Labour induction with prostaglandins: a systematic review and network meta-analysis.
Labour induction with prostaglandins: a systematic review and network meta-analysis.
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DOI：
10.1136/bmj.h217
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发表时间：
2015-02-05
期刊：
影响因子：
--
通讯作者：
Caldwell DM
中科院分区：
文献类型：
--
作者：
Alfirevic Z;Keeney E;Dowswell T;Welton NJ;Dias S;Jones LV;Navaratnam K;Caldwell DM
目的评价前列腺素用于引产的有效性和安全性。用贝叶斯网络Meta分析数据来源Cochrane妊娠和分娩小组的试验数据库(它结合了对所有妊娠和产后试验的广泛通用搜索的结果)进行系统回顾。资料来源包括CENTAL、Medline、Embase、NHS经济评估数据库、CINAHL、相关期刊、会议记录和正在进行的试验登记。选择研究的资格标准：用于晚期妊娠宫颈成熟或引产的前列腺素或前列腺素类似物的随机临床试验与安慰剂或不治疗、替代前列腺素剂量或给药或不同类型前列腺素的比较。我们纳入了招募有存活胎儿的女性的研究，但没有其他关于引产适应症或发表语言的限制。评估的结果是严重的新生儿发病率(三联者定义)或围产期死亡；严重的孕产妇发病率(三联者定义)或死亡；24小时内未实现阴道分娩、剖腹产和子宫过度刺激伴胎儿心率变化。结果纳入280项随机临床试验(48,068名女性)。产妇和新生儿死亡率以及严重发病率很少有报道，并作了叙述性的总结。对于过度刺激的结果，观察到未解决的不一致。与安慰剂相比，米索前列醇阴道分娩失败的几率最低(≥50微克)(优势比0.06(95%可信区间0.02至0.12))，发生事件的绝对概率为39%(95%可信区间1%至94%)。与安慰剂相比，口服米索前列醇滴定溶液(<；50微克)的剖宫产率最低(优势比0.65(0.49比0.83))，事件的绝对概率为15%(3%到40%)。结论小剂量(<；50µg)米索前列醇口服液的剖宫产率最低，而阴道米索前列醇(≥，50µg)24小时内阴道分娩的几率最高。这些研究结果对目前关于引产的一系列国家和国际准则以及今后在这一领域的研究具有重要影响。系统评审注册PROSPERO 2013：CRD42013005116
Objectives To assess the effectiveness and safety of prostaglandins used for labour induction. Design Systematic review with Bayesian network meta-analysis Data sources The Cochrane Pregnancy and Childbirth Group’s Database of Trials (which incorporates the results of a broad generic search for all pregnancy and postpartum trials). Sources included are CENTRAL, Medline, Embase, NHS Economic Evaluation Database, CINAHL, relevant journals, conference proceedings, and registries of ongoing trials. Eligibility criteria for selecting studies Randomised clinical trials of prostaglandin or prostaglandin analogues used for third trimester cervical ripening or labour induction versus placebo or no treatment, alternative prostaglandin dose or administration, or a different type of prostaglandin. We included studies recruiting women with a viable fetus, but had no other restrictions relating to indication for labour induction or language of publication. Outcomes assessed were serious neonatal morbidity (trialist defined) or perinatal death; serious maternal morbidity (trialist defined) or death; vaginal delivery not achieved within 24 hours, caesarean section, and uterine hyperstimulation with fetal heart rate changes. Results 280 randomised clinical trials were included (48 068 women) in the review. Maternal and neonatal mortality and serious morbidity were rarely reported and are summarized narratively. Unresolved inconsistency was observed for the hyperstimulation outcome. Relative to placebo, the odds of failing to achieve a vaginal delivery were lowest for vaginal misoprostol (≥50 µg) (odds ratio 0.06 (95% credible interval 0.02 to 0.12)), with a 39% absolute probability of event (95% credible interval 1% to 94%). Compared with placebo, odds of caesarean section were lowest for titrated oral misoprostol solution (<50 µg) (odds ratio 0.65 (0.49 to 0.83)), with an absolute probability of event of 15% (3% to 40%). Conclusions Low dose(<50 µg) titrated oral misoprostol solution had the lowest probability of caesarean section, whereas vaginal misprostol (≥50 µg) had the highest probability of achieving a vaginal delivery within 24 hours. These findings have important implications for a series of current national and international guidelines for induction of labour and future research in this area. Systematic review registration PROSPERO 2013:CRD42013005116
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DOI：
10.1136/bmj.e6226
发表时间：
2012-10-09
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Haas DM;Caldwell DM;Kirkpatrick P;McIntosh JJ;Welton NJ
通讯作者：
Welton NJ
影响因子：
3.1
作者：
Mozurkewich EL;Chilimigras JL;Berman DR;Perni UC;Romero VC;King VJ;Keeton KL
通讯作者：
Keeton KL
DOI：
10.1016/j.ijgo.2012.12.009
发表时间：
2013-05-01
影响因子：
3.8
作者：
Tang, Jennifer;Kapp, Nathalie;de Souza, Joao Paulo
通讯作者：
de Souza, Joao Paulo
影响因子：
2.4
作者：
Brooks, SP;Gelman, A
通讯作者：
Gelman, A
DOI：
10.3109/14767058.2012.668584
发表时间：
2012-10-01
影响因子：
1.8
作者：
Facchinetti, Fabio;Fontanesi, Francesca;Del Giovane, Cinzia
通讯作者：
Del Giovane, Cinzia