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. 2001;2001(4):CD003393.
doi: 10.1002/14651858.CD003393.

Oestrogens alone or with amniotomy for cervical ripening or induction of labour

J Thomas  1 , A J Kelly, J Kavanagh
Affiliations

Oestrogens alone or with amniotomy for cervical ripening or induction of labour

J Thomas et al. Cochrane Database Syst Rev. 2001.

Abstract

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 have failed to demonstrate a similar physiological mechanism. The use of oestrogen as an induction agent is not currently common practice, as such this systematic review should be regarded as an historical review. This is one of a series of reviews of methods of cervical ripening and labour induction using a standardised methodology.

Objectives: To determine, from the best available evidence, the effectiveness and safety of oestrogens alone or with amniotomy for third trimester cervical ripening and induction of labour in comparison with other methods of induction of labour.

Search strategy: The Cochrane Pregnancy and Childbirth Group trials register, the Cochrane Controlled Trials Register and bibliographies of relevant papers. Last searched: April 2001.

Selection criteria: (1) randomised controlled trials comparing oestrogens alone used for third trimester cervical ripening or labour induction with placebo/no treatment or other methods listed above it on a predefined list of labour induction methods; (2) random allocation to the treatment or control group; (3) adequate allocation concealment; (4) violations of allocated management not sufficient to materially affect conclusions; (5) clinically meaningful outcome measures reported; (6) data available for analysis according to the random allocation; (7) missing data insufficient to materially affect the conclusions.

Data collection and analysis: A generic strategy has been developed to deal with the large volume and complexity of trial data relating to labour induction. This involved a two-stage method of data extraction. The initial data extraction was done centrally.

Main results: When comparing oestrogen with placebo there was no difference between the rate of caesarean section (7.1% versus 10.3%, relative risk (RR) 0.70, 95% confidence interval (CI) 0.30,1.62). There were no differences between rates of uterine hyperstimulation with or without fetal heart rate changes or instrumental vaginal delivery. None of the studies reported the rates of either vaginal delivery not achieved in 24 hours, or cervix unfavourable/unchanged after 12-24 hours. There were insufficient data to make any meaningful conclusions when comparing oestrogen with vaginal PGE2, intracervical PGE2, oxytocin alone or extra amniotic PGF2a, as to whether oestrogen is effective in inducing labour.

Reviewer's conclusions: There were insufficient data to draw any conclusions regarding the efficacy of oestrogen as an induction agent.

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Conflict of interest statement

None known.

