leiden, Netherlands

  2. 2

    The University of Adelaide, School of Paediatrics and Reproductive Health, Discipline of Obstetrics and Gynaecology, Adelaide, South Australia, Australia

*Marta Jozwiak, Leiden University Medical Center, Leiden, Netherlands. jozwiak.marta@gmail.com.

Publication History

  1. Publication Status: New
  2. Published Online: 28 MAR 2013

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Characteristics of included studies [ordered by study ID]
Taylor 1993

MethodsProspective randomised trial, sealed numbered envelopes, no sample size calculation.


ParticipantsWomen requiring labour induction due to prolonged pregnancy or pre-eclampsia, 1 previous pregnancy delivered by lower segment caesarean section, singleton in cephalic presentation, GA ≥ 37 weeks, BS < 9, no cephalopelvic disproportion anticipated.


InterventionsAmniotomy and IV oxytocin (n = 21) versus 2.5 mg PGE2 pessary, followed by amniotomy 3 hours later + oxytocin (if necessary) 6 hours later (n = 21).


OutcomesInduction to delivery time, analgesia, mode of delivery, uterine rupture.


NotesOnly half of the women included had an unfavourable cervix (BS < 6).

1 uterine rupture in PGE 2 group (after oxytocin) reported in abstract Sellers 1988.


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear risk'predetermined code envelope.'

Allocation concealment (selection bias)Low riskSealed envelopes.

Incomplete outcome data (attrition bias)
All outcomes
Low riskData of all women included were reported, no ITT analysis done.

Selective reporting (reporting bias)Unclear riskPublished report includes expected outcomes, but no outcome measures were prespecified in the methods section.

Other biasLow riskThe baseline characteristics were comparable between the groups.

Blinding of participants and personnel (performance bias)
All outcomes
High riskNot feasible.

Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskBlinding was not described in the report.

Wing 1998

MethodsPrematurely terminated RCT, due to safety concerns.


ParticipantsWomen with a singleton pregnancy in cephalic presentation with one prior caesarean section were eligible for inclusion.


Interventions25 mcg misoprostol every 6 hours (maximum of 4 doses) (n = 17) versus IV oxytocin (n = 21).


OutcomesNot described in detail, included uterine tachysystole, hypertonus, hyperstimulation syndrome, uterine dehiscence (defined at laparotomy or digital examination), uterine rupture (that required emergency laparotomy).


Notes2 uterine ruptures occurred in the misoprostol group and the trial was ended prematurely due to safety concerns.


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear riskMethod of sequence generation not described.

Allocation concealment (selection bias)Unclear riskMethod not described in the report.

Incomplete outcome data (attrition bias)
All outcomes
Unclear riskThe expected outcomes are not described; the report only describes the cases of uterine rupture in detail.

Selective reporting (reporting bias)Unclear riskThis report only describes the cases of uterine rupture in detail.

Other biasUnclear riskThe study was terminated prematurely due to safety concerns.

Blinding of participants and personnel (performance bias)
All outcomes
High riskBlinding was not feasible due to the nature of the interventions.

Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskBlinding was not described in the report.

 
Characteristics of excluded studies [ordered by study ID]

StudyReason for exclusion

Arraztoa 1994Compares, in women with a prior caesarean birth in labour, a pharmacologic approach (oxytocin + epidural) to expectant management (spontaneous evolution). Does not compare methods of induction for women in whom labour is induced.

Ben-Aroya 2001Is not a randomised controlled trial, but rather a cohort study.

Hamdan 2009Compares weekly membrane sweeping to weekly vaginal examination, does not compare 2 different methods of cervical ripening or induction.

Lelaidier 1994Mifepristone was used as a pre-induction agent, only after the women were randomised.

Morales 1986Compares induction of labour with oxytocin to expectant management in women with premature rupture of membranes, not especially women with a prior caesarean birth.

Rayburn 1999Compares weekly administration of cervical PGE2 gel to expectant management in women with a prior caesarean birth, not 2 different methods of cervical ripening or induction.

Sciscione 2001Initially all women were included, subsequently women with a prior caesarean were excluded.

Spallicci 2007Women did not require induction of labour.

 
Comparison 1. Prostaglandin E2 versus oxytocin

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Caesarean section142Risk Ratio (M-H, Fixed, 95% CI)0.67 [0.22, 2.03]

 2 Serious neonatal morbidity/perinatal death142Risk Ratio (M-H, Fixed, 95% CI)3.0 [0.13, 69.70]

 3 Serious maternal morbidity or death142Risk Ratio (M-H, Fixed, 95% CI)3.0 [0.13, 69.70]

 4 Uterine rupture142Risk Ratio (M-H, Fixed, 95% CI)3.0 [0.13, 69.70]

 5 Epidural analgesia142Risk Ratio (M-H, Fixed, 95% CI)1.42 [0.93, 2.17]

 6 Instrumental vaginal delivery142Risk Ratio (M-H, Fixed, 95% CI)1.25 [0.39, 4.02]

 7 Apgar score < 7 at 5 minutes142Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 
Comparison 2. Misoprostol versus oxytocin

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Uterine rupture138Risk Ratio (M-H, Fixed, 95% CI)6.11 [0.31, 119.33]