Comparison of effectiveness and safety of cervical ripening methods for induction of labour: A population-based study using coarsened exact matching.
Administration, Intravaginal
Adult
Catheterization
/ methods
Cervical Ripening
/ drug effects
Cervix Uteri
/ drug effects
Delivery, Obstetric
Dinoprostone
/ administration & dosage
Female
France
/ epidemiology
Humans
Labor, Induced
Misoprostol
/ administration & dosage
Oxytocics
/ administration & dosage
Pessaries
Pregnancy
Pregnancy Outcome
Prospective Studies
balloon catheter
cervical ripening
coarsened exact matching
dinoprostone
induction of labour
misoprostol
Journal
Paediatric and perinatal epidemiology
ISSN: 1365-3016
Titre abrégé: Paediatr Perinat Epidemiol
Pays: England
ID NLM: 8709766
Informations de publication
Date de publication:
09 2019
09 2019
Historique:
received:
21
12
2018
revised:
31
05
2019
accepted:
23
06
2019
pubmed:
26
7
2019
medline:
11
8
2020
entrez:
26
7
2019
Statut:
ppublish
Résumé
There is no consensus about the ideal cervical ripening method to use for induction of labour. To compare in current practice the effectiveness and safety of four cervical ripening methods. We performed a matched comparative study using data from the MEDIP prospective population-based cohort conducted during one month in 2015 in all maternity units of seven French perinatal networks (3042 consecutive women with a live fetus and induction of labour). We analysed 1671 women with singleton cephalic fetus, unscarred uterus, and bishop score <7. Dinoprostone vaginal pessary (reference) was compared to dinoprostone vaginal gel, misoprostol vaginal tablet, and balloon catheter. Effectiveness outcomes were the need for more than one induction agent, oxytocin use, failure to achieve vaginal delivery within 24 hours (VD < 24 hours), and caesarean delivery. Safety outcomes were meconium-stained amniotic fluid, uterine hyperstimulation, NICU admission, and post-partum haemorrhage. Coarsened exact matching was used to balance confounders among the groups. Outcomes were compared using multivariable logistic regression models. Compared to the dinoprostone pessary (N = 1142, 68.3%), dinoprostone gel (N = 335, 20.1%) was associated with less failure to achieve VD < 24 hours (adjusted OR 0.66, 95% CI 0.47, 0.91). Misoprostol (N = 103, 6.2%) was associated with less need of more than one induction agent (aOR 0.56, 95% CI 0.34, 0.92) and less oxytocin use (aOR 0.60, 95% CI 0.37, 0.99). The balloon catheter (N = 91, 5.4%) was associated with more failure to achieve VD < 24 hours (aOR 2.62, 95% CI 1.37, 5.01), more caesarean delivery (aOR 1.84, 95% CI 1.09, 3.08), and less meconium-stained amniotic fluid (aOR 0.12, 95% CI 0.02, 0.70). Uterine hyperstimulation rates seemed lower with the balloon catheter (1.2% vs 4.2% for the pessary). In current practice, no cervical ripening method appears clearly superior to the others considering all effectiveness and safety outcomes.
Sections du résumé
BACKGROUND
There is no consensus about the ideal cervical ripening method to use for induction of labour.
OBJECTIVE
To compare in current practice the effectiveness and safety of four cervical ripening methods.
METHODS
We performed a matched comparative study using data from the MEDIP prospective population-based cohort conducted during one month in 2015 in all maternity units of seven French perinatal networks (3042 consecutive women with a live fetus and induction of labour). We analysed 1671 women with singleton cephalic fetus, unscarred uterus, and bishop score <7. Dinoprostone vaginal pessary (reference) was compared to dinoprostone vaginal gel, misoprostol vaginal tablet, and balloon catheter. Effectiveness outcomes were the need for more than one induction agent, oxytocin use, failure to achieve vaginal delivery within 24 hours (VD < 24 hours), and caesarean delivery. Safety outcomes were meconium-stained amniotic fluid, uterine hyperstimulation, NICU admission, and post-partum haemorrhage. Coarsened exact matching was used to balance confounders among the groups. Outcomes were compared using multivariable logistic regression models.
RESULTS
Compared to the dinoprostone pessary (N = 1142, 68.3%), dinoprostone gel (N = 335, 20.1%) was associated with less failure to achieve VD < 24 hours (adjusted OR 0.66, 95% CI 0.47, 0.91). Misoprostol (N = 103, 6.2%) was associated with less need of more than one induction agent (aOR 0.56, 95% CI 0.34, 0.92) and less oxytocin use (aOR 0.60, 95% CI 0.37, 0.99). The balloon catheter (N = 91, 5.4%) was associated with more failure to achieve VD < 24 hours (aOR 2.62, 95% CI 1.37, 5.01), more caesarean delivery (aOR 1.84, 95% CI 1.09, 3.08), and less meconium-stained amniotic fluid (aOR 0.12, 95% CI 0.02, 0.70). Uterine hyperstimulation rates seemed lower with the balloon catheter (1.2% vs 4.2% for the pessary).
CONCLUSIONS
In current practice, no cervical ripening method appears clearly superior to the others considering all effectiveness and safety outcomes.
Substances chimiques
Oxytocics
0
Misoprostol
0E43V0BB57
Dinoprostone
K7Q1JQR04M
Types de publication
Journal Article
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
313-322Informations de copyright
© 2019 John Wiley & Sons Ltd.
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