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Alliance Francophone pour l’Accouchement Respecté (AFAR) Compilation
« Déclenchement de l’accouchement »
Base de données de l’AFAR
http://afar.info
Etude réalisée le 27 juillet 2004
(c) AFAR 2004 - Nous autorisons la reproduction de ce document exclusivementdans sa version intégrale, pour une diffusion non-commerciale.
Compilation
« Déclenchement de l’accouchement »
Méthode de travail : Nous avons sélectionné 51 fiches parmi les 75 contenant le
mot-clé « Déclenchement » dans la base de données de l’AFAR, fin juillet 2004.
Convention : Le numéro entre [crochets] est celui de la fiche dans la base de données.
- Amélioration de la sécurité des naissances, - Organisation individuelle et collective de Il faut néanmoins pratiquer une analyse autocritique.
Le premier danger est celui de la prématurité induite, il faut savoir attendre quelques jours même quand le col est très favorable plutôt que de déclencher trop près Le deuxième danger est une réflexion d’obstétricien quidit : la décision de déclencher le travail est unedécision responsable, il ne faut pas que cela devienneune responsabilité transformée en culpabilité, c’est àdire que nous avons tous mal vécu le fait qu’undéclenchement ne se passe pas comme il avait été prévu; Par rapport à l’accouchement spontané où l’obstétricienest considéré comme le sauveur et par rapport audéclenchement médical où la femme est prévenue desrisques de pathologie et du risque de césarienne, dansle déclenchement de principe, on se sent responsabled’où des déviations dans la décision obstétricaledifficile à prendre dans ces cas.
Comme disait MALINAS, dans le déclenchement,l’objectivité et la sérénité doivent être mises àl’honneur. On pratique parfois les césariennes trop tôtpar manque de patience mais parfois aussi trop tard, cequi expliquerait le taux de morbidité un peu élevé.
Troisième danger : Développement de politiquesobstétricales " actives " Il n’y a sans doute pas de taux idéal de déclenchementmais incontestablement entre 10 % de déclenchements et50 %, les cas ne sont pas les mêmes. Le problème est desavoir si en augmentant de façon importante le taux de Source et mises à jour de ce document : http://afar.ws/compilations/declenchement-compil.pdf Compilation « Déclenchement de l’accouchement » ………… 2 déclenchement, on ne devient pas nocif en déclenchantdans des conditions médiocres.
Plus il y a de déclenchements et plus il y a dedéclenchements difficiles; il se peut qu’au delà de 30ou 35 %, on rentre dans une certaine pathologie Les services qui font autour de 20 % de déclenchementsont environ 2 % de césariennes. Par contre, les servicesqui font autour de 50 % ont 6 % de césariennes.
Il semble donc qu’il faille garder une certaine mesure.
N’en faisons-nous pas trop ? J’étais prêt il y aquelques mois à augmenter mon taux de déclenchementsmais je pense maintenant revenir un peu en arrière, untaux de déclenchement de 30 à 40% me semblant idéal Guerre, Philippe. L’induction artificielle du travail
est-elle susceptible d’entraîner un risque foetal ?
Congrès « La programmation systématique de
l’accouchement », 19 novembre 1994, Bordeaux, Collège de
Gynécologie de Bordeaux.
http://www.gyneweb.fr/Sources/obstetrique/bx/94/souffoe.
html [22] “Déclenchement du travail: c’est la Nature qui sait le mieux que faire.” -- Le déclenchement de l’accouchement est paradoxal: il fonctionne au mieux quand on en a le moins besoin, et il échoue souvent quand on en a le plus besoin. De plus, il est souvent à la source même des problèmes qu’il est supposé prévenir.
Goer, Henci. Induction of Labor: Mother Nature Knows
Best. In “The Thinking Woman’s Guide to a Better Birth.
Practical Information for a Safe, Satisfying
Childbirth.” New York: Berkley, p.49-74
Remarques :Pour commander l’ouvrage:http://www.amazon.fr/exec/obidos/ASIN/0399525173/ [36] “Dépassement de terme: déclenchement, ou Mythe: Pour éviter tout problème, le travail devrait être déclenché en cas de dépassement du terme de deux Réalité: Il apparaît dans toute la littérature scientifique qu’aucune donnée ni aucun indice ne prouve que le déclenchement systématique à n’importe quel âgegestationnel n’améliore les résultats périnataux.
Goer, Henci. Postdates Pregnancy: Induction Versus
Watching and Waiting. In “Obstetric Myths Versus
Research Realities: A Guide to the Medical Literature.”
Westport: Bergin & Garvey, p.180-202
Alliance Francophone pour l’Accouchement Respecté <http://afar.info> Compilation « Déclenchement de l’accouchement » ………… 3 http://www.hencigoer.com/obmyth/epis.html Remarques :Pour commander l’ouvrage:http://www.amazon.com/exec/obidos/tg/detail/-/0897894278/ [718] OBJECTIVE: To review randomised controlled trials of alternative maternity services characterised by METHODS: A systematic review of randomised controlledtrials, analysed on an intention to treat basis, inwhich the study intervention was characterised by amidwife or small group of midwives providing care fromearly pregnancy to the postnatal period (defined as thatprovided on the postnatal ward); and the controls bystandard maternity care as practised in the place wherethe trial was conducted. The seven trials identifiedincluded 9148 women. Main outcome measures wereinterventions during labour, maternal outcomes andinfant outcomes.
RESULTS: The alternative models with continuity ofmidwifery care were associated with less use ofobstetric interventions during labour (eg, induction,augmentation of labour, electronic fetal monitoring,obstetric analgesia, instrumental vaginal delivery andepisiotomy). However, the caesarean section rate did notdiffer statistically between the trial groups (OR 0.91;95% CI 0.78 to 1.05). The lower episiotomy rate in thealternative models of care (OR 0.69; 95% CI 0.61 to0.77) was associated with a significantly higher rate ofperineal tears in the pooled alternative groups (OR1.15; 95% CI 1.05 to 1.26). The percentage of intactperineums was very similar for the two groups (OR 1.11;95% CI 1.00 to 1.24). There was no maternal death, andrates of maternal complications based on unpooledestimates did not show any statistically significantdifferences. The proportion of babies with an Apgarscore < 7 at five minutes after the birth wasapproximately the same in the pooled alternative groupsas in the control groups (OR 1.13 95% CI 0.69 to 1.84).
Admission to intensive care or special care baby unitwas similar (OR 0.86; 95% CI 0.71 to 1.04). Thedifference in perinatal deaths was bordering onstatistical significance (OR 1.60; 95% CI 0.99 to 2.59).
CONCLUSION: Continuity of midwifery care is associatedwith lower intervention rates than standard maternitycare. No statistically significant differences wereobserved in maternal and infant outcomes. However, moreresearch is necessary to make definite conclusions aboutsafety, for the infant as well as for the mother. Thisreview illustrates the variation in the different modelsof alternative and standard maternity care, and thus theproblems associated with pooling data from differenttrials.
Alliance Francophone pour l’Accouchement Respecté <http://afar.info> Compilation « Déclenchement de l’accouchement » ………… 4 Waldenstrom U, Turnbull D. A systematic review
comparing continuity of midwifery care with standard
maternity services.
Br J Obstet Gynaecol. 1998 Nov;105(11):1160-70.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9853764 [330] OBJECTIVE: We sought to determine whether there is a difference in the rate of symptomatic uterine rupture after a trial of labor in women who have had 1 STUDY DESIGN: The medical records of all women with a history of either 1 or 2 prior cesarean deliveries who elected to undergo a trial of labor during a 12-year period (July 1984-June 1996) at the Brigham and Women’s Hospital were reviewed. Rates of uterine rupture were compared for these 2 groups. Potential confounding variables were controlled by using logistic regression RESULTS: Women with 1 prior cesarean delivery (n = 3757)had a rate of uterine rupture of 0.8%, whereas womenwith 2 prior cesarean deliveries (n = 134) had a rate ofuterine rupture of 3.7% (P =.001). In a logisticregression analysis that was controlled for maternalage, use of epidural analgesia, oxytocin induction,oxytocin augmentation, the use of prostaglandin E(2)gel, birth weight, gestational age, type of priorhysterotomy, year of trial of labor, and prior vaginaldelivery, the odds ratio for uterine rupture in thosepatients with 2 prior cesarean deliveries was 4.8 (95%confidence interval, 1.8-13. 2) CONCLUSIONS: Women with a history of 2 prior cesareandeliveries have an almost 5-fold greater risk of uterinerupture than those with only 1 prior cesarean delivery.
Caughey AB, Shipp TD, Repke JT, Zelop CM, Cohen A,
Lieberman E. Rate of uterine rupture during a trial of
labor in women with one or two prior cesarean
deliveries.
Am J Obstet Gynecol. 1999 Oct;181(4):872-6.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10521745&dopt=Abstract [331] OBJECTIVE: Our purpose was to examine the risk of uterine rupture during induction or augmentation of labor in gravid women with 1 prior cesarean delivery.
STUDY DESIGN: The medical records of all gravid women with history of cesarean delivery who attempted a trial of labor during a 12-year period at a single center were reviewed. The current analysis was limited to women at term with 1 prior cesarean delivery and no other deliveries. The rate of uterine rupture in gravid women within that group undergoing induction was compared with Alliance Francophone pour l’Accouchement Respecté <http://afar.info> Compilation « Déclenchement de l’accouchement » ………… 5 that in spontaneously laboring women. The association of oxytocin induction, oxytocin augmentation, and use ofprostaglandin E(2) gel with uterine rupture wasdetermined. Logistic regression analysis was used toexamine these associations, with control for confoundingfactors.
RESULTS: Of 2774 women in the analysis, 2214 hadspontaneous onset of labor and 560 women had laborinduced with oxytocin or prostaglandin E(2) gel. Theoverall rate of rupture among all patients withinduction of labor was 2.3%, in comparison with 0.7%among women with spontaneous labor (P =.001). Among 1072patients receiving oxytocin augmentation, the rate ofuterine rupture was 1.0%, in comparison with 0.4% innonaugmented, spontaneously laboring patients (P =.1).
In a logistic regression model with control for birthweight, use of epidural, duration of labor, maternalage, year of delivery, and years since last birth,induction with oxytocin was associated with a 4.6-foldincreased risk of uterine rupture compared with nooxytocin use (95% confidence interval, 1.5-14.1). Inthat model, augmentation with oxytocin was associatedwith an odds ratio of 2.3 (95% confidence interval, 0.8-7.0), and use of prostaglandin E(2) gel was associatedwith an odds ratio of 3.2 (95% confidence interval, 0.9-10.9). These differences were not statisticallysignificant.
CONCLUSION: Induction of labor with oxytocin isassociated with an increased rate of uterine rupture ingravid women with 1 prior uterine scar in comparisonwith the rate in spontaneously laboring women. Althoughthe rate of uterine rupture was not statisticallyincreased during oxytocin augmentation, use of oxytocinin such cases should proceed with caution.
Zelop CM, Shipp TD, Repke JT, Cohen A, Caughey AB,
Lieberman E. Uterine rupture during induced or
augmented labor in gravid women with one prior cesarean
delivery.
