Corticosteroids for induction of labour.
BACKGROUND
The role of corticosteroids in the process of labour is not well understood. Animal studies have shown the importance of cortisol secretion by the fetal adrenal gland in initiating labour in sheep. Infusion of glucocorticosteroids into the fetus has also shown to induce premature labour in sheep. Some assumptions have been proposed regarding the mode of action of corticosteroids, including both a paracrine and autocrine action, following the identification of glucocorticoid receptors on human amnion. Given these studies it has been postulated that corticosteroids given intraamniotically will promote the induction of labour. This is one of a series of reviews of methods of cervical ripening and labour induction using standardised methodology.


OBJECTIVE
To determine the effects of corticosteroids for third trimester cervical ripening or induction of labour in comparison with other methods of cervical priming or induction of labour.


METHODS
The Cochrane Pregnancy and Childbirth Group trials register, the Cochrane Controlled Trials Register and bibliographies of relevant papers. Last searched: November 2000.


METHODS
(1) clinical trials comparing corticosteroids 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.


METHODS
A strategy has been developed to deal with the large volume and complexity of trial data relating to labour induction. This involves a two-stage method of data extraction.


RESULTS
There are no included trials, hence no results are presented.


CONCLUSIONS
The effectiveness of corticosteroids for induction of labour is uncertain. Use of this method of induction of labour is not commonly used and further research in this area is probably unwarranted.
Kavanagh
J
J
Clinical Effectiveness Support Unit, Royal College of Obstetricians and Gynaecologists, 27 Sussex Place, Regent's Park, London, UK, NW1 4RG. jkavanagh@rcog.org.uk
Kelly
A J
AJ
Thomas
J
J
D000287:Administration, Topical; D000893:Anti-Inflammatory Agents; D020070:Cervical Ripening; D003907:Dexamethasone; D005260:Female; D005938:Glucocorticoids; D006801:Humans; D007751:Labor, Induced / Q000379:methods*; D011247:Pregnancy; D011263:Pregnancy Trimester, Third
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D003907:Dexamethasone