Figures

1.2
1.2. Analysis
Comparison 1 Oestrogen versus placebo: all women, Outcome 2 Uterine hyperstimulation with FHR changes.
1.3
1.3. Analysis
Comparison 1 Oestrogen versus placebo: all women, Outcome 3 Caesarean section.
1.4
1.4. Analysis
Comparison 1 Oestrogen versus placebo: all women, Outcome 4 Serious neonatal morbidity or perinatal death.
1.7
1.7. Analysis
Comparison 1 Oestrogen versus placebo: all women, Outcome 7 Oxytocin augmentation.
1.8
1.8. Analysis
Comparison 1 Oestrogen versus placebo: all women, Outcome 8 Uterine hyperstimulation without FHR changes.
1.11
1.11. Analysis
Comparison 1 Oestrogen versus placebo: all women, Outcome 11 Instrumental vaginal delivery.
1.12
1.12. Analysis
Comparison 1 Oestrogen versus placebo: all women, Outcome 12 Meconium stained liquor.
1.14
1.14. Analysis
Comparison 1 Oestrogen versus placebo: all women, Outcome 14 Neonatal intensive care unit admission.
1.16
1.16. Analysis
Comparison 1 Oestrogen versus placebo: all women, Outcome 16 Perinatal death.
1.20
1.20. Analysis
Comparison 1 Oestrogen versus placebo: all women, Outcome 20 Serious maternal complications.
2.2
2.2. Analysis
Comparison 2 Oestrogen versus placebo: all women, unfavourable, Outcome 2 Uterine hyperstimulation with FHR changes.
2.3
2.3. Analysis
Comparison 2 Oestrogen versus placebo: all women, unfavourable, Outcome 3 Caesarean section.
2.4
2.4. Analysis
Comparison 2 Oestrogen versus placebo: all women, unfavourable, Outcome 4 Serious neonatal morbidity or perinatal death.
2.7
2.7. Analysis
Comparison 2 Oestrogen versus placebo: all women, unfavourable, Outcome 7 Oxytocin augmentation.
2.8
2.8. Analysis
Comparison 2 Oestrogen versus placebo: all women, unfavourable, Outcome 8 Uterine hyperstimulation without FHR changes.
2.11
2.11. Analysis
Comparison 2 Oestrogen versus placebo: all women, unfavourable, Outcome 11 Instrumental vaginal delivery.
2.12
2.12. Analysis
Comparison 2 Oestrogen versus placebo: all women, unfavourable, Outcome 12 Meconium stained liquor.
2.14
2.14. Analysis
Comparison 2 Oestrogen versus placebo: all women, unfavourable, Outcome 14 Neonatal intensive care unit admission.
2.16
2.16. Analysis
Comparison 2 Oestrogen versus placebo: all women, unfavourable, Outcome 16 Perinatal death.
2.20
2.20. Analysis
Comparison 2 Oestrogen versus placebo: all women, unfavourable, Outcome 20 Serious maternal complications.
3.3
3.3. Analysis
Comparison 3 Oestrogen versus placebo: all women, intact membranes, unfavourable, Outcome 3 Caesarean section.
3.7
3.7. Analysis
Comparison 3 Oestrogen versus placebo: all women, intact membranes, unfavourable, Outcome 7 Oxytocin augmentation.
3.11
3.11. Analysis
Comparison 3 Oestrogen versus placebo: all women, intact membranes, unfavourable, Outcome 11 Instrumental vaginal delivery.
3.12
3.12. Analysis
Comparison 3 Oestrogen versus placebo: all women, intact membranes, unfavourable, Outcome 12 Meconium stained liquor.
3.14
3.14. Analysis
Comparison 3 Oestrogen versus placebo: all women, intact membranes, unfavourable, Outcome 14 Neonatal intensive care unit admission.
3.20
3.20. Analysis
Comparison 3 Oestrogen versus placebo: all women, intact membranes, unfavourable, Outcome 20 Serious maternal complications.
4.3
4.3. Analysis
Comparison 4 Oestrogen versus placebo: all women, intact membranes, variable or undefined cervix, Outcome 3 Caesarean section.
5.2
5.2. Analysis
Comparison 5 Oestrogen versus placebo: all primiparae, Outcome 2 Uterine hyperstimulation with FHR changes.
5.3
5.3. Analysis
Comparison 5 Oestrogen versus placebo: all primiparae, Outcome 3 Caesarean section.
5.4
5.4. Analysis
Comparison 5 Oestrogen versus placebo: all primiparae, Outcome 4 Serious neonatal morbidity or perinatal death.
5.8
5.8. Analysis
Comparison 5 Oestrogen versus placebo: all primiparae, Outcome 8 Uterine hyperstimulation without FHR changes.
5.11
5.11. Analysis
