Methods of induction of labour: a systematic review

<p>Abstract</p> <p>Background</p> <p>Rates of labour induction are increasing. We conducted this systematic review to assess the evidence supporting use of each method of labour induction.</p> <p>Methods</p> <p>We listed methods of labour induction then reviewed the evidence supporting each. We searched MEDLINE and the Cochrane Library between 1980 and November 2010 using multiple terms and combinations, including labor, induced/or induction of labor, prostaglandin or prostaglandins, misoprostol, Cytotec, 16,16,-dimethylprostaglandin E2 or E2, dinoprostone; Prepidil, Cervidil, Dinoprost, Carboprost or hemabate; prostin, oxytocin, misoprostol, membrane sweeping or membrane stripping, amniotomy, balloon catheter or Foley catheter, hygroscopic dilators, laminaria, dilapan, saline injection, nipple stimulation, intercourse, acupuncture, castor oil, herbs. We performed a best evidence review of the literature supporting each method. We identified 2048 abstracts and reviewed 283 full text articles. We preferentially included high quality systematic reviews or large randomised trials. Where no such studies existed, we included the best evidence available from smaller randomised or quasi-randomised trials.</p> <p>Results</p> <p>We included 46 full text articles. We assigned a quality rating to each included article and a strength of evidence rating to each body of literature. Prostaglandin E2 (PGE2) and vaginal misoprostol were more effective than oxytocin in bringing about vaginal delivery within 24 hours but were associated with more uterine hyperstimulation. Mechanical methods reduced uterine hyperstimulation compared with PGE2 and misoprostol, but increased maternal and neonatal infectious morbidity compared with other methods. Membrane sweeping reduced post-term gestations. Most included studies were too small to evaluate risk for rare adverse outcomes.</p> <p>Conclusions</p> <p>Research is needed to determine benefits and harms of many induction methods.</p

Patient Expectations of Acupuncture in Pregnancy

BACKGROUND: Expectations for treatment have been associated with outcomes. Expectations in acupuncture treatment have rarely been addressed, and due to the unique concerns of pregnancy and childbirth, obstetric patients merit special attention. PRIMARY STUDY OBJECTIVE: Assess treatment expectations of acupuncture clinic patients treated for obstetric and related concerns. METHODS/DESIGN: Descriptive follow-up involving a patient-completed survey; chief treatment concern and number of treatment sessions were validated against patient records. PARTICIPANTS: Of 265 former clinic patients, 137 (51.7%) completed the internet survey. MAIN OUTCOME MEASURES: Self-reported demographic variables; responses to open-ended questions on treatment expectations; general treatment variables. RESULTS: Using standard qualitative data analytic strategies, we identified five major treatment expectations, for example, affecting labor and delivery, benefiting the whole system, and treating specific symptoms. LIMITATIONS: Retrospective method and recall bias may have influenced reported expectations. CONCLUSION: Obstetric acupuncture patients' expectations overlap with other subgroups in terms of symptom treatment. They also indicate a distinct interest in taking an active role in childbirth and in replacing conventional interventions, warranting further inquiry into obstetric acupuncture effects and safety in childbearing women