Am J Obstet Gynecol. 1999 Oct;181(4):882-6.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10521747&dopt=Abstract [299] The purpose of this study is to identify pregnancy and labor factors that place women at increased risk for symptomatic uterine rupture during trial of labor following cesarean section. The study population consisted of 16 women with uterine rupture after a trial of labor who were compared with 32 women without uterine rupture after a trial of labor.
Using a case-control study design with a 1:2 match, we examined risk factors that might be associated with an increased risk of uterine rupture. Cases were more likely to have an induction of labor with the use of oxytocin and/or amniotomy (56 vs. 34%) and more likely Alliance Francophone pour l’Accouchement Respecté <http://afar.info> Compilation « Déclenchement de l’accouchement » ………… 6 to undergo augmentation with oxytocin (25 vs. 19%) incomparison with controls. In addition, cases were morelikely to be given oxytocin (for either induction oraugmentation) (75 vs. 50%) and cervical ripening agents(31 vs. 9%) versus controls.
Neonates born after uterine rupture had a higher rate ofsignificant acidosis (pH < 7.0, 57 vs. 0%, p = 0.0002)and lower Apgar scores. There was a significantly higherrisk of maternal infection (36 vs. 3%, p = 0.003),transfusion (13 vs. 0%, p = 0.03), and longer length ofstay in patients with uterine rupture.
There is a trend for increased use of augmentation andinduction agents to be associated with uterine rupture.
Serious maternal and fetal morbidities are increasedfollowing uterine rupture.
Miles AL, Monga M, Waller DK, Dande D, Pschirrer ER.
Risk factors for symptomatic uterine rupture during a
trial of labor: the 1990s.
Am J Perinatol. 2000;17(7):385-9.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12141526&dopt=Abstract [314] BACKGROUND: To examine the effect of implementation of guidelines for induction of labor on the process of care and outcome measures.
METHOD: Guidelines for induction of labor were implemented in January 1996 following an audit report identifying inconsistency in clinical practice. Aprospective audit was carried out following theimplementation of a new strategy directed towards pre-induction cervical ripening in nulliparae withunfavorable cervices and the use of low dosages ofvaginal prostaglandin E2 for induction of labor. Levelof compliance and outcome measures were compared beforeand after implementation of guidelines.
RESULTS: In the period of January 1995 to November 1997,1,230 women were induced with a singleton viablepregnancy in a cephalic presentation with a gestationalage > or = 37 weeks with no history of rupture ofmembranes or cesarean section. Completed forms wereavailable for 1,147 women (370, 421 and 356 in 1995,1996 and 1997, respectively). Among nulliparous women,there was a reduction in the number of women who wereadmitted with cervical score of < or = 4 (24%, 40%, and54% in 1997, 1996, and 1995, respectively; p=0.0001), anincrease in the number of women who had amniotomy onadmission (32%, 25% and 12% in 1997, 1996, and 1995,respectively; p=0.0001) and a shorter induction-deliveryinterval. No change in outcome measures was noted amongmultiparous women despite reduced dose of prostaglandinE2 used for induction of labor. A marginal reduction ofboth Cesarean section and failed induction rates were Alliance Francophone pour l’Accouchement Respecté <http://afar.info> Compilation « Déclenchement de l’accouchement » ………… 7 noted in both nulliparae and multiparae. Level ofcompliance improved with successive rounds of audit.
CONCLUSION: Explicit guidelines do improve clinicalpractice, when introduced and monitored in the contextof rigorous evaluations. However, the size ofimprovement could vary.
Mousa HA, Mahmood TA. Do practice guidelines guide
practice? A prospective audit of induction of labor
three years experience.
Acta Obstet Gynecol Scand. 2000 Dec;79(12):1086-92.
http://www.blackwell-synergy.com/openurl?genre=article&sid=nlm:pubmed&issn=0001-6349&date=2000&volume=79&issue=12&spage=1086 [403] OBJECTIVE: To evaluate the effect of early amniotomy in term gestation on the mode of delivery and pregnancy outcome in comparison with premature rupture of membranes (PROM) and oxytocin induction.
STUDY DESIGN: The study population consisted of 60 consecutive parturients induced by early amniotomy. Thetwo comparison groups were 147 women admitted with termPROM and 65 patients induced by oxytocin. All studyparticipants were evaluated prospectively and hadunfavorable cervical scores.
RESULTS: The duration of the first stage of labor wassignificantly longer in the PROM group (987.8 +/- 572.3min) as compared with the early amniotomy group (615.0+/- 389.6 min) and the oxytocin induction group (650.9+/- 349.5 min, P<0.001). Higher rates of CS were foundin the study group (26.7%) as compared to the controls(11.6% in the PROM and 16.9% in the oxytocin groups,p=0.012). Neonatal outcome was similar in all groups. Astratified analysis comparing the risk of CS whilecontrolling for a previous one did not show asignificant difference between the early amniotomy andthe oxytocin administration groups.
CONCLUSIONS: Early amniotomy is associated with a higherrate of CS. While controlling for a previous CS, bothways of induction were comparable. In order to decreasethe CS rates, induction should probably start withcervical ripening techniques in order to improve theBishop scores.
Sheiner E, Segal D, Shoham-Vardi I, Ben-Tov J, Katz M,
Mazor M. The impact of early amniotomy on mode of
delivery and pregnancy outcome.
Arch Gynecol Obstet. 2000 Sep; 264(2): 63-7.
http://www.springerlink.com/app/home/contribution.asp?wasp=99a0hcrxtp4kqmm3ng86&referrer=parent&backto=issue,2,15;journal,22,50;linkingpublicationresults,id:100399,1 [404] BACKGROUND: Amniotomy (deliberate rupture of the Alliance Francophone pour l’Accouchement Respecté <http://afar.info> Compilation « Déclenchement de l’accouchement » ………… 8 membranes) is a simple procedure which can be used alone for induction of labour if the membranes are accessible, thus avoiding the need for pharmacological intervention.
However, the time interval from amniotomy to established labour may not be acceptable to clinicians and women, and in a number of cases labour may not ensue. This is one of a series of reviews of methods of cervicalripening and labour induction using standardisedmethodology.
OBJECTIVES: To determine the effects of amniotomy alonefor third trimester labour induction in women with alive fetus.
SEARCH STRATEGY: The Cochrane Pregnancy and ChildbirthGroup trials register, the Cochrane Controlled trialsregister and bibliographies of relevant papers.
SELECTION CRITERIA: The criteria for inclusion includedthe following: (1) clinical trials comparing amniotomyalone for third trimester cervical ripening or labourinduction with placebo/no treatment or other methodslisted above it on a predefined list of labour inductionmethods; (2) random or pseudo-random allocation to thetreatment or control group; (3) ideally adequateallocation concealment (4) violations of allocatedmanagement not sufficient to materially affectconclusions; (5) clinically meaningful outcome measuresreported; (6) data available for analysis according tothe random allocation; (7) missing data insufficient tomaterially affect the conclusions.
DATA COLLECTION AND ANALYSIS: This is one of a series ofreviews of methods of cervical ripening and labourinduction using standardised methodology. A strategy wasdeveloped to deal with the large volume and complexityof trial data relating to labour induction. Thisinvolved a two-stage method of data extraction. Theinitial data extraction was done centrally, andincorporated into the series of primary reviews arrangedby methods of induction of labour. The data from theprimary reviews will be incorporated into a series ofsecondary reviews, arranged by category of woman toreflect clinical scenarios. To avoid duplication of datain the primary reviews, the labour induction methodshave been listed in a specific order, from one to 25.
Each primary review includes comparisons between one ofthe methods (from two to 25) with only those methodsabove it on the list. This review includes comparisonsbetween amniotomy alone (number 5 on the list) with onlythose methods above it on the list (no treatment /placebo; intravaginal prostaglandins; intracervicalprostaglandins; and oxytocin alone).
MAIN RESULTS: Two trials comprising 50 and 260 womenrespectively were eligible for inclusion in this review.
No conclusions could be drawn from comparisons ofamniotomy alone versus no intervention, and amniotomy Alliance Francophone pour l’Accouchement Respecté <http://afar.info> Compilation « Déclenchement de l’accouchement » ………… 9 alone versus oxytocin alone (small trial, only one pre-specified outcome reported). No trials comparedamniotomy alone with intracervical prostaglandins. Onetrial compared amniotomy alone with a single dose ofvaginal prostaglandins for women with a favourablecervix, and found a significant increase in the need foroxytocin augmentation in the amniotomy alone group (44%versus 15%; RR 2.85, 95% CI 1.82-4.46). This should beviewed with caution as this was the result of a singlecentre trial. Furthermore, secondary interventionoccurred 4 hours after amniotomy, and this time intervalmay not have been appropriate.
REVIEWER’S CONCLUSIONS: Data is lacking about the valueof amniotomy alone for induction of labour. While thereare now other modern methods available for induction oflabour (pharmacological agents), there remain clinicalscenarios where amniotomy alone may be desirable andappropriate, and this method is worthy of furtherresearch. This research should include evaluation of theappropriate time interval from amniotomy to secondaryintervention, women and caregivers’ satisfaction andeconomic analysis.
Bricker L, Luckas M. Amniotomy alone for induction of
labour.
Cochrane Database Syst Rev. 2000; (4): CD002862.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11034776&dopt=Abstract [405] OBJECTIVE: To estimate the adverse effects of glyceryl trinitrate compared with prostaglandin (PG) E2 vaginal tablet for cervical ripening in term pregnancy.
METHODS: One hundred ten women with term pregnancies referred for induction of labor with Bishop scores of 6 or less were randomly assigned to receive a 500-microg glyceryl trinitrate tablet vaginally (n = 54) or a 3-mgPGE2 tablet vaginally (n = 56), every 6 hours formaximum of two doses. Subjects were sent to the laborward for amniotomy or oxytocin if their Bishop scoreswere more than 6 or their cervices were not ripe 24hours after treatment. Adverse effects, changes in theBishop scores, progress, and outcomes of labor wereassessed.
RESULTS: Glyceryl trinitrate was associated with fewerepisodes of uterine tachysystole (0% versus 9%; P =.02).
The median Bishop score after 12 hours was lower inwomen given glyceryl trinitrate compared with thosegiven PGE2. Adverse effects, including headache andpalpitations, were more frequent with glyceryltrinitrate than with PGE2. The cesarean rate was notsignificantly different between groups.
CONCLUSION: Cervical ripening with glyceryl trinitrateresulted in fewer episodes of tachysystole, but therewere significantly more minor side effects. It can be Alliance Francophone pour l’Accouchement Respecté <http://afar.info> Compilation « Déclenchement de l’accouchement » ………… 10 used for cervical ripening at term, but it was not aseffective as PGE2.
Chanrachakul B, Herabutya Y, Punyavachira P. Randomized
comparison of glyceryl trinitrate and prostaglandin E2
for cervical ripening at term.
Obstet Gynecol. 2000 Oct; 96(4): 549-53.
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6TB2-417N83M-F&_coverDate=10%2F31%2F2000&_alid=141982247&_rdoc=1&_fmt=&_orig=search&_qd=1&_cdi=5130&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=b5243821aa66f3e73b98b1384fc745ae [411] OBJECTIVE: To compare the outcome of induction of labor and patient’s preferences using a protocol with the first dose of prostaglandin E2 endocervical gel in the evening versus a protocol with the first dose in the DESIGN: We performed a randomized trial comparing administration of prostaglandin E2 endocervical gel in the morning with administration of prostaglandin E2 gelin the evening, followed if necessary by a second dosebeing given after six hours if labor had not started orthe cervix was still unripe. Formal induction of laborby amniotomy and oxytocin infusion was performed themorning after the initial prostaglandin E2 dose.
