Prostaglandins versus oxytocin for prelabour rupture of membranes at term.

Abstract

The conventional method of induction of labour is with intravenous oxytocin. More recently, induction with prostaglandins, followed by an infusion of oxytocin if necessary, has been used. The objective of this review was to assess the effects of induction of labour with prostaglandins versus oxytocin for prelabour rupture of membranes at term. We searched the Cochrane Pregnancy and Childbirth Group trials register. Randomised and quasi-randomised trials of early stimulation of uterine contractions with prostaglandins (with or without oxytocin) versus with oxytocin alone (not combined with prostaglandins) in women with spontaneous rupture of membranes at term (37 weeks or more gestation). Two reviewers assessed trial quality and extracted data. Eight trials were included. Based on three trials, prostaglandins compared to oxytocin were associated with increased chorioamnionitis (odds ratio of 1.51, 95% confidence interval 1.07 to 2.12) and neonatal infections (odds ratio 1.63, 95% confidence interval 1.00 to 2.66). Based on four trials, prostaglandins were associated with a decrease in epidural analgesia (odds ratio of 0.86, 95% confidence interval 0.73 to 1.00) and internal fetal heart rate monitoring (based on one trial). Caesarean section, endometritis and perinatal mortality were not significantly different between the groups. Women with prelabour rupture of membranes at term having their labour induced with prostaglandins appear to have a lower risk of epidural analgesia and fetal heart rate monitoring. However there appears to be an increased risk of chorioamnionitis and neonatal infections after prostaglandin induction compared to oxytocin.