Abstract:
BACKGROUND:Misoprostol (Cytotec, Searle) is a prostaglandin E1 analogue marketed for use in the prevention and treatment of peptic ulcer disease. It is inexpensive, easily stored at room temperature and has few systemic side effects. It is rapidly absorbed orally and vaginally. Although not registered for such use, misoprostol has been widely used for obstetric and gynaecological indications, such as induction of abortion and of labour. 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 vaginal misoprostol for third trimester cervical ripening or induction of labour. SEARCH STRATEGY:The Cochrane Pregnancy and Childbirth Group trials register, the Cochrane Controlled Trials Register and bibliographies of relevant papers. Date of last search: April 2001. SELECTION CRITERIA:The criteria for inclusion included the following: (1) clinical trials comparing vaginal misoprostol 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 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, and incorporated into a series of primary reviews arranged by methods of induction of labour, following a standardised methodology. The data will then be extracted from the primary reviews into a series of secondary reviews, arranged by category of woman. To avoid duplication of data in the primary reviews, the labour induction methods have been listed in a specific order, from one to 25. Each primary review includes comparisons between one of the methods (from two to 25) with only those methods above it on the list. MAIN RESULTS:Forty-five trials have been included. Compared to placebo, misoprostol was associated with increased cervical ripening (relative risk of unfavourable or unchanged cervix after 12 to 24 hours with misoprostol 0.09, 95% confidence interval 0.03 to 0.24). It was also associated with a reduced need for oxytocin (relative risk 0.52, 95% confidence interval 0.41 to 0.68) and reduced failure to achieve vaginal delivery within 24 hours (relative risk 0.36, 95% confidence interval 0.19 to 0.68). Uterine hyperstimulation, without fetal heart rate changes, was increased (relative risk 10.11, 95% confidence interval 1.91 to 53.6). Compared with vaginal prostaglandin E2, intracervical prostaglandin E2 and oxytocin, vaginal misoprostol labour induction resulted in fewer failures to achieve vaginal delivery within 24 hours and more uterine hyperstimulation without fetal heart rate changes. Compared with vaginal or intracervical prostaglandin E2, unchanged or unfavourable cervix after 12 to 24 hours, and oxytocin augmentation were less common with misoprostol. Compared with intracervical prostaglandin E2, uterine hyperstimulation with fetal heart rate changes and meconium stained liquor were increased and epidural analgesia was reduced. Compared with oxytocin, caesarean sections and epidural analgesia were reduced with misoprostol. Lower doses of misoprostol compared to higher doses did not show significant differences except for more need for oxytocin augmentation and less uterine hyperstimulation, with and without fetal heart rate changes. Information on women's views is conspicuously lacking. REVIEWER'S CONCLUSIONS:Although vaginal misoprostol appears to be more effective than conventional methods of cervical ripening and labour induction, the apparent increase in uterine hyperstimulation is of concern. The studies were not large enough to exclude the possibility of rare but serious adverse effects, particularly uterine rupture, which has been reported anecdotally following misoprostol use in women with and without previous caesarean section. The authors request information on cases of uterine rupture known to readers. Further research is needed to establish safety.
journal_name
Cochrane Database Syst Revjournal_title
The Cochrane database of systematic reviewsauthors
Hofmeyr GJ,Gulmezoglu AMdoi
10.1002/14651858.CD000941keywords:
subject
Has Abstractpub_date
2001-01-01 00:00:00pages
CD000941issue
3issn
1469-493Xpii
CD000941pub_type
杂志文章,评审abstract:BACKGROUND:Bed rest is prescribed to all patients with acute myocardial infarction (AMI), but to a variable extent. Current guidelines (American College of Cardiology/ American Heart Association) recommend at least 12 hours bed rest in patients with uncomplicated ST-elevation myocardial infarction, however the basis fo...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD003836.pub2
更新日期:2007-04-18 00:00:00
abstract:BACKGROUND:Routine use of nasogastric tubes after abdominal operations is intended to hasten the return of bowel function, prevent pulmonary complications, diminish the risk of anastomotic leakage, increase patient comfort and shorten hospital stay. OBJECTIVES:To investigate the efficacy of routine nasogastric decompr...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD004929.pub3
更新日期:2007-07-18 00:00:00
abstract:BACKGROUND:Cardiovascular disease, which includes coronary artery disease, stroke and congestive heart failure, is a leading cause of death worldwide. Homocysteine is an amino acid with biological functions in methionine metabolism. A postulated risk factor is an elevated circulating total homocysteine level, which is ...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD006612.pub4
更新日期:2015-01-15 00:00:00
abstract:BACKGROUND:Symptoms of attention deficit hyperactivity disorder (ADHD), diagnosed mainly in children, often persist into adulthood. Adults in this group have a high rate of other psychiatric problems and functional difficulties in a number of key areas such as academic achievement, interpersonal relationships, and empl...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD005041.pub2
更新日期:2014-09-18 00:00:00
abstract:BACKGROUND:Postnatal depression is a common disorder that can have adverse short- and long-term effects on maternal morbidity, the new infant and the family as a whole. Treatment is often largely by social support and psychological interventions. It is not known whether antidepressants are an effective and safe choice ...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD002018.pub2
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abstract:BACKGROUND:In areas where vitamin A deficiency (VAD) is a public health concern, the maternal dietary intake of vitamin A may be not sufficient to meet either the maternal nutritional requirements, or those of the breastfed infant, due the low retinol concentrations in breast milk. OBJECTIVES:To evaluate the effects o...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD005944.pub3
更新日期:2016-03-25 00:00:00
abstract:BACKGROUND:Hallux valgus is classified as an abnormal deviation of the great toe (hallux) towards the midline of the foot. OBJECTIVES:To identify and evaluate the evidence from randomised trials of interventions used to correct hallux valgus. SEARCH STRATEGY:We searched the Cochrane Bone, Joint and Muscle Trauama Gro...