Patients’ preferences were assessed using aquestionnaire that was completed after delivery.
SETTING: Tertiary care hospital in the Netherlands with1,600 deliveries per year.
PARTICIPANTS: One-hundred and twenty-six women withviable singleton pregnancies at term who had inductionof labor with prostaglandins.
MAIN OUTCOME MEASURES: Time of delivery (daytime,evening or night) and patient’s satisfaction.
RESULTS: Fifty-eight women were allocated foradministration of gel in the morning, whereas 68 hadtheir gel in the evening. Administration of gel in theevening did not significantly reduce delivery between23.00 hours and 08.00 hours, although there was areduction in delivery between 23.00 hours and 08.00hours in nulliparae. None of the multiparous womendelivered between 18.00 hours and 23.00 hours afterinduction of labor in the evening. The relative risk fordelivery by vacuum or forceps was increased afterallocation of gel in the evening (4.2; 95% confidencelimits 1.4 to 13). Patients’ preferences favoredadministration of gel in the morning.
CONCLUSIONS: There was no benefit in starting inductionof labor with prostaglandin E2 in the evening, comparedwith starting in the morning.
Alliance Francophone pour l’Accouchement Respecté <http://afar.info> Compilation « Déclenchement de l’accouchement » ………… 11 Oei SG, Jongmans L, Mol BW. Randomized trial of
administration of prostaglandin E2 gel for induction of
labor in the morning or the evening.
J Perinat Med. 2000; 28(1): 20-5.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10765510&dopt=Abstract [878] Il y a dix-neuf études randomisées ou quasiment randomisées qui ont comparé une politique de déclenchement de l’accouchement avec une attitude expectative sous surveillance fœtale serrée (17).
Dans le groupe des patientes suivies de manière expectative, 20 à 36 % des femmes ont eu une induction de l’accouchement ou une césarienne avant le début du travail (31). Cela implique qu’une attitude expectative ne signifie pas forcément que le travail pourra commencer spontanément. Il n’y a aucune évidence qu’une politique de déclenchement systématique augmente la probabilité d’accouchement par césarienne (17). Dans certaines études (26), les patientes subissant un déclenchement artificiel du travail à 41 semaines ou plus, avaient un taux significativement plus bas de césarienne par rapport aux patientes avec prise en charge expectative (26, 32). Cette réduction du taux de césarienne a été observée aussi bien pour les nullipares Le fait d’induire le travail à 41 semaines ou pluspermet d’obtenir une réduction du nombre de CTG suspectsselon plusieurs auteurs. On note également un plusfaible taux de liquide amniotique méconial et demacrosomie (17).
L’induction du travail à 41 semaines ou plus permet uneréduction de la mortalité fœtale ou néonatale (àl’exclusion des malformations congénitales létales oumajeures) (17), par rapport à l’attitude expectative(risque relatif 0.23; intervalle de confiance à 95%:0.06 à 0.90). Cette réduction est en grande partie due àune diminution du risque de mort in utero et la plupartdes décès observés dans ces études sont associés à desasphyxies ou à des aspirations méconiales.
Enfin, l’adoption d’une politique de déclenchement à 41semaines ou plus permet une diminution du coût des soinspar rapport à une attitude expectative (33).
En résumé, le dépassement de terme entraîne un risqueplus élevé de complications maternelles fœtales etnéonatales que les grossesses se terminant spontanémentà terme. Lorsque des morts périnatales surviennent,elles sont fréquemment associées à des phénomènesd’asphyxie ou à des aspirations de liquide amniotiqueméconial. Il y a de nombreuses méthodes disponibles poureffectuer une surveillance fœtale dans les grossesses àterme, mais leur efficacité est encore incertaine. Les Alliance Francophone pour l’Accouchement Respecté <http://afar.info> Compilation « Déclenchement de l’accouchement » ………… 12 études randomisées comparant l’induction systématique dutravail à 41 semaines de gestation avec une attitudeexpectative associée à une surveillance fœtale montrentque l’induction à 41 semaines diminue les anomalies duCTG, les liquides amniotiques méconiaux, les macrosomiesfœtales et le risque de décès durant la périodepérinatale.
L’évidence à disposition suggère qu’une politique dedéclenchement systématique des grossesses à 41 - 42semaines n’a pas d’influence sur le risqued’accouchement par césarienne par rapport à une attitudeexpectative. Les patientes atteignant 41 semaines degestation devraient être orientées de manière adéquate.
Elles devraient être informées des risques et desbénéfices des différentes attitudes. Les résultats de lalittérature suggèrent qu’un déclenchement devrait êtrediscuté avec la patiente. On peut estimer que 500déclenchements artificiels sont nécessaires pour éviterune mort périnatale (17).
Commission Qualité de la Société Suisse de Gynécologieet Obstétrique. Recommandations pour la pratiqueclinique : Surveillance et prise en chargeen cas de dépassement de terme.
http://www.sggg.ch/F/guidelines/pdf/ueberwachung_f.pdf [885] De nombreux auteurs ont évalué le misoprostol comme moyen de déclenchement du travail. Ce produit semble avoir une efficacité au moins équivalente aux PGE2 ou à l’ocytocine. Le risque d’effets secondaires (hypercinésie, contracture utérine, hyperstimulation accompagnée d’anomalies du tracé foetal, liquide amniotique méconial) semble plus important, surtout lorsque des doses élevées sont utilisées. À faible dose, les effets secondaires maternels et néo-nataux semblentcomparables à ceux des PGE2 ou de l’ocytocine. La voieet la dose optimale restent à déterminer. Les comprimésde misoprostol coûtent moins cher que lesprostaglandines E2. Toutefois, l’analyse du rapportcoût/efficacité n’a pas été réalisée. Ce produit eststable à la température ambiante, ce qui facilite lestockage. Le misoprostol est contre-indiqué chez lesfemmes avec césarienne antérieure, étant donné le risquede rupture utérine.
M. Boulvain, C.-M. Stan. Misoprostol pour le
déclenchement du travail. Mises à jour en gynécologie
obstétrique, tome XXIV, volume Gynécologie obstétrique,
p. 47. CNGOF
http://www.cngof.asso.fr/D_PAGES/PUMA_2000.HTM#47 [303] BACKGROUND: Studies in sheep showed that there is a pre-labour rise in oestrogen and a decrease in progesterone, both of these changes stimulate prostaglandin production and may help initiate labour.
Though oestrogen has been suggested as an effective cervical ripening or induction agent, research in humans Alliance Francophone pour l’Accouchement Respecté <http://afar.info> Compilation « Déclenchement de l’accouchement » ………… 13 have failed to demonstrate a similar physiological mechanism. The use of oestrogen as an induction agent is not currently common practice, as such this systematicreview should be regarded as an historical review. Thisis one of a series of reviews of methods of cervicalripening and labour induction using a standardisedmethodology.
OBJECTIVES: To determine, from the best availableevidence, the effectiveness and safety of oestrogensalone or with amniotomy for third trimester cervicalripening and induction of labour in comparison withother methods of induction of labour.
SEARCH STRATEGY: The Cochrane Pregnancy and ChildbirthGroup trials register, the Cochrane Controlled TrialsRegister and bibliographies of relevant papers. Lastsearched: April 2001.
SELECTION CRITERIA: (1) randomised controlled trialscomparing oestrogens alone used for third trimestercervical ripening or labour induction with placebo/notreatment or other methods listed above it on apredefined list of labour induction methods; (2) randomallocation to the treatment or control group; (3)adequate allocation concealment; (4) violations ofallocated management not sufficient to materially affectconclusions; (5) clinically meaningful outcome measuresreported; (6) data available for analysis according tothe random allocation; (7) missing data insufficient tomaterially affect the conclusions.
DATA COLLECTION AND ANALYSIS: A generic strategy hasbeen developed to deal with the large volume andcomplexity of trial data relating to labour induction.
This involved a two-stage method of data extraction. Theinitial data extraction was done centrally.
MAIN RESULTS: When comparing oestrogen with placebothere was no difference between the rate of caesareansection (7.1% versus 10.3%, relative risk (RR) 0.70, 95%confidence interval (CI) 0.30,1.62). There were nodifferences between rates of uterine hyperstimulationwith or without fetal heart rate changes or instrumentalvaginal delivery. None of the studies reported the ratesof either vaginal delivery not achieved in 24 hours, orcervix unfavourable/unchanged after 12-24 hours. Therewere insufficient data to make any meaningfulconclusions when comparing oestrogen with vaginal PGE2,intracervical PGE2, oxytocin alone or extra amnioticPGF2a, as to whether oestrogen is effective in inducinglabour.
REVIEWER’S CONCLUSIONS: There were insufficient data todraw any conclusions regarding the efficacy of oestrogenas an induction agent.
Thomas J, Kelly AJ, Kavanagh J. Oestrogens alone or
Alliance Francophone pour l’Accouchement Respecté <http://afar.info> Compilation « Déclenchement de l’accouchement » ………… 14 with amniotomy for cervical ripening or induction of
labour.
Cochrane Database Syst Rev. 2001;(4):CD003393.
http://www.cochrane.org/cochrane/revabstr/AB003393.htm [304] BACKGROUND: Induction of labour is a common obstetric intervention. Amniotomy alone for induction of labour is reviewed separately and oxytocin alone for induction of labour is being prepared for inclusion in The Cochrane Library. This review will address the use of the combination of these two methods for induction oflabour in the third trimester. This is one of a seriesof reviews of methods of cervical ripening and labourinduction using standardised methodology.
OBJECTIVES: To determine, from the best availableevidence, the efficacy and safety of amniotomy andintravenous oxytocin for third trimester induction oflabour.
SEARCH STRATEGY: The Cochrane Pregnancy and ChildbirthGroup Trials Register, the Cochrane Controlled TrialsRegister and reference lists of articles were searched.
Date of last search: May 2001.
SELECTION CRITERIA: The criteria for inclusion includedthe following: (1) clinical trials comparing amniotomyplus intravenous oxytocin used for third trimestercervical ripening or labour induction with placebo/notreatment or other methods listed above it on apredefined list of labour induction methods; (2) randomallocation to the treatment or control group; (3)adequate allocation concealment; (4) violations ofallocated management not sufficient to materially affectconclusions; (5) clinically meaningful outcome measuresreported; (6) data available for analysis according tothe random allocation; (7) missing data insufficient tomaterially affect the conclusions.
DATA COLLECTION AND ANALYSIS: Trial quality assessmentand data extraction were done by both reviewers. Astrategy was developed to deal with the large volume andcomplexity of trial data relating to labour induction.
This involved a two-stage method of data extraction. Theinitial data extraction was done centrally, andincorporated into a series of primary reviews arrangedby methods of induction of labour, following astandardised methodology. The data is to be extractedfrom the primary reviews into a series of secondaryreviews, arranged by category of woman.
