Indications for Induction of Labour -checksum="30956" ends

Oxytocin for prelabour rupture of membranes at or near term.

• Tan BP, Hannah ME.

Suite 406, 988 West 21st Avenue, Vancouver, British Colombia, Canada, V5Z 1Z1. bptan88@hotmail.com

Background:

Induction of labour after prelabour rupture of membranes may reduce the risk of neonatal infection.

Objectives:

The objective of this review was to assess the effects of induction of labour with oxytocin versus expectant management for prelabour rupture of membranes at or near term (34 weeks or more).

Search Strategy:

We searched the Cochrane Pregnancy and Childbirth Group trials register.

Selection Criteria:

Randomised and quasi-randomised trials of early use of oxytocin versus no early use of oxytocin for spontaneous rupture of membranes, before labour (34 weeks gestation or more).

Data Collection and Analysis:

Trials were assessed for quality and data were abstracted.

Main Results:

Eighteen studies were included. The trials were of variablequality with potential for significant bias. Compared to expectant management, induction of labour by oxytocin was associated with a decreased risk of maternal infection (odds ratio for chorioamnionitis of 0.63, 95% confidence interval 0.51 to 0.78, endometritis 0.72, 95% confidence interval 0.52 to 0.99). There was also a decreased risk of neonatal infection (odds ratio 0.64, 95% confidence interval 0.44 to 0.93). The size of this effect may have been biased in favour of oxytocin. Based on one trial, women were more likely to view their care positively if labour was induced with oxytocin. Caesarean section rates were not statistically different between groups, although the trend was towards fewer interventions with expectant management. Oxytocin was associated with more frequent use of pain relief and internal fetal heart rate monitoring. Perinatal mortality rates were low and not significantly different between groups, although the trend was towards fewer deaths with induction of labour by oxytocin.

REVIEWER'S

Conclusions:

Induction of labour by oxytocin may decrease the risk of maternal and neonatal infection compared to expectant management. Induction of labour with oxytocin does not appear to increase the rate of caesarean section, although it may increase use of pain relief and internal fetal heart rate monitoring.