Intravenous prostaglandin for induction of labour

Inducing labour with intravenous prostaglandin is effective but has adverse effects. Induction of labour is common when continuing the pregnancy poses a greater risk to the mother or her unborn child. Prostaglandins, produced naturally by the body, can ripen the cervix and stimulate contractions. This review found that giving prostaglandins intravenously during the third trimester of pregnancy is effective in inducing labour, but is more expensive and causes more adverse effects than oxytocin (another hormone for inducing labour).

Authors' conclusions: 

Intravenous prostaglandin is no more efficient than intravenous oxytocin for the induction of labour but its use is associated with higher rates of maternal side-effects and uterine hyperstimulation.

No conclusions can be drawn form the comparisons of combination of prostaglandin F2 alpha and oxytocin compared to oxytocin alone or extra-amniotic and intravenous prostaglandin E2.

[Note: The two citations in the awaiting classification section of the review may alter the conclusions of the review once assessed.]

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Background: 

Intravenous prostaglandin E2 and F2 alpha can be used to induce labour, however their use is limited by unacceptable maternal side-effect profiles. This is one of a series of reviews of methods of cervical ripening and labour induction using standardised methodology.

Objectives: 

To determine the effects of intravenous prostaglandin for third trimester cervical ripening or induction of labour.

Search strategy: 

We searched the Cochrane Pregnancy and Childbirth Group Trials Register (31 January 2004) and bibliographies of relevant papers. We updated this search on 7 May 2010 and added the results to the awaiting classification section.

Selection criteria: 

Randomised controlled trials comparing intravenous prostaglandin used for third trimester cervical ripening or labour induction with placebo/no treatment or other methods listed above it on a predefined list of labour induction methods.

Data collection and analysis: 

A generic strategy was developed to deal with the large volume and complexity of trial data relating to labour induction. This involved a two-stage method of data extraction. The initial data extraction was done centrally.

Main results: 

Thirteen trials (1165 women) were included in the review.

The use of intravenous prostaglandin was associated with higher rates of uterine hyperstimulation both with changes in the fetal heart rate (relative risk (RR) 6.76, 95% confidence interval (CI) 1.23 to 37.11) and without (RR 4.25, 95% CI 1.48 to 12.24) compared to oxytocin. Use of prostaglandin was also associated with significantly more maternal side-effects (gastrointestinal, thrombophlebitis and pyrexia, RR 3.75, 95% CI 2.46 to 5.70) than oxytocin. Prostaglandin was no more likely to result in vaginal delivery than oxytocin (RR 0.85, 95% CI 0.61 to 1.18).

No significant differences emerged from subgroup analysis or from the trials comparing combination oxytocin/prostaglandin F2 alpha and oxytocin or extra-amniotic versus intravenous prostaglandin E2.

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