Abstract

Assessed as up to date: 1996/12/31

Background

The conventional method of induction of labour is with intravenous oxytocin. More recently, induction with prostaglandins, followed by an infusion of oxytocin if necessary, has been used.

Objectives

The objective of this review was to assess the effects of induction of labour with prostaglandins versus oxytocin for prelabour rupture of membranes at term.

Search strategy

We searched the Cochrane Pregnancy and Childbirth Group trials register.

Selection criteria

Randomised and quasi-randomised trials of early stimulation of uterine contractions with prostaglandins (with or without oxytocin) versus with oxytocin alone (not combined with prostaglandins) in women with spontaneous rupture of membranes at term (37 weeks or more gestation).

Data collection and analysis

Two reviewers assessed trial quality and extracted data.

Main results

Eight trials were included. Based on three trials, prostaglandins compared to oxytocin were associated with increased chorioamnionitis (odds ratio of 1.51, 95% confidence interval 1.07 to 2.12) and neonatal infections (odds ratio 1.63, 95% confidence interval 1.00 to 2.66). Based on four trials, prostaglandins were associated with a decrease in epidural analgesia (odds ratio of 0.86, 95% confidence interval 0.73 to 1.00) and internal fetal heart rate monitoring (based on one trial). Caesarean section, endometritis and perinatal mortality were not significantly different between the groups.

Authors' conclusions

Women with prelabour rupture of membranes at term having their labour induced with prostaglandins appear to have a lower risk of epidural analgesia and fetal heart rate monitoring. However there appears to be an increased risk of chorioamnionitis and neonatal infections after prostaglandin induction compared to oxytocin.

[This abstract has been prepared centrally.]

Author(s)

Tan Brenda P, Hannah Mary

Summary

Prostaglandins versus oxytocin for prelabour rupture of membranes at term 

To be prepared.

Reviewer's Conclusions

Implications for practice 

Women with prelabour rupture of membranes at or near term should be informed of a) the benefits associated with having their labour induced with prostaglandins (lower risk of epidural analgesia and internal fetal heart rate monitoring); b) the risks associated with having labour induced with prostaglandins (increased risk of chorioamnionitis, maternal nausea and/or vomiting, numerous vaginal examinations, neonatal infection, neonatal antibiotic therapy and admission to NICU); compared with a policy of induction of labour with oxytocin. Women should be encouraged to choose the treatment option they would prefer.

Implications for research 

Future research should evaluate women's preferences of treatment plans. A cost-analysis of the (TERMPROM) trial is currently in progress.

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