MAIN RESULTS: Seventeen trials involving 2566 women wereincluded. Amniotomy and intravenous oxytocin were foundto result in fewer women being undelivered vaginally at24 hours than amniotomy alone (relative risk (RR) 0.03,95% confidence intervals (CI) 0.001-0.49). This findingwas based on the results of a single study of 100 women.
As regards secondary results amniotomy and intravenous Alliance Francophone pour l’Accouchement Respecté <http://afar.info> Compilation « Déclenchement de l’accouchement » ………… 15 oxytocin resulted in significantly fewer instrumentalvaginal deliveries than placebo (RR 0.18, CI 0.05-0.58).
Amniotomy and intravenous oxytocin resulted in morepostpartum haemorrhage than vaginal prostaglandins (RR5.5, CI 1.26-24.07). Significantly more women were alsodissatisfied with amniotomy and intravenous oxytocinwhen compared with vaginal prostaglandins, RR 53, CI3.32-846.51.
REVIEWER’S CONCLUSIONS: Data on the effectiveness andsafety of amniotomy and intravenous oxytocin arelacking. No recommendations for clinical practice can bemade on the basis of this review. Amniotomy andintravenous oxytocin is a combination of two methods ofinduction of labour and both methods are utilised inclinical practice. If their use is to be continued it isimportant to compare the effectiveness and safety ofthese methods, and to define under which clinicalcircumstances one may be preferable to another.
Howarth GR, Botha DJ. Amniotomy plus intravenous
oxytocin for induction of labour.
Cochrane Database Syst Rev. 2001;(3):CD003250.
http://www.cochrane.org/cochrane/revabstr/AB003250.htm Remarques :Je suis pas sure que c’est tout public, mais je metssystematiquement lesCochrane Review en Tout public .
[305] BACKGROUND: Oxytocin is the commonest induction agent used worldwide. It has been used alone, in combination with amniotomy or following cervical ripening with other pharmacological or non- pharmacological methods. Prior to the introduction of prostaglandin agents oxytocin was used as a cervical ripening agent as well. In developed countries oxytocin alone is more commonly used in the presence of rupturedmembranes whether spontaneous or artificial. Indeveloping countries where the incidence of HIV is high,delaying amniotomy in labour reduces verticaltransmission rates and hence the use of oxytocin withintact membranes warrants further investigation. Thisreview will address the use of oxytocin alone forinduction of labour. Amniotomy alone or oxytocin withamniotomy for induction of labour has been reviewedelsewhere in the Cochrane Library. Trials which considerconcomitant administration of oxytocin and amniotomywill not be considered. This is one of a series ofreviews of methods of cervical ripening and labourinduction using a standardised methodology.
OBJECTIVES: To determine the effects of oxytocin alonefor third trimester cervical ripening or induction oflabour in comparison with other methods of induction oflabour or placebo/no treatment.
SEARCH STRATEGY: The Cochrane Pregnancy and Childbirth Alliance Francophone pour l’Accouchement Respecté <http://afar.info> Compilation « Déclenchement de l’accouchement » ………… 16 Group Trials Register, the Cochrane Controlled TrialsRegister and bibliographies of relevant papers. Lastsearched: May 2001.
SELECTION CRITERIA: The criteria for inclusion includedthe following: (1) clinical trials comparing vaginalprostaglandins used for third trimester cervicalripening or labour induction with placebo/no treatmentor other methods listed above it on a predefined list oflabour induction methods; (2) random allocation to thetreatment or control group; (3) adequate allocationconcealment; (4) violations of allocated management notsufficient to materially affect conclusions; (5)clinically meaningful outcome measures reported; (6)data available for analysis according to the randomallocation; (7) missing data insufficient to materiallyaffect the conclusions.
DATA COLLECTION AND ANALYSIS: A strategy was developedto deal with the large volume and complexity of trialdata relating to labour induction. This involved a two-stage method of data extraction. The initial dataextraction was done centrally, and incorporated into aseries of primary reviews arranged by methods ofinduction of labour, following a standardisedmethodology. The data is to be extracted from theprimary reviews into a series of secondary reviews,arranged by category of woman.
MAIN RESULTS: In total, 110 trials were considered; 52have been excluded and 58 included examining a total of11,129 women. Comparing oxytocin alone with expectantmanagement: Oxytocin alone reduced the rate ofunsuccessful vaginal delivery within 24 hours whencompared with expectant management (8.3% versus 54%,relative risk (RR) 0.16, 95% confidence interval (CI)0.10,0.25) but the caesarean section rate was increased(10.4% versus 8.9%, RR 1.17, 95% CI 1.01,1.36). Thisincrease in caesarean section rate was not apparent inthe subgroup analyses. Women were less likely to beunsatisfied with induction rather than expectantmanagement, in the one trial reporting this outcome(5.5% versus 13.7%, RR 0.43, 95% CI 0.33, 0.56).
Comparing oxytocin alone with vaginal prostaglandins:Oxytocin alone was associated with an increase inunsuccessful vaginal delivery within 24 hours (52%versus 28%, RR 1.85, 95% CI 1.41, 2.43), irrespective ofmembrane status, but there was no difference incaesarean section rates (11.4% versus 10%, RR 1.12, 95%CI 0.95, 1.33). Comparing oxytocin alone withintracervical prostaglandins: Oxytocin alone wasassociated with an increase in unsuccessful vaginaldelivery within 24 hours when compared withintracervical PGE2 (51% versus 35%, RR 1.49, 95% CI1.12,1.99). For all women with an unfavourable cervixregardless of membrane status, the caesarean sectionrates were increased (19.0% versus 13.1%, RR 1.42, 95%CI 1.11, 1.82).
Alliance Francophone pour l’Accouchement Respecté <http://afar.info> Compilation « Déclenchement de l’accouchement » ………… 17 REVIEWER’S CONCLUSIONS: Overall, comparison of oxytocinalone with either intravaginal or intracervical PGE2reveals that the prostaglandin agents probably overallhave more benefits than oxytocin alone. The amount ofinformation relating to specific clinical subgroups islimited, especially with respect to women with intactmembranes. Comparison of oxytocin alone to vaginal PGE2in women with ruptured membranes reveals that bothinterventions are probably equally efficacious with eachhaving some advantages and disadvantages over theothers. With respect to current practice in women withruptured membranes induction can be recommended byeither method and in women with intact membranes thereis insufficient information to make firmrecommendations.
Kelly AJ, Tan B. Intravenous oxytocin alone for
cervical ripening and induction of labour.
Cochrane Database Syst Rev. 2001;(3):CD003246.
http://www.cochrane.org/cochrane/revabstr/AB003246.htm [306] BACKGROUND: Amniotomy and oxytocin infusion are the routine methods most frequently applied to induce labor. These methods are not effective when the cervix is unripe. Prostaglandins may accelerate the process of cervical ripening independently of the stimulation of uterine contractions, since they induce the formation of a gap junction (spread of excitation) and releaseuterine contractions. The purpose of this study is acomparative analysis of the effectiveness and safety ofmisoprostol and PGE2 in the process of cervical ripeningand inducing labor in patients at full term deliverywith a live fetus and indications for inducing labor dueto an unripe uterine cervix.
MATERIAL AND METHODS: The experimental group consistedof 30 patients at 38-41 weeks of gestation who receivedmisoprostol administered into the posterior vaginalfornix (group M). The control group included 26 patientsat 39-42 weeks of gestation in whom labor was inducedusing natural prostaglandin E(2) (group P).
RESULTS: There were no statistically significantdifferences in maternal age, body weight and height, oruterine cervical ripening between the two groups ofpatients. The average time of gestation was 0.92 weeksshorter in group M. The time from administration of thedrug to the onset of regular contraction activity of theuterus and delivery of an infant was shorter in thegroup of patients receiving misoprostol intravaginally.
CONCLUSIONS: Our results would seem to indicate thatmisoprostol is an effective drug that can be used forelective preinduction and induction of labor. However,the application of this drug to induce labor with a livefetus requires special caution and care, as well ascontinuous cardiotocographic monitoring to assure the Alliance Francophone pour l’Accouchement Respecté <http://afar.info> Compilation « Déclenchement de l’accouchement » ………… 18 safety of both the mother and the infant.
Leszczynska-Gorzelak B, Laskowska M, Oleszczuk J.
Comparative analysis of the effectiveness of misoprostol
and prostaglandin E(2) in the preinduction and induction
of labor.
Medical Science Monitor. 2001 Sep-Oct;7(5):1023-8.
http://www.medscimonit.com/medscimonit/modules.php?name=GetPDF&pg=2&idm=1731 [308] BACKGROUND: This is one of a series of reviews of methods of cervical ripening and labour induction using OBJECTIVES: To determine the effects of oralprostaglandin E2 for third trimester induction oflabour.
SEARCH STRATEGY: The Cochrane Pregnancy and ChildbirthGroup trials register, the Cochrane Controlled TrialsRegister and bibliographies of relevant papers. Date oflast search: December 2000.
SELECTION CRITERIA: The criteria for inclusion includedthe following: (1) clinical trials comparing oralprostaglandin E2 used for third trimester cervicalripening or labour induction with placebo/no treatmentor other methods listed above it on a predefined list oflabour induction methods; (2) random allocation to thetreatment or control group; (3) adequate allocationconcealment; (4) violations of allocated management notsufficient to materially affect conclusions; (5)clinically meaningful outcome measures reported; (6)data available for analysis according to the randomallocation; (7) missing data insufficient to materiallyaffect the conclusions.
DATA COLLECTION AND ANALYSIS: A strategy has beendeveloped to deal with the large volume and complexityof trial data relating to labour induction. Thisinvolves a two-stage method of data extraction. Theinitial data extraction is done centrally, andincorporated into a series of primary reviews arrangedby methods of induction of labour, following astandardised methodology. The data will then beextracted from the primary reviews into a series ofsecondary reviews, arranged by category of woman. Toavoid duplication of data in the primary reviews, thelabour induction methods have been listed in a specificorder, from one to 25. Each primary review includescomparisons between one of the methods (from two to 25)with only those methods above it on the list.
MAIN RESULTS: There were 19 studies included in thereview. Of these 15 included a comparison using eitheroral or intravenous oxytocin with or without amniotomy.
The quality of studies reviewed was not high. Only seven Alliance Francophone pour l’Accouchement Respecté <http://afar.info> Compilation « Déclenchement de l’accouchement » ………… 19 studies had clearly described allocation concealment.
Only two studies stated that providers and/orparticipants were blinded to treatment group. For theoutcome of vaginal delivery not achieved within 24hours, in the composite comparison of oral PGE2 versusall oxytocin treatments (oral and intravenous, with andwithout amniotomy), there was a trend favoring oxytocintreatments (relative risk (RR) 1.97, 95% confidenceinterval (CI) 0.86 to 4.48). For the outcome of cesareansection, in the comparison of PGE2 versus no treatmentor placebo, PGE2 was favored (relative risk (RR) 0.54,95% confidence interval (CI) 0.29,0.98). Otherwise,there were no significant differences between groups forthis outcome. Oral prostaglandin was associated withvomiting across all comparison groups.
REVIEWER’S CONCLUSIONS: Oral prostaglandin consistentlyresulted in more frequent gastrointestinal side effects,in particular vomiting, compared with the othertreatments included in this review. There were no clearadvantages to oral prostaglandin over other methods ofinduction of labour.
French L. Oral prostaglandin E2 for induction of
labour.
