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CC BY-NC-ND 4.0 · AJP Rep 2018; 08(04): e365-e378
DOI: 10.1055/s-0038-1676577
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Challenges and Limitations of Clinical Trials on Labor Induction: A Review of the Literature

Oscar A. Viteri
1   Avera Medical Group Maternal Fetal Medicine, Avera McKennan Hospital and University Health Center, Sioux Falls, South Dakota
,
Baha M. Sibai
2   Department of Obstetrics, Gynecology and Reproductive Sciences, UTHealth McGovern Medical School, Houston, Texas
› Author Affiliations
Further Information

Publication History

15 June 2018

12 October 2018

Publication Date:
26 December 2018 (online)

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Abstract

Induction of labor is a common obstetric procedure performed in nearly a quarter of all deliveries in the United States. Pharmacological (prostaglandins, oxytocin) and/or mechanical methods (balloon catheters) are commonly used for labor induction; however, there is ongoing debate as to which method is the safest and most effective. This narrative review discusses key limitations of published trials on labor induction, including the lack of well-designed randomized controlled trials directly comparing specific methods of induction, heterogeneous trial populations, and wide variation in the protocols used and outcomes reported. Furthermore, the majority of published trials were underpowered to detect significant differences in the most clinically relevant efficacy and safety outcomes (e.g., cesarean delivery, neonatal mortality). By identifying the limitations of labor induction trials, we hope to highlight the importance of quality published data to better inform guidelines and drive evidence-based treatment decisions.

Keywords

labor induction - prostaglandins - dinoprostone - misoprostol - oxytocin - clinical trials
 

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