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Meta-Analysis
. 2013 Jul 24;2013(7):CD003099.
doi: 10.1002/14651858.CD003099.pub2.

Castor oil, bath and/or enema for cervical priming and induction of labour

Anthony J Kelly  1 , Josephine Kavanagh, Jane Thomas
Affiliations
Meta-Analysis

Castor oil, bath and/or enema for cervical priming and induction of labour

Anthony J Kelly et al. Cochrane Database Syst Rev. .

Abstract

Background: Castor oil, a potent cathartic, is derived from the bean of the castor plant. Anecdotal reports, which date back to ancient Egypt have suggested the use of castor oil to stimulate labour. Castor oil has been widely used as a traditional method of initiating labour in midwifery practice. Its role in the initiation of labour is poorly understood and data examining its efficacy within a clinical trial are limited. 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 castor oil or enemas for third trimester cervical ripening or induction of labour in comparison with other methods of cervical ripening or induction of labour.

Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 April 2013) and bibliographies of relevant papers.

Selection criteria: Clinical trials comparing castor oil, bath or enemas 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.

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.

Main results: Three trials, involving 233 women, are included. There was no evidence of differences in caesarean section rates between the two interventions in the two trials reporting this outcome (risk ratio (RR) 2.04, 95% confidence interval (CI) 0.92 to 4.55). There were no data presented on neonatal or maternal mortality or morbidity.There was no evidence of a difference between castor oil and placebo/no treatment for the rate of instrumental delivery, meconium-stained liquor, or Apgar score less than seven at five minutes. The number of participants was too small to detect all but large differences in outcome. All women who ingested castor oil felt nauseous (RR 59.92, 95% CI 8.46 to 424.52).

Authors' conclusions: The three trials included in the review contain small numbers of women. All three studies used single doses of castor oil. The results from these studies should be interpreted with caution due to the risk of bias introduced due to poor methodological quality. Further research is needed to attempt to quantify the efficacy of castor oil as an cervical priming and induction agent.

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Conflict of interest statement

None known.

Figures

1
1
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Castor oil versus no treatment/placebo (all women), Outcome 1 Caesarean section.
1.2
1.2. Analysis
Comparison 1 Castor oil versus no treatment/placebo (all women), Outcome 2 instrumental vaginal delivery.
1.3
1.3. Analysis
Comparison 1 Castor oil versus no treatment/placebo (all women), Outcome 3 Meconium‐stained liquor.
1.4
1.4. Analysis
Comparison 1 Castor oil versus no treatment/placebo (all women), Outcome 4 Apgar score < 7 at 5 minutes.
1.5
1.5. Analysis
Comparison 1 Castor oil versus no treatment/placebo (all women), Outcome 5 Maternal side effects (all).
1.6
1.6. Analysis
Comparison 1 Castor oil versus no treatment/placebo (all women), Outcome 6 Nausea (maternal).
1.7
1.7. Analysis
Comparison 1 Castor oil versus no treatment/placebo (all women), Outcome 7 Serious maternal complications.
2.1
2.1. Analysis
Comparison 2 Castor oil versus no treatment/placebo (all women, unfavourable cervix), Outcome 1 Caesarean section.
2.2
2.2. Analysis
Comparison 2 Castor oil versus no treatment/placebo (all women, unfavourable cervix), Outcome 2 Meconium‐stained liquor.
2.3
2.3. Analysis
Comparison 2 Castor oil versus no treatment/placebo (all women, unfavourable cervix), Outcome 3 Apgar score < 7 at 5 minutes.
2.4
2.4. Analysis
Comparison 2 Castor oil versus no treatment/placebo (all women, unfavourable cervix), Outcome 4 Maternal side effects (all).
2.5
2.5. Analysis
Comparison 2 Castor oil versus no treatment/placebo (all women, unfavourable cervix), Outcome 5 Nausea (maternal).
3.1
3.1. Analysis
Comparison 3 Castor oil versus no treatment (all women, intact membranes, unfavourable cervix), Outcome 1 Caesarean section.
3.2
3.2. Analysis
Comparison 3 Castor oil versus no treatment (all women, intact membranes, unfavourable cervix), Outcome 2 Meconium‐stained liquor.
3.3
3.3. Analysis
Comparison 3 Castor oil versus no treatment (all women, intact membranes, unfavourable cervix), Outcome 3 Apgar score < 7 at 5 minutes.
3.4
3.4. Analysis
Comparison 3 Castor oil versus no treatment (all women, intact membranes, unfavourable cervix), Outcome 4 Maternal side effects (all).
3.5
3.5. Analysis
Comparison 3 Castor oil versus no treatment (all women, intact membranes, unfavourable cervix), Outcome 5 Nausea (maternal).
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Update of

References

References to studies included in this review

Azhari 2006 {published data only}
    1. Azhari S, Pirdadeh S, Lotfalizadeh M, Shakeri MT. Evaluation of the effect of castor oil on initiating labor in term pregnancy. Saudi Medical Journal 2006;27(7):1011‐4. - PubMed
Garry 2000 {published data only}
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Gilad 2012 {published data only}
    1. Gilad R, Hochner H, Vinograd O, Saam R, Hochner‐Celnikier D, Porat S. The CIC Trial ‐ castor oil for induction of contractions in post‐term pregnancies. American Journal of Obstetrics and Gynecology 2012;206(Suppl 1):S77‐S78.

References to studies excluded from this review

Azharkish 2008 {published data only}
    1. Azarkish F, Absalan N, Roudbari M, Barahooie F, Mirlashari S, Bameri M. Effect of oral castor oil on labor pain in post term pregnancy. Scientific Journal of Kurdistan University of Medical Sciences 2008;13(3):e1‐e6, En1.
Mathie 1959 {published data only}
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Saberi 2008 {published data only}
    1. Saberi F, Abedzadeh M, Sadat Z, Eslami A. Effect of castor oil on induction of labour. Journal of the Kashan University of Medical Sciences 2008; Vol. 11, issue 4.
Wang 1997 {published data only}
    1. Wang L, Shi C, Yang G. Comparison of misoprostol and ricinus oil meal for cervical ripening and labor induction. Chung‐Hua Fu Chan Ko Tsa Chih [Chinese Journal of Obstetrics and Gynaecology] 1997;32(11):666‐8. - PubMed

References to studies awaiting assessment

Porat 2006 {published data only}
    1. Porat S. The use of castor oil as a labor initiator in post‐date pregnancies (planned trial). ClinicalTrials.gov (http://clinicaltrials.gov/) (accessed 21 March 2006).

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References to other published versions of this review

Kelly 2001a
    1. Kelly AJ, Kavanagh J, Thomas J. Castor oil, bath and/or enema for cervical priming and induction of labour. Cochrane Database of Systematic Reviews 2001, Issue 2. [DOI: 10.1002/14651858.CD003099] - DOI - PubMed

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