Comparison 5 Oestrogen versus placebo: all primiparae, Outcome 11 Instrumental vaginal delivery.
5.16
5.16. Analysis
Comparison 5 Oestrogen versus placebo: all primiparae, Outcome 16 Perinatal death.
6.2
6.2. Analysis
Comparison 6 Oestrogen versus placebo: all primiparae, unfavourable cervix, Outcome 2 Uterine hyperstimulation with FHR changes.
6.3
6.3. Analysis
Comparison 6 Oestrogen versus placebo: all primiparae, unfavourable cervix, Outcome 3 Caesarean section.
6.4
6.4. Analysis
Comparison 6 Oestrogen versus placebo: all primiparae, unfavourable cervix, Outcome 4 Serious neonatal morbidity or perinatal death.
6.8
6.8. Analysis
Comparison 6 Oestrogen versus placebo: all primiparae, unfavourable cervix, Outcome 8 Uterine hyperstimulation without FHR changes.
6.11
6.11. Analysis
Comparison 6 Oestrogen versus placebo: all primiparae, unfavourable cervix, Outcome 11 Instrumental vaginal delivery.
6.16
6.16. Analysis
Comparison 6 Oestrogen versus placebo: all primiparae, unfavourable cervix, Outcome 16 Perinatal death.
7.3
7.3. Analysis
Comparison 7 Oestrogen versus placebo: all multiparae, Outcome 3 Caesarean section.
7.4
7.4. Analysis
Comparison 7 Oestrogen versus placebo: all multiparae, Outcome 4 Serious neonatal morbidity or perinatal death.
7.11
7.11. Analysis
Comparison 7 Oestrogen versus placebo: all multiparae, Outcome 11 Instrumental vaginal delivery.
7.16
7.16. Analysis
Comparison 7 Oestrogen versus placebo: all multiparae, Outcome 16 Perinatal death.
8.3
8.3. Analysis
Comparison 8 Oestrogen versus placebo: all multiparae, unfavourable cervix, Outcome 3 Caesarean section.
8.4
8.4. Analysis
Comparison 8 Oestrogen versus placebo: all multiparae, unfavourable cervix, Outcome 4 Serious neonatal morbidity or perinatal death.
8.11
8.11. Analysis
Comparison 8 Oestrogen versus placebo: all multiparae, unfavourable cervix, Outcome 11 Instrumental vaginal delivery.
8.16
8.16. Analysis
Comparison 8 Oestrogen versus placebo: all multiparae, unfavourable cervix, Outcome 16 Perinatal death.
9.3
9.3. Analysis
Comparison 9 Oestrogen versus placebo: all primiparae, intact membranes, variable or undefined cervix, Outcome 3 Caesarean section.
10.2
10.2. Analysis
Comparison 10 Oestrogen versus vaginal prostaglandins: all women, Outcome 2 Uterine hyperstimulation with FHR changes.
10.3
10.3. Analysis
Comparison 10 Oestrogen versus vaginal prostaglandins: all women, Outcome 3 Caesarean section.
10.8
10.8. Analysis
Comparison 10 Oestrogen versus vaginal prostaglandins: all women, Outcome 8 Uterine hyperstimulation without FHR changes.
10.10
10.10. Analysis
Comparison 10 Oestrogen versus vaginal prostaglandins: all women, Outcome 10 Epidural analgesia.
11.2
11.2. Analysis
Comparison 11 Oestrogen versus vaginal prostaglandins: all women, unfavourable cervix, Outcome 2 Uterine hyperstimulation with FHR changes.
11.3
11.3. Analysis
Comparison 11 Oestrogen versus vaginal prostaglandins: all women, unfavourable cervix, Outcome 3 Caesarean section.
11.8
11.8. Analysis
Comparison 11 Oestrogen versus vaginal prostaglandins: all women, unfavourable cervix, Outcome 8 Uterine hyperstimulation without FHR changes.
11.10
11.10. Analysis
Comparison 11 Oestrogen versus vaginal prostaglandins: all women, unfavourable cervix, Outcome 10 Epidural analgesia.
15.3
15.3. Analysis
Comparison 15 Oestrogen versus intracervical prostaglandins: all women, Outcome 3 Caesarean section.
15.7
15.7. Analysis
Comparison 15 Oestrogen versus intracervical prostaglandins: all women, Outcome 7 Oxytocin augmentation.
15.11
15.11. Analysis
Comparison 15 Oestrogen versus intracervical prostaglandins: all women, Outcome 11 Instrumental vaginal delivery.
15.12
15.12. Analysis
Comparison 15 Oestrogen versus intracervical prostaglandins: all women, Outcome 12 Meconium stained liquor.
15.14
15.14. Analysis
Comparison 15 Oestrogen versus intracervical prostaglandins: all women, Outcome 14 Neonatal intensive care unit admission.
