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A META-ANALYSIS OF CONTROLLED-RELEASE PROSTAGLANDIN FOR CERVICAL RIPENING AND LABOUR INDUCTION
Joan M.G. Crane1, Kelly A. Bennett
1Health Care Corporation of St. John's, St. John's, NF, Canada.
Journal SOGC : Journal of the Society of Obstetricians and Gynaecologists of Canada
|November 29, 2002
Summary
Controlled-release prostaglandin (dinoprostone) effectively ripens the cervix and increases vaginal delivery rates within 12 hours. However, it may lead to more uterine activity compared to other methods.
Area of Science:
- Obstetrics and Gynecology
- Reproductive Medicine
- Pharmacology
Background:
- Cervical ripening is crucial for initiating labor induction.
- Various methods exist for cervical ripening, each with specific efficacy and safety profiles.
- Controlled-release prostaglandin formulations offer a sustained delivery mechanism.
Purpose of the Study:
- To evaluate the effectiveness and safety of controlled-release vaginal prostaglandin (dinoprostone) for cervical ripening.
- To compare its outcomes against placebo, Prepidil, and misoprostol.
- To assess its impact on labor induction, delivery rates, and uterine activity.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs) published between 1980-1999.
- Computerized literature search using specific keywords (Cervidil, Propess, prostaglandin/dinoprostone, pessary, controlled release, vaginal insert).
- Inclusion of nine RCTs comparing controlled-release prostaglandin with a retrieval string against other methods or placebo.
Main Results:
- Controlled-release prostaglandin significantly improved cervical change (OR=3.99) and vaginal delivery within 12 hours (OR=29.01) compared to placebo.
- It reduced the need for oxytocin (OR=0.14) but increased excessive uterine activity and hyperstimulation.
- Compared to misoprostol, it showed lower vaginal delivery rates in 12 hours and higher oxytocin use; compared to Prepidil/immediate oxytocin, it had a longer induction-delivery interval.
Conclusions:
- Controlled-release prostaglandin is effective for cervical ripening, comparable to Prepidil, but associated with increased uterine activity.
- It may be less effective than misoprostol or Prepidil/immediate oxytocin regarding delivery speed and oxytocin augmentation.
- Larger RCTs are necessary to definitively assess maternal morbidity and neonatal outcomes.