Cochrane Database Syst Rev. 2001;(2):CD003098.
http://www.cochrane.org/cochrane/revabstr/AB003098.htm [309] BACKGROUND: Prostaglandins are hormones naturally present in the uterus that cause contractions during labour. A synthetic prostaglandin analogue misoprostol is produced in tablets that can be given orally orvaginally, but it is not yet licensed for use inpregnancy. Unlicensed use of misoprostol in pregnancy isincreasingly common, because misoprostol is cheap,stable at room temperature and effective in causinguterine contractions. Oral use of the drug misoprostolmay be convenient, but high doses could cause uterinehyperstimulation and uterine rupture which may be life-threatening for both mother and fetus.
OBJECTIVES: The objective of this review was to assessthe effects of oral misoprostol used for labourinduction in women with a viable fetus in the thirdtrimester of pregnancy.
SEARCH STRATEGY: The Cochrane Pregnancy and ChildbirthGroup trials register and the Cochrane Controlled TrialsRegister were searched in December 2000.
SELECTION CRITERIA: Randomised trials of oralmisoprostol versus other methods, placebo or notreatment, given to women with a viable fetus for labourinduction.
DATA COLLECTION AND ANALYSIS: This is one of a series ofthe Cochrane reviews of methods of cervical ripening andlabour induction using standardised methodology. This Alliance Francophone pour l’Accouchement Respecté <http://afar.info> Compilation « Déclenchement de l’accouchement » ………… 20 review includes comparisons between oral misoprostolwith placebo, vaginal prostaglandins, intracervicalprostaglandins, oxytocin, amniotomy, oxytocin andamniotomy or vaginal misoprostol. Data from all relevanttrials are extracted by the reviewer using centrallydesigned data sheets.
MAIN RESULTS: One trial with 80 randomised women withprelabour rupture of membranes at term showed that,compared with placebo, oral misoprostol reduces the needfor oxytocin infusion from 51 percent to 13 percent(relative risk 0.25, 95% confidence interval (CI) 0.1 to0.6) and shortens delivery time by 8.7 hours (95% CI 6.0to 11.3). Compared with vaginal or intracervicalprostaglandins, oral misoprostol showed no beneficial orharmful effects. However, only two trials with 962randomised women in total compared oral misoprostol withvaginal dinoprostone and one trial with 200 womencompared oral misoprostol with intracervicaldinoprostone. Two small trials with 188 women in totalcompared oral misoprostol and oxytocin in women withterm ruptured membranes and found no significantdifferences in prespecified outcomes. In seven trialswith 1278 randomised women that compared oral withvaginal misoprostol, oral misoprostol appeared to beless effective. More women in the oral misoprostol groupdid not achieve vaginal delivery within 24 hours ofrandomisation (50%) compared with 39.7% in the vaginalmisoprostol group (relative risk 1.27, 95% confidenceintervals 1.09 to 1.47). The caesarean section rate waslower in the oral misoprostol group (16.7%) comparedwith 21.7% in the vaginal misoprostol group (relativerisk 0.77, 95% confidence intervals 0.61 to 0.97). Therewas no difference in uterine hyperstimulation with fetalheart rate changes (8.5% versus 7.4%; relative risk1.11, 95% confidence intervals 0.78 to 1.59). There wereno reported cases of severe neonatal and maternalmorbidity.
REVIEWER’S CONCLUSIONS: Oral misoprostol is an effectivemethod for labour induction in the third trimester.
However, the data on optimal regimens and safety arelacking. It is possible that effective oral regimens mayhave an unacceptably high incidence of complicationssuch as uterine hyperstimulation and possibly uterinerupture.
Alfirevic Z. Oral misoprostol for induction of labour.
Cochrane Database Syst Rev. 2001;(2):CD001338.
http://www.cochrane.org/cochrane/revabstr/AB001338.htm [310] BACKGROUND: This is one of a series of reviews of methods of cervical ripening and labour induction using standardised methodology. Sweeping of the membranes, also commonly named stripping of the membranes, is a relatively simple technique usually performed without admission to hospital. During vaginal examination, the clinician’s finger is introduced into the cervical os.
Alliance Francophone pour l’Accouchement Respecté <http://afar.info> Compilation « Déclenchement de l’accouchement » ………… 21 Then, the inferior pole of the membranes is detached from the lower uterine segment by a circular movement of the examining finger. This intervention has the potential to initiate labour by increasing localproduction of prostaglandins and, thus, reduce pregnancyduration or pre-empt formal induction of labour witheither oxytocin, prostaglandins or amniotomy.
OBJECTIVES: To determine the effects of membranesweeping for third trimester induction of labour.
SEARCH STRATEGY: The Cochrane Pregnancy and ChildbirthGroup trials register, the Cochrane Controlled TrialsRegister and bibliographies of relevant papers (lastsearched November 2000).
SELECTION CRITERIA: The criteria for inclusion includedthe following: (1) clinical trials comparing membranesweeping used for third trimester labour induction withno vaginal examination or vaginal examination forcervical assessment only or with other methods listedabove it on a predefined list of labour inductionmethods (i.e. administration of prostaglandins andoxytocin); (2) random allocation to the treatment orcontrol group; (3) adequate or unclear allocationconcealment; (4) violations of allocated management notsufficient to materially affect conclusions; (5)clinically meaningful outcome measures reported; (6)data available for analysis according to the randomallocation; (7) missing data insufficient to materiallyaffect the conclusions.
DATA COLLECTION AND ANALYSIS: The data extraction wasdone centrally and incorporated into a series of reviewsarranged by methods of induction of labour, following astandardised methodology. Two of the reviewers alsoassessed trial quality and extracted data. To avoidduplication of data in the reviews, the labour inductionmethods have been listed in a specific order, from oneto 25. Each review includes comparisons between one ofthe methods with only those methods above it on thelist. Therefore, sweeping of membranes was compared tono treatment, intravaginal prostaglandins and oxytocin.
Results are reported as relative risk (RR) and their 95%confidence interval (CI) and number-needed-to-treat(NNT).
MAIN RESULTS: Nineteen trials were included, 17comparing sweeping of membranes with no treatment, threecomparing sweeping with prostaglandins and one comparingsweeping with oxytocin (two studies reported more thanone comparison). Risk of caesarean section was similarbetween groups (RR 0.97, 95% CI 0.73 to 1.28). Sweepingof the membranes, performed as a general policy in womenat term, was associated with reduced duration ofpregnancy and reduced frequency of pregnancy continuingbeyond 41 weeks (RR 0.62, 95% CI 0.49 to 0.79) and 42weeks (RR 0.28, 95% CI 0.15 to 0.50). To avoid one Alliance Francophone pour l’Accouchement Respecté <http://afar.info> Compilation « Déclenchement de l’accouchement » ………… 22 formal induction of labour, sweeping of membranes mustbe performed in seven women (NNT = 7). There was noevidence of a difference in the risk of maternal orneonatal infection. Discomfort during vaginalexamination and other adverse effects (bleeding,irregular contractions) were more frequently reported bywomen allocated to sweeping. Studies comparing sweepingwith prostaglandin administration are of limited samplesize and do not provide evidence of benefit.
REVIEWER’S CONCLUSIONS: Routine use of sweeping ofmembranes from 38 weeks of pregnancy onwards does notseem to produce clinically important benefits. When usedas a means for induction of labour, the reduction in theuse of more formal methods of induction needs to bebalanced against women’s discomfort and other adverseeffects.
Boulvain M, Stan C, Irion O. Membrane sweeping for
induction of labour.
Cochrane Database Syst Rev. 2001;(2):CD000451.
http://www.cochrane.org/cochrane/revabstr/AB000451.htm [313] OBJECTIVE: To compare the efficacy of oral with vaginal misoprostol for induction of labour at term.
PARTICIPANTS: One hundred and sixty-seven womenrequiring induction of labour.
METHODS: The women were randomised to receive 50 microgof misoprostol orally or vaginally every 6 h until thecervix was favourable for amniotomy, spontaneous ruptureof membranes, or active labour occurred. Sample size wascalculated with a two-tailed alpha of 0.05 and a powerof 95% to detect a 5 h difference in induction-to-delivery time. Student’s t test was used for comparisonof normally distributed continuous variables and theMann-Whitney U test was used for non-Gaussiandistributed continuous variables. Fisher’ s exact andchi2 tests were used for comparison of categoricalvariables. The main outcome measure was induction todelivery time.
RESULTS: The median induction to delivery time wassignificantly shorter with vaginal misoprostol (15.7 hrange 4.3-55.7), compared with oral misoprostol (23.0 hrange 3.2-141.7, P = 0.0013). The median number of doseswas also significantly less in the vaginal misoprostolgroup, 1 (range 1-3), compared with the oral group, 2(range 1-8), (P < 0.0001). The significant differencesin outcome held true when nulliparous and multiparouswomen were analysed separately. There were nodifferences between the two routes of administrationwith respect to rates of hyperstimulation or neonatal Alliance Francophone pour l’Accouchement Respecté <http://afar.info> Compilation « Déclenchement de l’accouchement » ………… 23 asphyxia. There were more caesarean sections in thevaginal misoprostol group, but the difference was notstatistically significant.
CONCLUSIONS: Compared with oral misoprostol, vaginalmisoprostol for induction of labour at term results in ashorter induction-to-delivery time, with fewer dosesrequired per patient. Vaginal misoprostol may beassociated with higher rates of caesarean section thanoral misoprostol.
Kwon JS, Davies GA, Mackenzie VP. A comparison of oral
and vaginal misoprostol for induction of labour at term:
a randomised trial.
BJOG, International Journal of Obstetrics and
Gynaecology. 2001 Jan;108(1):23-6.
[872] Nous avions pour objectif d’évaluer les risques de morbidité maternelle et périnatale associés au déclenchement du travail pour des grossesses à terme sans complications. Nous avons mené une étude rétrospective concernant 7430 femmes qui n’avaient pas été transférées d’une autre institution, et qui attendaient un bébé en position de vertex après 38 à 40 semaines de gestation. Parmi ces femmes, 3546 ont été exclues de l’étude car elles avaient eu des complications de grossesse avant le début du travail.
Nous avons calculé les risques relatifs (RR), ajustés selon la parité, comparant 3353 femmes dont le travail avait débuté spontanément, avec 531 dont le travail Nous avons trouvé que le déclenchement du travail étaitassocié à un risque accru de césarienne [RR = 2.4, 95%CI 1.8, 3.4]. L’utilisation d’analgésie autre que lapéridurale [RR = 1.5, 95% CI 1.2, 1.8] et de lapéridurale [RR = 1.4, 95% CI 1.1, 1.7] ont été plusfréquentes après un déclenchement. La réanimation dunouveau-né [RR = 1.2, 95% CI 1.0, 1.5] et son admissionen soins intensifs [RR = 1.6, 95% CI 1.0, 2.4] ou enphotothérapie [RR = 1.3, 95% CI 1.0, 1.6] ont été plusfréquentes après un déclenchement.
Les résultats étaient semblables lorsqu’on contrôlaitsimultanément la parité, l’âge maternel, l’âgegestationnel, l’année de l’accouchement, le poids à lanaissance et le médecin chargé de la surveillance, dansune analyse de régression logistique.