15.20
15.20. Analysis
Comparison 15 Oestrogen versus intracervical prostaglandins: all women, Outcome 20 Serious maternal complications.
16.3
16.3. Analysis
Comparison 16 Oestrogen versus intracervical prostaglandins: all women, unfavourable cervix, Outcome 3 Caesarean section.
16.7
16.7. Analysis
Comparison 16 Oestrogen versus intracervical prostaglandins: all women, unfavourable cervix, Outcome 7 Oxytocin augmentation.
16.11
16.11. Analysis
Comparison 16 Oestrogen versus intracervical prostaglandins: all women, unfavourable cervix, Outcome 11 Instrumental vaginal delivery.
16.12
16.12. Analysis
Comparison 16 Oestrogen versus intracervical prostaglandins: all women, unfavourable cervix, Outcome 12 Meconium stained liquor.
16.14
16.14. Analysis
Comparison 16 Oestrogen versus intracervical prostaglandins: all women, unfavourable cervix, Outcome 14 Neonatal intensive care unit admission.
16.20
16.20. Analysis
Comparison 16 Oestrogen versus intracervical prostaglandins: all women, unfavourable cervix, Outcome 20 Serious maternal complications.
17.3
17.3. Analysis
Comparison 17 Oestrogen versus intracervical prostaglandins: all women, intact membranes, unfavourable cervix, Outcome 3 Caesarean section.
17.7
17.7. Analysis
Comparison 17 Oestrogen versus intracervical prostaglandins: all women, intact membranes, unfavourable cervix, Outcome 7 Oxytocin augmentation.
17.11
17.11. Analysis
Comparison 17 Oestrogen versus intracervical prostaglandins: all women, intact membranes, unfavourable cervix, Outcome 11 Instrumental vaginal delivery.
17.12
17.12. Analysis
Comparison 17 Oestrogen versus intracervical prostaglandins: all women, intact membranes, unfavourable cervix, Outcome 12 Meconium stained liquor.
17.14
17.14. Analysis
Comparison 17 Oestrogen versus intracervical prostaglandins: all women, intact membranes, unfavourable cervix, Outcome 14 Neonatal intensive care unit admission.
17.20
17.20. Analysis
Comparison 17 Oestrogen versus intracervical prostaglandins: all women, intact membranes, unfavourable cervix, Outcome 20 Serious maternal complications.
20.3
20.3. Analysis
Comparison 20 Oestrogen versus oxytocin alone: all women, Outcome 3 Caesarean section.
20.11
20.11. Analysis
Comparison 20 Oestrogen versus oxytocin alone: all women, Outcome 11 Instrumental vaginal delivery.
21.3
21.3. Analysis
Comparison 21 Oestrogen versus oxytocin alone: all women, unfavourable cervix, Outcome 3 Caesarean section.
21.11
21.11. Analysis
Comparison 21 Oestrogen versus oxytocin alone: all women, unfavourable cervix, Outcome 11 Instrumental vaginal delivery.
22.3
22.3. Analysis
Comparison 22 Oestrogen versus oxytocin alone: all women, intact membranes, unfavourable cervix, Outcome 3 Caesarean section.
22.11
22.11. Analysis
Comparison 22 Oestrogen versus oxytocin alone: all women, intact membranes, unfavourable cervix, Outcome 11 Instrumental vaginal delivery.
25.2
25.2. Analysis
Comparison 25 Oestrogen versus extraamniotic prostaglandins: all women, Outcome 2 Uterine hyperstimulation with FHR changes.
25.3
25.3. Analysis
Comparison 25 Oestrogen versus extraamniotic prostaglandins: all women, Outcome 3 Caesarean section.
25.4
25.4. Analysis
Comparison 25 Oestrogen versus extraamniotic prostaglandins: all women, Outcome 4 Serious neonatal morbidity or perinatal death.
25.8
25.8. Analysis
Comparison 25 Oestrogen versus extraamniotic prostaglandins: all women, Outcome 8 Uterine hyperstimulation without FHR changes.
25.11
25.11. Analysis
Comparison 25 Oestrogen versus extraamniotic prostaglandins: all women, Outcome 11 Instrumental vaginal delivery.
25.16
25.16. Analysis
Comparison 25 Oestrogen versus extraamniotic prostaglandins: all women, Outcome 16 Perinatal death.
26.2
26.2. Analysis
Comparison 26 Oestrogen versus extraamniotic prostaglandins: all women, unfavourable cervix, Outcome 2 Uterine hyperstimulation with FHR changes.