journal_title:The Cochrane database of systematic reviews
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doi:10.1002/14651858.CD000964.pub3
更新日期:2009-04-15 00:00:00
abstract:BACKGROUND:Systemic cytostatic therapies for advanced, metastatic thyroid carcinomas have been poorly effective. Tumor growth and metastasis depend on blood supply and blood vessel formation (angiogenesis). Therefore, inhibition of angiogenesis may represent a promising target for cancer therapy. OBJECTIVES:To evaluat...
journal_title:The Cochrane database of systematic reviews
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doi:10.1002/14651858.CD007958.pub2
更新日期:2010-03-17 00:00:00
abstract:BACKGROUND:Psychological interventions are widely used in the treatment of post-traumatic stress disorder (PTSD). OBJECTIVES:To perform a systematic review of randomised controlled trials of all psychological treatments following the guidelines of The Cochrane Collaboration. SEARCH STRATEGY:Systematic searches of com...
journal_title:The Cochrane database of systematic reviews
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doi:10.1002/14651858.CD003388.pub3
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abstract:BACKGROUND:Delirium is a common clinical syndrome defined as alterations in attention with an additional disturbance in cognition or perception, which develop over a short period of time and tend to fluctuate during the course of the episode. Delirium is commonly treated in hospitals or community settings and is often ...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD012494.pub2
更新日期:2018-06-28 00:00:00
abstract:BACKGROUND:This is an updated version of the original Cochrane review published in Issue 5, 2015.Cervical cancer is the fourth most common cancer among women worldwide, with estimated 569,847 new diagnoses and 311,365 deaths per year. However, incidence and stage at diagnosis vary greatly between geographic areas and a...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章
doi:10.1002/14651858.CD011000.pub3
更新日期:2019-03-19 00:00:00
abstract:BACKGROUND:Care within a stroke unit reduces death or dependency after stroke. However, studies have found significant variations in clinical practice, access to stroke unit care, organisation of patient care, and clinical outcome. Stroke care pathways have been introduced as a method to promote organised and efficient...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD002924
更新日期:2002-01-01 00:00:00
abstract:BACKGROUND:Neonatal extracorporeal membrane oxygenation (ECMO) is a complex procedure of life support used in severe but potentially reversible respiratory failure in term infants. Although the number of babies eligible for ECMO is small and the use of ECMO invasive and potentially expensive, its benefits may be high. ...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD001340.pub2
更新日期:2008-07-16 00:00:00
abstract:BACKGROUND:Pelvic organ prolapse is common, and some degree of prolapse is seen in 50% of parous women. Women with prolapse can experience a variety of pelvic floor symptoms. Treatments include surgery, mechanical devices and conservative management. Conservative management approaches, such as giving lifestyle advice a...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD003882.pub3
更新日期:2006-10-18 00:00:00
abstract:BACKGROUND:Leprosy causes nerve damage which may result in nerve function impairment and disability. Decompressive surgery is used for treating nerve damage, although the effect is uncertain. OBJECTIVES:To assess the effects of decompressive surgery on nerve damage in leprosy. SEARCH STRATEGY:We searched the Cochrane...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD006983.pub2
更新日期:2009-01-21 00:00:00
abstract:BACKGROUND:Venous access is an essential part of caring for the sick neonate. However, problems such as contamination of fluids with bacteria, endotoxins and particulates have been associated with intravenous infusion therapy. Intravenous in-line filters claim to be an effective strategy for the removal of bacteria, en...
