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Mechanical methods for induction of labour.

M Boulvain1, A Kelly, C Lohse

  • 1Unité de Développement en Obstétrique, Maternité Hôpitaux Universitaires de Genève, Département de Gynécologie et d'Obstétrique, Boulevard de la Cluse, 32, Geneva 14, Switzerland, CH-1211. michel.boulvain@hcuge.ch

The Cochrane Database of Systematic Reviews
|November 1, 2001
PubMed
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Mechanical methods for cervical ripening and labor induction show reduced hyperstimulation risk compared to prostaglandins. They also decrease cesarean section rates versus oxytocin in women with unfavorable cervices.

Area of Science:

  • Obstetrics and Gynecology
  • Reproductive Medicine
  • Clinical Trials Methodology

Background:

  • Mechanical methods, including catheters and laminaria tents, were historically used for cervical ripening and labor induction.
  • While largely replaced by pharmacological methods, mechanical techniques offer potential advantages like simpler preservation and lower costs.
  • However, contraindications, infection risks, and maternal discomfort necessitate careful consideration.

Purpose of the Study:

  • To evaluate the efficacy and safety of mechanical methods for third-trimester cervical ripening or labor induction.
  • Comparisons were made against placebo/no treatment, prostaglandins (vaginal, intracervical, misoprostol), and oxytocin.

Main Methods:

  • A systematic review of randomized controlled trials was conducted.

Related Experiment Videos

  • Data were extracted centrally and analyzed using a standardized methodology, focusing on outcomes like vaginal delivery within 24 hours, cesarean section, and hyperstimulation.

    • Main Results:

    • Mechanical methods showed reduced hyperstimulation risk compared to prostaglandins (vaginal PGE2, intracervical PGE2, misoprostol).
    • Compared to oxytocin, mechanical methods reduced the risk of cesarean section in women with unfavorable cervices.
    • Effectiveness in achieving vaginal delivery within 24 hours was not sufficiently established against placebo or prostaglandins. Extra-amniotic infusion showed no benefits.

    Conclusions:

    • Mechanical methods offer a reduced risk of hyperstimulation when compared to prostaglandins.
    • They are effective in lowering cesarean section rates compared to oxytocin for women with unfavorable cervices.
    • Further evidence is needed to fully assess their effectiveness for achieving vaginal delivery within 24 hours.