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. 2006 Apr 19;2006(2):CD003097.
doi: 10.1002/14651858.CD003097.pub2.

Hyaluronidase for cervical ripening and induction of labour

J Kavanagh  1 , A J Kelly, J Thomas
Affiliations

Hyaluronidase for cervical ripening and induction of labour

J Kavanagh et al. Cochrane Database Syst Rev. .

Abstract

Background: Dilatation and effacement of the cervix are not only a result of uterine contractions, but are also dependent upon ripening processes within the cervix. The cervix is a fibrous organ composed principally of hyaluronic acid, collagen and proteoglycan. Hyaluronic acid increases markedly after the onset of labour. An increase in the level of hyaluronic acid is associated with an increase in tissue water content. Cervical ripening during labour is characterised by changes of the cervix and an increased water content. Cervical injection of hyaluronidase was postulated to increase cervical ripening. This is one of a series of reviews of methods of cervical ripening and labour induction using standardised methodology.

Objectives: To determine the effects of hyaluronidase for third trimester cervical ripening or induction of labour in comparison with other methods of induction of labour.

Search strategy: We searched the Cochrane Pregnancy and Childbirth Group Trials Register (January 2006) and bibliographies of relevant papers.

Selection criteria: Clinical trials of hyaluronidase for third trimester cervical ripening or labour induction.

Data collection and analysis: A strategy was 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. We assessed trial quality. We contacted study authors for additional information. We collected adverse effects information from the trials.

Main results: One trial, with 168 women participating, was included in the review. When compared with placebo for cervical ripening intracervical injections of hyaluronidase resulted in women receiving significantly fewer caesarean sections (18% versus 49%, relative risk (RR) 0.37, 95% confidence interval (CI) 0.22 to 0.61), less need for oxytocin augmentation (10% versus 47%, RR 0.20, 95% CI 0.10 to 0.41), and increased cervical favourability after 24 hours (60% versus 98%, RR 0.62, 95% CI 0.52 to 0.74). No side-effects for mother or baby were reported in this trial.

Authors' conclusions: Intracervical injections of hyaluronidase for cervical ripening appear beneficial. However, this is not common practice. In addition it is an invasive procedure that women may find unacceptable in the presence of less invasive methods.

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Conflict of interest statement

None known.

Figures

1.2
1.2. Analysis
Comparison 1 Hyaluronidase versus placebo (all women), Outcome 2 Uterine hyperstimulation with fetal heart rate changes.
1.3
1.3. Analysis
Comparison 1 Hyaluronidase versus placebo (all women), Outcome 3 Caesarean section.
1.6
1.6. Analysis
Comparison 1 Hyaluronidase versus placebo (all women), Outcome 6 Cervix unfavourable/unchanged after 24 hours.
1.7
1.7. Analysis
Comparison 1 Hyaluronidase versus placebo (all women), Outcome 7 Oxytocin augmentation.
1.8
1.8. Analysis
Comparison 1 Hyaluronidase versus placebo (all women), Outcome 8 Uterine hyperstimulation wihout fetal heart rate changes.
1.18
1.18. Analysis
Comparison 1 Hyaluronidase versus placebo (all women), Outcome 18 Maternal infection.
1.23
1.23. Analysis
Comparison 1 Hyaluronidase versus placebo (all women), Outcome 23 Maternal pain.
2.2
2.2. Analysis
Comparison 2 Hyaluronidase versus placebo (all primiparae), Outcome 2 Uterine hyperstimulation with fetal heart rate changes.
2.3
2.3. Analysis
Comparison 2 Hyaluronidase versus placebo (all primiparae), Outcome 3 Caesarean section.
3.2
3.2. Analysis
Comparison 3 Hyaluronidase versus placebo (all multiparae), Outcome 2 Uterine hyperstimulation with fetal heart rate changes.
3.3
3.3. Analysis
Comparison 3 Hyaluronidase versus placebo (all multiparae), Outcome 3 Caesarean section.
4.2
4.2. Analysis
Comparison 4 Hyaluronidase versus placebo (all women with previous caesarean section), Outcome 2 Uterine hyperstimulation with fetal heart rate changes.
4.3
4.3. Analysis
Comparison 4 Hyaluronidase versus placebo (all women with previous caesarean section), Outcome 3 Caesarean section.
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Update of

References

References to studies included in this review

Spallicci 2003 {published and unpublished data}
    1. Spallicci MDB, Bittar RE. Randomized double blind study of ripening the cervix with hyaluronidase in term gestations [Estudo clinico aleatorizado com grupo controle e mascaramento duplo da maturacao do colo uterino pela hialuronidase em gestacoes a termo]. Revista Brasileira de Ginecologia e Obstetricia 2003;25:67.
    1. Spallicci MDB, Chiea M, Bittar R, Singer Motta J, Basto De Alberquerque P, Zugaib M. Hyaluronidase: a new approach to cervical ripening in pregnancies at term. Personal Communication 2002.

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