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更新日期:2015-08-06 00:00:00
abstract:BACKGROUND:Good neurologic outcome after cardiac arrest is hard to achieve. Interventions during the resuscitation phase and treatment within the first hours after the event are critical. Experimental evidence suggests that therapeutic hypothermia is beneficial, and a number of clinical studies on this subject have bee...
journal_title:The Cochrane database of systematic reviews
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doi:10.1002/14651858.CD004128.pub2
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abstract:BACKGROUND:In women with preterm labor, tocolysis has not been shown to improve perinatal mortality; however, it is often given for 48 hours to allow for the corticosteroid effect for fetal maturation. In women with preterm premature rupture of membranes (PPROM), the use of tocolysis is still controversial. In theory, ...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
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pub_type: 杂志文章,meta分析,评审
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更新日期:2018-05-29 00:00:00
abstract:BACKGROUND:Potentially disabling postural headache occurs after dural puncture in 1-70% of patients. It has been suggested that such headaches may be less common if patients routinely have a period of bed rest or receive supplementary fluids after the procedure. OBJECTIVES:To assess the effects on post dural puncture ...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD001790
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abstract:BACKGROUND:Postnatal depression, with a prevalence of at least 10%, is probably the most common complication of the puerperium. A deficiency or imbalance of sex hormones has repeatedly been suggested as a cause. OBJECTIVES:The objective of this review was to evaluate the role of oestrogens and progestogens in the prev...
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更新日期:2000-01-01 00:00:00
abstract:BACKGROUND:A particularly difficult challenge for community treatment of people with serious mental illnesses is the delivery of an acceptable level of care during the acute phases of severe mental illness. Crisis-intervention models of care were developed as a possible solution. OBJECTIVES:To review the effects of cr...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
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更新日期:2015-12-03 00:00:00
abstract:BACKGROUND:Recurrent respiratory papillomatosis (RRP) is a benign condition of the mucosa of the upper aerodigestive tract. It is characterised by recurrent papillomatous lesions and is associated with human papillomavirus (HPV). Frequent recurrence and rapid papilloma growth are common and in part responsible for the ...
journal_title:The Cochrane database of systematic reviews
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更新日期:2014-06-05 00:00:00
abstract:BACKGROUND:Malabsorption and deficiency of fat-soluble vitamins K may occur in cystic fibrosis, a genetic disorder affecting multiple organs. Vitamin K is known to play an important role in both blood coagulation and bone formation, hence the role of supplementation of vitamin K in this category needs to be reviewed. T...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章
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更新日期:2020-06-04 00:00:00
abstract:BACKGROUND:Family centred care is an important part of neonatal intensive care. Ensuring effective communication in the neonatal intensive care unit (NICU) is a challenge but is crucial to the implementation of family centred care. Providing parents in NICU with audiotape recordings of their conversations with neonatol...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
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更新日期:2005-01-25 00:00:00
abstract:BACKGROUND:Percutaneous dilatational tracheostomy (PDT) is one of the most common bedside surgical procedures performed in critically ill adults, on intensive care units (ICUs), who require long-term ventilation. PDT is associated with relevant life-threatening complications: Cuff rupture or accidental extubation may l...
journal_title:The Cochrane database of systematic reviews
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更新日期:2018-11-15 00:00:00
abstract:BACKGROUND:Respiratory failure due to lung immaturity is a major cause of mortality in preterm infants. Although intermittent positive pressure ventilation (IPPV) saves lives, lung distortion during its use is associated with lung injury and chronic lung disease (CLD). Conventional IPPV is provided at 30-80 breaths per...
journal_title:The Cochrane database of systematic reviews
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更新日期:2001-01-01 00:00:00
abstract:BACKGROUND:While all asthma consensus statements recommend the use of written action plan (WAP) as a central part of asthma management, a recent systematic review of randomised trials highlighted the paucity of trials where the only difference between groups was the provision or not of a written action plan. OBJECTIVE...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
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更新日期:2006-07-19 00:00:00
abstract:BACKGROUND:Virtual reality and interactive video gaming have emerged as new treatment approaches in stroke rehabilitation. In particular, commercial gaming consoles are being rapidly adopted in clinical settings; however, there is currently little information about their effectiveness. OBJECTIVES:To evaluate the effec...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
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更新日期:2011-09-07 00:00:00
abstract:BACKGROUND:Many dental procedures cause bacteraemia and it is believed that this may lead to bacterial endocarditis (BE) in a few people. Guidelines in many countries recommend that prior to invasive dental procedures antibiotics are administered to people at high risk of endocarditis. However, it is unclear whether th...
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更新日期:2004-01-01 00:00:00