Les résultats de cette étude suggèrent que ledéclenchement du travail est associé à un risque accrude césariennes et de certaines complicationspérinatales. Il devrait être réservé aux cas pourlesquels les bénéfices maternels et périnataux dépassentces risques de complications.
Boulvain, Marcoux, Bureau, Fortier and Fraser. Risks of
induction of labour in uncomplicated term pregnancies.
Paediatric
Alliance Francophone pour l’Accouchement Respecté <http://afar.info> Compilation « Déclenchement de l’accouchement » ………… 24 & Perinatal Epidemiology 15 (2), 131-138.
http://www.blackwell-synergy.com/Journals/content/abstracts/ppe/2001/15/2/abstract_ppe337.asp?journal=ppe&issueid=6360&artid=119523&cid=ppe.2001.2&ftype=abstracts[294] Induction of labor is one of the most importantmeans for therapeutic intervention in modern obstetrics.
The aim of labor induction is to achieve a betterperinatal result for mother and baby as compared toexpectative management. Different methods for inductioninclude administration of oxytocin or prostaglandins,amniotomy, and mechanical means of cervical dilatation.
The success of the labor induction depends primarily onthe readiness of the uterus to go into labor, and themethod used for induction. If the cervical ripeness isvery advanced, induction with amniotomy and oxytocinseems beneficial. However if the cervix is not yetready, intravaginal or intracervical prostaglandins aremore promising. Until recently, prostaglandins E2 areused in the first line. Now, the prostaglandin E1-analogon misoprostol is also increasingly used. As arule, induction of labor should be performed as aninpatient procedure in order to be able to provide thesurveillance for maternal and fetal safety.
Surbek DV, Hosli I, Holzgreve W. [Current aspects of
labor induction] [Article in German]
Ther Umsch. 2002 Dec;59(12):650-9.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12584952&dopt=Abstract [295] Slow release prostaglandin pessary (propess) is compared with instant release prostaglandin gel (prostin) for the induction of labour in nulliparous women with a modified Bishop’s score of less than 6. Inthis randomised study 50 women received prostin gel and45 received propess. More than one dose of prostaglandinwas required to achieve amniotomy more often in thepropess group (53%) compared with the prostin group(34%) (P=0.03). Propess was unable to demonstrate anyadvantage over Prostin gel group. Propess was not cost-effective in this study.
Mukhopadhyay M, Lim KJ, Fairlie FM. Is propess a better
method of induction of labour in nulliparous women?
J Obstet Gynaecol. 2002 May;22(3):294-5.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12521503&dopt=Abstract [296] OBJECTIVE: To compare the efficacy and safety of 100 microg oral misoprostol for induction of labor between the regimen of 3 hour and 6 hour interval METHODS: Singleton pregnancies indicated for inductionof labor between 34 and 42 weeks of gestation in thecondition of unfavorable cervix (Bishop score < or = 4) Alliance Francophone pour l’Accouchement Respecté <http://afar.info> Compilation « Déclenchement de l’accouchement » ………… 25 and no contraindication for prostaglandins therapy wererecruited into the study. All pregnant women wererandomly assigned to receive 100 microg oral misoprostolevery 3 hours or 6 hours until the cervix was favorablefor amniotomy, spontaneous rupture of membranes oractive labor occurred.
RESULTS: The mean time interval from induction tovaginal delivery was significantly shorter in the 3 hourinterval group, compared with the 6 hour interval group(13.82 +/- 6.98h and 17.66 +/- 7.48h, P = 0.0019). Therewas no significant difference between the groups withregard to mode of delivery, analgesic requirement,maternal complication and neonatal outcome.
CONCLUSIONS: 100 microg oral misoprostol every 3 hoursis more effective for labor induction than every 6 hoursbut there was no difference in mode of delivery,analgesic requirement, maternal complications andneonatal outcome. A dose of 100 microg misoprostolorally every 3 hours seems to be the optimum regimen andthe new option for labor induction. However, furtherstudy should be performed.
Pongsatha S, Sirisukkasem S, Tongsong T. A comparison
of 100 microg oral misoprostol every 3 hours and 6 hours
for labor induction: a randomized controlled trial.
J Obstet Gynaecol Res. 2002 Dec;28(6):308-12.
http://www.blackwell-synergy.com/openurl?genre=article&sid=nlm:pubmed&issn=1341-8076&date=2002&volume=28&issue=6&spage=308 [298] OBJECTIVES: To assess the adverse effects of isosorbide mononitrate (IMN) compared with misoprostol METHODS: One hundred and seven women with term pregnancies referred for induction of labor with Bishop scores of 6 or less were randomly allocated to receive either a 40-mg IMN tablet vaginally (n = 55) or 50 microg misoprostol vaginally (n = 52) every 6 h for amaximum of three doses. They were sent to the labor wardfor amniotomy or oxytocin if either their Bishop scoreswere more than 6 or their cervices were not ripe 24 hafter the treatment. Adverse effects, progress, andoutcomes of labor were assessed.
RESULTS: Isosorbide mononitrate was associated withfewer adverse effects especially uterine tachysystole (0vs. 19.2%, P < 0.01) and hyperstimulation (0 vs. 15.4%,P < 0.01). The time from start of medication to vaginaldelivery in IMN group was significantly longer (25.6 +/-6.1 vs. 14 +/- 6.9 h, P < 0.01). Oxytocin was needed in51 women (92%) of the isosorbide mononitrate group andsix women (11%) of the misoprostol group (P < 0.001).
The cesarean rate was not significantly differentbetween the groups, but the major indications weredifferent: dystocia (45%) in the IMN group vs.
Alliance Francophone pour l’Accouchement Respecté <http://afar.info> Compilation « Déclenchement de l’accouchement » ………… 26 persistent non-reassuring fetal heart rate pattern (56%)in the misoprostol group.
CONCLUSIONS: Cervical ripening with IMN resulted infewer adverse effects, but was less effective thanmisoprostol.
Chanrachakul B, Herabutya Y, Punyavachira P. Randomized
trial of isosorbide mononitrate versus misoprostol for
cervical ripening at term.
Int J Gynaecol Obstet. 2002 Aug;78(2):139-45.
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T7M-462BNYK-2&_coverDate=08%2F31%2F2002&_alid=136283461&_rdoc=1&_fmt=&_orig=search&_qd=1&_cdi=5062&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=b10287aefa7b791c9f9ff1bad802eba5 [301] OBJECTIVES: Ripening of the cervix with a Foley catheter commonly results in cervical dilatation without contractions. We examined the outcome of labour in women who underwent induction of labour using a Foley catheter, followed by either 1. early amniotomy, or 2.
augmentation of labour by oxytocin and late amniotomy.
DESIGN: Prospective randomised clinical trial.
SETTING: Labour and delivery ward of a university teaching hospital. PARTICIPANTS: Pregnant women > or =38 weeks of a singleton gestation, who had had no priorcaesarean section.
METHODS: All women underwent cervical ripening using aFoley catheter. Following removal of the catheter, womenwere randomly assigned to either early (n = 80) or lateamniotomy (n = 88).
MAIN OUTCOME MEASURES: Comparison of mode of deliveryand duration of labour between the two groups.
RESULTS: The rate of caesarean section was significantlyhigher in the early amniotomy group compared with thelate amniotomy group (25% vs 7.9%; relative risk 1.74;95% CI 1.3 - 2.34). The increase in caesarean sectionrate was due primarily to dystocia (15% vs 3.3%;relative risk 1.8; 95% CI 1.32 - 2.45). When excludingcaesarean deliveries, no significant difference wasfound in duration of labour between the groups (8.3hours (3.8) vs 7.7 hours (2.9)).
CONCLUSIONS: In women who undergo cervical ripening witha Foley catheter, augmentation of labour by oxytocinfollowed by amniotomy during active labour results in alower rate of caesarean delivery for dystocia.
Levy R, Ferber A, Ben-Arie A, Paz B, Hazan Y, Blickstein
I, Hagay ZJ. A randomised comparison of early versus
late amniotomy following cervical ripening with a Foley
Alliance Francophone pour l’Accouchement Respecté <http://afar.info> Compilation « Déclenchement de l’accouchement » ………… 27 catheter.
BJOG. 2002 Feb;109(2):168-72.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11888099&dopt=Abstract [881] Introduction: Labor induction is considered elective when it is undertaken for the purpose of convenience and in the absence of any maternal or fetal condition that justifies delivery. The elective labor induction is commonly practiced in Flanders (North Belgium). From 1996 to 1997, 30% of all deliveries were induced, of which 71% were elective. Therefore, 1 in 5 pregnant woman in Flanders had a labor induction for convenience. The outcome of elective induction compared with labor of spontaneous onset has not been extensivelystudied.
Aims: The study was designed to determine whether thecurrent practice of elective labor induction in Flanderswas associated with differences in mode of delivery,demand for pain relief, and need for neonatal care whencompared with labor of spontaneous onset.
Methods: During the study, from January 1, 1996, throughDecember 31, 1997, 124,680 deliveries took place inFlanders. Labor was induced in 30% of the deliveries,and elective labor induction took place in 21% of thedeliveries. Of the deliveries, 46% were nulliparous;14.3%were cesarean deliveries; 13.2% were instrumentaldeliveries; 53% required epidural analgesia; 16.8% weretransferred to the neonatal ward; and 1.7% of infantshad congenital malformations. The perinatal mortalityrate was 0.7%. The inclusion criteria for the woman withelectively induced labor and those with a labor ofspontaneous onset were as follows: nulliparous womanwith a low-risk, singleton pregnancy in cephalicpresentation, and delivery of a liveborn infant. Bothstudy groups were matched for maternal age, gestationalage (between 266 and 287 dy), birth weight (between 3000and 4000 g), and gender of the infant. There were 7683cases of electively induced labor and 7683 cases ofspontaneous labor selected as controls. The variablesstudied included: incidence of cesarean delivery,instrumental delivery, epidural analgesia, transfer tothe neonatal ward, congenital malformations, andneonatal death. The nonparametric Mann-Whitney U testwas used for comparing the induction rates in thehospitals with a different level of specialization. Chi-square tests were used to evaluate the associationbetween discrete variables. The relative risks weregiven together with their 95% confidence intervals tomeasure the strength of these associations.
Results: Elective labor induction was most frequentlyperformed in the four university hospitals (mean, 25%)followed by the teaching hospitals (mean, 23%). Theinduction ratio in the peripheral hospitals amounted to20% (P < 0.001 Mann-Whitney U test). Induced labor was Alliance Francophone pour l’Accouchement Respecté <http://afar.info> Compilation « Déclenchement de l’accouchement » ………… 28 associated with significantly more cesarean deliveries(9.9% versus 6.5%) and slightly, but significantly, moreinstrumental deliveries. The increased frequency ofcesarean delivery in induced labor was predominantly theresult of higher incidence of first-stage dystocia (5.9%versus 3.3%). Fetal distress as a reason for cesareandelivery was more frequently encountered when labor hadbeen electively induced (2.6% versus 1.8%). Babies whowere born after induced labor were transferred moreoften to the neonatal ward (10.7% versus 9.4%). Theepidural analgesia was utilized more often in theelective induction group (79.8% versus 57.6%).