26.3
26.3. Analysis
Comparison 26 Oestrogen versus extraamniotic prostaglandins: all women, unfavourable cervix, Outcome 3 Caesarean section.
26.4
26.4. Analysis
Comparison 26 Oestrogen versus extraamniotic prostaglandins: all women, unfavourable cervix, Outcome 4 Serious neonatal morbidity or perinatal death.
26.8
26.8. Analysis
Comparison 26 Oestrogen versus extraamniotic prostaglandins: all women, unfavourable cervix, Outcome 8 Uterine hyperstimulation without FHR changes.
26.11
26.11. Analysis
Comparison 26 Oestrogen versus extraamniotic prostaglandins: all women, unfavourable cervix, Outcome 11 Instrumental vaginal delivery.
26.16
26.16. Analysis
Comparison 26 Oestrogen versus extraamniotic prostaglandins: all women, unfavourable cervix, Outcome 16 Perinatal death.
27.2
27.2. Analysis
Comparison 27 Oestrogen versus extraamniotic prostaglandins: all primiparae, Outcome 2 Uterine hyperstimulation with FHR changes.
27.3
27.3. Analysis
Comparison 27 Oestrogen versus extraamniotic prostaglandins: all primiparae, Outcome 3 Caesarean section.
27.4
27.4. Analysis
Comparison 27 Oestrogen versus extraamniotic prostaglandins: all primiparae, Outcome 4 Serious neonatal morbidity or perinatal death.
27.8
27.8. Analysis
Comparison 27 Oestrogen versus extraamniotic prostaglandins: all primiparae, Outcome 8 Uterine hyperstimulation without FHR changes.
27.11
27.11. Analysis
Comparison 27 Oestrogen versus extraamniotic prostaglandins: all primiparae, Outcome 11 Instrumental vaginal delivery.
27.16
27.16. Analysis
Comparison 27 Oestrogen versus extraamniotic prostaglandins: all primiparae, Outcome 16 Perinatal death.
28.2
28.2. Analysis
Comparison 28 Oestrogen versus extraamniotic prostaglandins: all primiparae, unfavourable cervix, Outcome 2 Uterine hyperstimulation with FHR changes.
28.3
28.3. Analysis
Comparison 28 Oestrogen versus extraamniotic prostaglandins: all primiparae, unfavourable cervix, Outcome 3 Caesarean section.
28.4
28.4. Analysis
Comparison 28 Oestrogen versus extraamniotic prostaglandins: all primiparae, unfavourable cervix, Outcome 4 Serious neonatal morbidity or perinatal death.
28.8
28.8. Analysis
Comparison 28 Oestrogen versus extraamniotic prostaglandins: all primiparae, unfavourable cervix, Outcome 8 Uterine hyperstimulation without FHR changes.
28.11
28.11. Analysis
Comparison 28 Oestrogen versus extraamniotic prostaglandins: all primiparae, unfavourable cervix, Outcome 11 Instrumental vaginal delivery.
28.16
28.16. Analysis
Comparison 28 Oestrogen versus extraamniotic prostaglandins: all primiparae, unfavourable cervix, Outcome 16 Perinatal death.
See this image and copyright information in PMC

References

References to studies included in this review

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Gordon 1977 {published data only}
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Kelly 2001a
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Kelly 2001b
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Kelly 2003
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Kelly 2008
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Kelly 2008a
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Luckas 2000
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Muzonzini 2004
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Neilson 2000
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RevMan 2008 [Computer program]
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Smith 2003
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Smith 2004
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Thomas 2001
    1. Thomas J, Kelly AJ, Kavanagh J. Oestrogens alone or with amniotomy for cervical ripening or induction of labour. Cochrane Database of Systematic Reviews 2001, Issue 4. [DOI: 10.1002/14651858.CD003393] - DOI - PMC - PubMed

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