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Prostaglandins before caesarean section for preventing neonatal respiratory distress

  1. Nkengafac V Motaze1,2,*,
  2. Lawrence Mbuagbaw1,
  3. Taryn Young3,4

Editorial Group: Cochrane Pregnancy and Childbirth Group

Published Online: 11 NOV 2013

Assessed as up-to-date: 30 OCT 2013

DOI: 10.1002/14651858.CD010087.pub2


How to Cite

Motaze NV, Mbuagbaw L, Young T. Prostaglandins before caesarean section for preventing neonatal respiratory distress. Cochrane Database of Systematic Reviews 2013, Issue 11. Art. No.: CD010087. DOI: 10.1002/14651858.CD010087.pub2.

Author Information

  1. 1

    Yaoundé Central Hospital, Centre for Development of Best Practices in Health (CDBPH), Yaoundé, Centre Province, Cameroon

  2. 2

    Stellenbosch University, Community Health, Faculty of Medicine and Health Sciences, Cape Town, South Africa

  3. 3

    Stellenbosch University, Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Cape Town, South Africa

  4. 4

    South African Medical Research Council, South African Cochrane Centre, Cape Town, South Africa

*Nkengafac V Motaze, Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Henri Dunant Avenue, PO Box 87, Yaoundé, Centre Province, Cameroon. villyen@yahoo.com.

Publication History

  1. Publication Status: New
  2. Published Online: 11 NOV 2013

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Characteristics of included studies [ordered by study ID]
Singh 2004

MethodsRandomised placebo controlled trial. The trial was carried out in a regional tertiary neonatal centre in Australia.


ParticipantsExpectant mothers eligible for ECS at 38 weeks' gestation or more who gave written consent.

The study included 36 women (18 in the intervention group and 18 in the control group).


InterventionsActive: intravaginal administration of 2 mg of prostaglandin E2 gel 60 minutes before ECS.

Placebo: intravaginal administration of 2 mg of K-Y jelly 60 minutes before ECS.


OutcomesThe main outcome for the study was adrenaline and noradrenaline levels in neonatal umbilical cord blood. Measurements of umbilical venous and arterial pH were obtained. Incidence of neonatal respiratory distress, Apgar score of the newborn, need for mechanical ventilation and proportion of neonates requiring admission into intensive care unit were also assessed.


NotesThe ethics committee of the tertiary neonatal care institution where the study was carried out provided ethics approval.


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskComputer-generated random numbers.

Allocation concealment (selection bias)Low riskSealed, coded, opaque, sequentially numbered envelopes.

Blinding of participants and personnel (performance bias)
All outcomes
Low riskIntervention group given prostaglandin E2 gel and control group given an equal volume of K-Y jelly.

Independent research assistant administered trial drug or placebo to participants.

Blinding of outcome assessment (detection bias)
All outcomes
Low riskOutcome assessors blinded.

Incomplete outcome data (attrition bias)
All outcomes
Low riskIntention-to-treat analysis done, no significant loss to follow-up.

Selective reporting (reporting bias)Low riskAll expected outcomes of interest to the review reported.

Other biasLow riskNo other potential source of bias.

 
Comparison 1. Prostaglandin E2 gel vs placebo

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

 1 Respiratory distress1Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 
Summary of findings for the main comparison. Prostaglandin E2 Administered Before Caesarean Section for Prevention of Neonatal Respiratory Distress

Prostaglandin E2 versus placebo before caesarean section for prevention of neonatal respiratory distress

Patient or population: pregnant women at term.
Settings: Regional tertiary neonatal care centre.
Intervention: prostaglandin E2 administered per vagina before caesarean section.

Control: K-Y jelly as placebo.

OutcomesIllustrative comparative risks* (95% CI)Relative effect
(95% CI)
No of participants
(studies)
Quality of the evidence
(GRADE)
Comments

Assumed riskCorresponding risk

ControlProstaglandin E2 administered before caesarean section

Respiratory distress
Respiratory rate at rest > 60/min and/or signs of respiratory distress.
Follow-up: 1 day.
Study populationRR 0.33, 95% CI 0.01 to 7.68,36
(1 study)
⊕⊕⊝⊝
low1

83 per 100027 per 1000
(0.01 to 637)



Need for mechanical ventilation
Follow-up: 1 day.
Study populationNot estimable36
(1 study)
⊕⊕⊝⊝
low1
There was no neonate requiring mechanical ventilation in either groups.

See commentSee comment

Moderate


All cause fetal mortality
Follow-up: 1 day.
Study populationNot estimable36
(1 study)
⊕⊕⊝⊝
low1
There was no reported neonatal death in the study.

See commentSee comment



Maternal adverse eventsStudy populationNot estimable36
(1 study)
⊕⊕⊝⊝
low1
There was no maternal adverse event reported in the study.

See commentSee comment



*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio;

GRADE Working Group grades of evidence
High quality: further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: we are very uncertain about the estimate.

 1 The optimal information size was not met, confidence intervals were wide and event rates were low.