Cammu H, Martens G, Ruyssinck G, Amy J. Outcome after
elective labor induction in nulliparous women: a matched
cohort study. Am J Obstet Gynecol 2002, 186:240–244.
http://www.biomedcentral.com/content/pdf/cr-wr312ct.pdf [882] Methods: This study was based on the data from the National Center for Health Statistics during the years 1989 to 1999. The study analyzed several variables in nulliparous and multiparous patients.
Results: Between 1990 and 1998, the rate of labor induction increased from 9.5% to 19.4% of all births nationwide. White woman were more likely to have induced labor in comparison with those of other races (20.6% versus 14%). Maternal age had little impact, except in the very young age group, in whom induction of labor was less common. Nulliparas had a higher rate than multiparas. The rate of labor induction for complicated pregnancies increased substantially, especially for those with renal diseases during pregnancy and those who had previously given birth to an infant who weighed less than 4000 g. The induction rate for pregnancies with anabruptio placentae, breech presentation, and multi-fetalpregnancy remained low during the study period; however,the rate increased significantly. The induction rateincreased with education and earlier initiation ofprenatal care.
Based on these findings, the authors conclude that giventhe increasing popularity of elective induction oflabor, even a small risk of cesarean delivery innullipara may translate into a large number of cesareandeliveries in excess nationwide. Considering the directfinancial costs, potential increase in maternalmorbidity, and likelihood of repeat cesarean delivery insubsequent pregnancies, the convenience of electiveinduction of labor bears a stiff price.
Based on this study, there is no question that electiveinduction of labor is becoming much more common. Therate of elective induction of labor has doubled in thepast 10 years and is expected to reach 30% by the year2007. The cause for an increased rate of elective Alliance Francophone pour l’Accouchement Respecté <http://afar.info> Compilation « Déclenchement de l’accouchement » ………… 29 induction of labor is most likely due to increased fetalsurveillance, improvements in neonatal care,improvements in cervical ripening agents, and increasednumber of patients with medical risks (due to oldermaternal age, reproductive technologies). However, thearticle states that the increase in indicated inductionwas significantly smaller than the overall increase (70%versus 100% increase), which suggests that the rate ofelective induction has risen much more rapidly. The useof pre-induction diagnoses such as impendingmacrosomatia and impending pregnancyinducedhypertension, and induction for patient or physicianconvenience have impacted this rate of growth. We shouldbegin to study and review our methods of practiceregarding elective inductions because long-termramifications of cesarean sections and more complicatedpregnancy outcomes might result, specifically for thenulliparous patient.
Experienced obstetricians know from years of practicethat an elective induction of labor in a multiparouspatient with a ripe cervix is completely different frominduction in a nulliparous patient with an unripecervix. Most likely, the answer for the future is tobecome more stringent with guidelines in the primiparouspatient and less concerned with the multiparous patientwith a ripe cervix.
Zhang J, Yancy MK, Henderson C. U.S. National Trends in
Labor Induction, 1989–1999. J Reprod Med 2002,
47:120–124.
http://www.biomedcentral.com/content/pdf/cr-wr312ct.pdf [883] Les complications des déclenchements ont deux origines: la physiologie du début du travail et les effets secondaires des procédures et des médicaments.
Pour commencer, contrairement à ce qu’on croit communément, les obstétriciens ne peuvent pas démarrer un accouchement en pressant un bouton… Pour démarrer le travail et lui donner de l’intensité, il faut mettre en place une cascade de mécanismes en boucle rétroactive qui se renforcent et se limitent mutuellement. Il s’agit d’une danse élégante et subtile d’hormones et autres substances échangées entre le bébé, qui initie et contrôle le processus, et sa mère. L’administration massive d’ocytocines -- combinée ou non avec des procédures de maturation du col -- ne permet pas en général d’initier le travail progressif, à moins qu’il ne soit sur le point de se déclencher lui-même. C’estla raison principale pour laquelle les études montrentde manière cohérente que le déclenchement del’accouchement, quelle qu’en soit la raison, augmenteconsidérablement la probabilité d’une césarienne pourles femmes qui accouchent de leur premier enfant.
(Quelques études sont arrivées à la conclusion inverse.
Les raisons en sont intéressantes à connaître, et nousles abordons dans la 2e partie.) Alliance Francophone pour l’Accouchement Respecté <http://afar.info> Compilation « Déclenchement de l’accouchement » ………… 30 Goer, Henci. Elective Induction of Labor. Revised and
reprinted from Childbirth Instructor Magazine.
http://www.hencigoer.com/articles/elective_induction/ [17] En avoir assez d’être enceinte, ou vouloir faire coincider l’accouchement avec les dates du vol de la belle mère font partie des raisons les moins convaincantes de déclencher un accouchement. “On me demande tout le temps des déclenchements” remarque Natale, qui ajoute que beaucoup de praticiens ne considèrent pas le côté pratique comme une raison suffisante pour déclencher le travail.
Pourquoi pas ? Comme tout autre médicament ou procédure médicale, les déclenchements comportent un risque qui doit être pesé par rapport au bénéfice potentiel.
Certaines femmes peuvent avoir une réaction inhabituelle au médicament, et avoir des contractions intenses, sansinterruption qui n’ouvrent pas toujours le cervix, etqui peuvent causer une détresse foétale.
Particulièrement si le cervix n’a pas commencé à seramollir, un travail déclenché peut durer plus longtempsqu’un travail qui a commencé spontanément, augmentantainsi la probabilité qu’une femme optera pour lapéridurale. Quelques études ont montré une relationentre ce genre d’anti-douleur et des accouchements pluslongs, ce qui peut alors augmenter les chancesd’interventions supplémentaires, telles quel’épisiotomie et même les césariennes.
« Si vous comparez les femmes pour lesquelles le travailcommence spontanément avec celles, sans aucun risqueidentifiable, dont le travail est déclenché, le secondgroupe pourrait en fait avoir un taux de césarienne plusélevé » explique Natale.
Difficile de dire de combien celui-ci est plus élevé.
Les recherches sont en désaccord : selon certainesétudes, le déclenchement plus que double les chances decésarienne ; cependant, une revue de la littératurescientifique a conclu que le déclenchement n’a aucuneffet sur le taux d’accouchement chirurgical, du moinsdans le cas de grossesses dont le terme est dépassé.
Alors qu’une étude publiée en 2001 dans « obstetrics andgynecology » a montré un lien entre le déclenchement etla césarienne, les auteurs affirment que c’est le tauxde péridurale plus élevé parmi les femmes dont letravail a été déclenché et les facteurs de risque telsque : premier accouchement, et un cervix non dilatéavant le déclenchement qui sont à blâmer et non laprocédure elle-même.
Il est également important de remarquer que beaucoup defemmes dont le travail est déclenché pour soit disantdépassement de terme ne remplissent pas vraiment lescritères, ce qui pourrait aussi augmenter la probabilitéde la césarienne. Un audit d’un gros hôpital a montré Alliance Francophone pour l’Accouchement Respecté <http://afar.info> Compilation « Déclenchement de l’accouchement » ………… 31 qu’avant qu’un protocole ferme concernant ledéclenchement soit mis en place, 1/3 des patientes quiétaient déclenchées pour dépassement du terme n’avaienten fait pas encore atteint la limite des 41 semaines et6 jours. Quand le travail est déclenché trop tôt, lesmédicaments sont moins susceptibles de déclencher unvéritable travail, ce qui peut déclencher une réactionen chaîne d’interventions finissant en césarienne.
“Dans le cas de déclenchements, la cause de césariennela plus commune est probablement un déclenchement raté”dit Mc Donald.
C’est parce qu’un déclenchement c’est un peu commeprendre un tapis roulant ; il est parfois difficiled’appuyer sur le bouton stop une fois que vous êtes enroute. Par exemple, si les prostaglandines ou lesocytocines ne marchent pas, il peut être difficile devous convaincre ou de convaincre le personnelhospitalier de laisser les choses évoluer pendantquelques jours, même si vous et votre bébé êtes en bonnesanté. Egalement, si votre poche des eaux a été rompuepour installer le moniteur interne ou pour essayer defaire avancer le travail vous pouvez être forcéed’accoucher dans une période donnée, et si vous ne lefaîtes pas, vous pouvez vous retrouver en chemin pour lasalle d’opération. Et, bien sûr, un accouchementchirurgical a ses propres risques, depuis les sérieusescomplications telles que l’infection, jusqu’àl’inconfort suivant la naissance qui rend les soins dubébé plus difficiles.
« Nous ne devrions pas procéder à des déclenchementsdans une population de femmes et de bébés qui vont bien,à moins qu’ils soient vraiment dans une situation quisoit favorable à l’accouchement » souligne Natale.
Haaf, Wendy. Induction of Labour. The Cons of Induction
http://www.todaysparent.com/pregnancybirth/labour/article.jsp?content=20030523_131728_1388 [288] Induction of labour is a common obstetric instrument to employ when the potential risk to continue a pregnancy is higher than to terminate it. The methodsof induction can be pharmacological or mechanical; thechoice of the method mainly depends by the cervicalripening, as it is significantly able to influence,according to the type of induction, its final issue. Themechanical methods are: stripping and sweeping of themembranes, hand dilatation of cervix, intrauterinepressure catheters, Laminaria Japonicum, transcervicalFoley catheter and amniotomy. To pharmacological methodsinclude some agents such as the prostaglandins (PG), themost common approach to induce a labour, and used aboveall by vaginal way in patients with unripe cervix. Theysimulate the natural PG effects at the beginning ofdelivery and show a great efficiency. There are a lot ofPG on the market, but except some of them, as Alliance Francophone pour l’Accouchement Respecté <http://afar.info> Compilation « Déclenchement de l’accouchement » ………… 32 Dinoprostone for PGE(2) and Misoprostol for PGE(1), noone of them shows the same safety in management oflabour. Oxitocin, another inductive method, administeredby diluted intravenous infusion, is utilized alone ormainly with other methods when the labour is started orwith rupture of the membranes, because it begins ormaintains the myometrial contraction.
Tinelli A, Tinelli R, Tinelli FG. [Induction of labour:
which method to use? ] [Article in italian]
Minerva Ginecol. 2003 Dec;55(6):463-82.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14676736&dopt=Abstract [289] Premature rupture of membranes (PROM) occurs in 8% of term deliveries. In this situation labour induction with prostaglandins, compared with expectant chorioamnionitis, neonatal antibiotic therapy, neonatal intensive care (NICU) admission, and increased maternal satisfaction. The use of prostaglandin is associated with an increased rate of diarrhoea and use of analgesia/anaesthesia. Compared with oxytocin,prostaglandin induction results in a lower rate ofepidural use and internal fetal heart rate monitoringbut a greater risk of chorioamnionitis, nausea,vomiting, more vaginal examinations, neonatal antibiotictherapy, NICU admission and neonatal infection. Womenshould be informed of the risks and benefits of eachmethod of induction.Misoprostol is gaining increasinginterest as an alternative induction agent. It appearsto be an effective method of labour induction with termPROM. Further research is needed to identify thepreferred dosage, route and interval of administration,and to assess uncommon maternal and neonataloutcomes.There has been limited research on the use ofprostaglandins, including misoprostol, for induction oflabour with a favourable cervix and intact membranes.
Compared with intravenous oxytocin (with and withoutamniotomy), labour induction using vaginalprostaglandins in women with a favourable cervix (withand without PROM) results in a higher rate of vaginaldelivery within 24 hours and increased maternalsatisfaction. In women with a favourable cervix,artificial rupture of membranes followed by oralmisoprostol has similar time to vaginal deliverycompared with artificial rupture of membranes followedby oxytocin. Further research with prostaglandins,including misoprostol, is needed to evaluate othermaternal and neonatal outcomes in women being inducedwith a favourable cervix.No form of prostaglandininduction in women with PROM or favourable cervix hasproven clearly superior to oxytocin infusion.
Crane JM, Young DC. Induction of labour with a
favourable cervix and/or pre-labour rupture of
membranes.
Best Pract Res Clin Obstet Gynaecol. 2003 Oct;17(5):795-
Alliance Francophone pour l’Accouchement Respecté <http://afar.info> Compilation « Déclenchement de l’accouchement » ………… 33 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12972015&dopt=Abstract [290] Labour induction is undertaken when the advantages for the mother and/or the baby are considered to outweigh the disadvantages. When the uterine cervix is unfavourable, oxytocin, with or without amniotomy, is frequently ineffective. Vaginal prostaglandin E(2) is most commonly used if it is affordable. Evidence regarding many alternative methods is discussed in thischapter. Of particular interest are misoprostol andextra-amniotic saline infusion.Misoprostol, an orallyactive prostaglandin E(1) analogue, has been used widelyby the vaginal and oral routes for labour induction ator near term. Several recent trials have confirmed thatit is highly effective. Overall Caesarean section ratesappear to be reduced, despite a relative increase inCaesarean sections for fetal heart rate abnormalities.
Concern remains regarding increased rates of uterinehyperstimulation and meconium-stained amniotic fluid,although data on perinatal outcome have been reassuring.
Postpartum haemorrhage may be increased following labourinduction with misoprostol, and isolated reports ofuterine rupture, with or without previous Caesareansection, have appeared. Using small dosages appears toreduce adverse outcomes. Very large trials are needed toevaluate rare adverse outcomes.Extra-amniotic salineinfusion is an effective method which appears to reducethe risk of uterine hyperstimulation that occurs withthe use of exogenous uterotonics.
Justus Hofmeyr G. Induction of labour with an
unfavourable cervix.
Best Pract Res Clin Obstet Gynaecol. 2003 Oct;17(5):777-
94.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12972014&dopt=Abstract [366] OBJECTIVE : Our aim was to examine the effect of the nitric oxide donor isosorbide mononitrate on the uterine cervix at term and to evaluate possible adverse STUDY DESIGN : Term pregnant women were randomly selected to receive either 40 mg vaginally administered isosorbide mononitrate or placebo 4 hours beforeelective cesarean section. Cervical status, maternalblood pressure, maternal pulse rate, fetal heart rate,umbilical arterial Doppler indices, and various sideeffects were examined.
RESULTS : Isosorbide mononitrate induced a significantincrease in cervical distensibility. It also caused asignificant change in maternal blood pressure andmaternal pulse rate. In addition, the frequency ofmaternal headache and palpitations was significantlyhigher in the isosorbide mononitrate group versus the Alliance Francophone pour l’Accouchement Respecté <http://afar.info> Compilation « Déclenchement de l’accouchement » ………… 34 placebo group. However, the intensity of these symptomswas moderate.
CONCLUSION : Vaginal administration of 40 mg ofisosorbide mononitrate induces cervical ripening atterm. Although the majority of women experienced sideeffects, no serious clinical maternal or fetal adverseeffects, resulting in specific medication or emergencycesarean section, were diagnosed.
Ekerhovd E, Bullarbo M, Andersch B, Norström A. Vaginal
administration of the nitric oxide donor isosorbide
mononitrate for cervical ripening at term: a randomized
controlled study.
American Journal of Obstetrics and Gynecology
2003;189(6):1692-1697.
[393]
Pitkin RM. Commentary on pelvic scoring for elective
induction. : Bishop EH. Pelvic scoring for elective
induction. Obstet Gynecol 1964;24:266-8, Page 846.
Obstetrics & Gynecology 2003;101(5):846. Editorial.
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6TB2-4BGH1GH-M2&_user=10&_handle=W-WA-A-A-VD-MsSAYWA-UUA-AUDVYDUYDD-AEEYWCAEB-VD-U&_fmt=summary&_coverDate=05%2F31%2F2003&_rdoc=4&_orig=browse&_srch=%23toc%235130%232003%23998989994.7998%23476526!&_cdi=5130&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=8a8de94b7b60dc4a9b69ddb26cecfeab [795] BACKGROUND: The incidence of anal sphincter tears is highest among nulliparous women. The aim of this study was to ascertain if there were other factors that METHODS: This was a retrospective study of all primigravid vaginal deliveries that had sustained an anal sphincter tear (n = 122), compared with deliveries that did not have this complication (n = 16,050). The study sample was drawn from a computerized maternity information database, comprising 52 916 deliveries in the South Glamorgan region during 1990-99. SPSS version 10 was used for statistical analysis.
RESULTS: The incidence of anal sphincter tears in this study population was 0.8% (122/16172). Postdates (OR = 1.8, 95% CI = 1.3-2.6) and fetal macrosomia (OR = 3.8, 2.4-6) together with induction of labor (OR = 1.5, 1.01-2.2), use of spinal analgesia at delivery (OR = 3.1,1.1-8.4), assisted vaginal delivery (OR = 1.9, 1.3-2.7;especially the use of forceps, OR = 2.2, 1.3-3.9) anddoctor-conducted deliveries (OR = 2.2, 1.6-3.2) werefound to be associated with a significantly higherincidence of anal sphincter tears. Logistic regressionrevealed fetal macrosomia and doctor-conducteddeliveries to be independent risk factors that, whenoccurring together, were associated with a fourfoldincrease in the risk of occurrence of anal sphincter Alliance Francophone pour l’Accouchement Respecté <http://afar.info> Compilation « Déclenchement de l’accouchement » ………… 35 CONCLUSIONS: This study suggests that careful assessmentand counseling of women, particularly > 40 weeksgestation or those potentially having macrosomicfetuses, especially if forceps are to be used forprolonged second stage in primigravid women, may help toidentify those at significant risk of anal sphinctertears.
Gupta N, Kiran TU, Mulik V, Bethel J, Bhal K. The
incidence, risk factors and obstetric outcome in
primigravid women sustaining anal sphincter tears.
Acta Obstet Gynecol Scand. 2003 Aug;82(8):736-43.
http://www.blackwell-synergy.com/openurl?genre=article&sid=nlm:pubmed&issn=0001-6349&date=2003&volume=82&issue=8&spage=736 [876] La maîtrise d’une technique médicale – dans le cas présent, le déclenchement de l’accouchement – implique-t-elle la nécessité d’étendre l’utilisation de cette technique au plus grand nombre de parturientes N’y aurait-il pas comme une perversion du rôle du médecin, rôle qui consiste à soigner et soulager, à défaut de toujours guérir, à inférer ainsi dans un processus – l’accouchement – qui ne requiert médicalement son intervention que dans dix à quinze pour N’y aurait-il pas risques, aussi bien pour le soignant que les parents mais aussi l’enfant, à ainsi perturber un phénomène qui ne donnait aucun signe de problème ? Et L’ENFANT ? C’est SA NAISSANCE, et il ne naîtra qu’unefois… Cette naissance que de nombreux chercheursd’obédiences diverses appellent "moment fondateur",cette naissance qui semble s’imprimer, pour le meilleurou pour le pire. au fer rouge, au plus profond del’individu… Le premier respect de l’enfant à naître neserait-il pas – quand tout se déroule bien – de lelaisser venir en SON temps et en SON heure ? Nous ne savons pas à moyen et long termes lesrépercussions réelles du déclenchement de convenance surl’individu, sur sa vie et sa santé à venir ni sur safaçon de gérer ses relations et ses problèmes… Pourtant, un certain nombre d’études sur lesretentissements de la naissance sur l’individu devrait,pour le moins, inciter à la plus grande des prudences…L’interventionnisme médical INUTILE autour del’accouchement semble laisser des séquelles durablesdans un nombre de cas non négligeable.
Poitel, Blandine. Programmation de l’accouchement : les
sirènes de la toute puissance. Les Dossiers de
Alliance Francophone pour l’Accouchement Respecté <http://afar.info> Compilation « Déclenchement de l’accouchement » ………… 36 l’Obstétrique No 316, mai 2003, p.10-15; No 317, juin
2003, p.16-21; No 318, juillet 2003, p.30-33.
http://users.swing.be/carrefour.naissance/Articles/sc/ProgramAcc.htm Remarques :Pour commander un tiré à part de cet article, il suffitd’envoyer vos nom prénom et adresse, ainsi que votrerèglement (10 euros, comprenant les frais de port) àBlandine POITEL, 1 Rue du Docteur Calmette, logement 38,17000 LA ROCHELLE.
[880] Doctors find it difficult to admit mistakes. Here we have a big mistake—Cytotec induction with VBAC—that went on for years. Yet, there is no discussion of the error or what to do so it won’t happen again.
Those doctors and midwives using Cytotec for induction of labor off-label need to understand that they are taking very big chances with the safety of the women and babies they serve. Just about everyone in the world, after taking a careful look at the scientific evidence, has concluded we don’t yet know enough about the risks to be willing to use it. This is illustrated in the following list of organizations that do and do not recommend Cytotec (misoprostol) for labor induction: 1. American College of Obstetricians and Gynecologists 1. U.S. Food and Drug Administration2. Best scientific opinion—Cochrane Database3. Searle (manufacturer of Cytotec)4. Society of Obstetricians and Gynaecologists of Canada5. British Royal College of Obstetricians andGynecologists6. All obstetric organizations in Scandinavia7. FIGO (International Federation of Gynecology andObstetrics)8. World Health Organization9. Obstetric organizations and drug regulatory agenciesin many other countries How can ACOG possibly be willing to stand alone inopposition to the best scientific opinion in the world?Because so many of ACOG’s members already use Cytotecinduction off-label for its incredible convenience, theorganization needs to support its members byrecommending this practice. This means ACOG must find apaper published in a prominent U.S. journal supportingCytotec induction. In ACOG’s recommendation on Cytotecinduction, the organization leans heavily on a paper byA.B. Goldberg and other authors published in the New Alliance Francophone pour l’Accouchement Respecté <http://afar.info> Compilation « Déclenchement de l’accouchement » ………… 37 England Journal of Medicine (2). Let’s take a carefullook at the contents of this paper, as it is a superbexample of torturing the data until it confesses to whatthe authors want it to say… Wagner, Marsden. Cytotec Induction and Off-Label Use.
Midwifery Today, 67, Fall 2003.
http://www.midwiferytoday.com/articles/cytotec.asp [884] Le déclenchement de l’accouchement est une pratique devenue fréquente (22 % des accouchements en France sont déclenchés). Ce n’est pourtant pas un exercice toujours facile notamment lorsque les conditions locales sont défavorables. À terme, toutes indications et parités confondues, les déclenchements sur conditions locales défavorables sont grevés d’un taux de césariennes supérieur à 20 %. Les indications doivent donc être posées avec rigueur.
Hors indication médicale, plusieurs enquêtes de pratique montrent un excès de césariennes en cas de

Source: http://afar.info/wp/docs/declenchement-compil1.pdf