Rédacteurs : Olivier Goret, Johan Nguyen, Claude Pernice, Jean-Luc Gerlier
Ceci est une ancienne révision du document !
Sommaire
Induction du travail : évaluation de l'acupuncture
1. Revues systématiques et méta-analyses
1.1. Smith 2013 ☆
Smith, CA, Crowther CA et al. Acupuncture for induction of labour. Cochrane Database Syst 2013 ;(8):CD002962. [160368].
| Purpose | To determine the effectiveness and safety of acupuncture for third trimester cervical ripening or induction of labour. |
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| Methods | We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (23 November 2012), PubMed (1966 to 23 November 2012), Embase (1980 to 23 November 2012), Dissertation Abstracts (1861 to 23 November 2012), CINAHL (1982 to 23 November 2012), the WHO International Clinical Trials Registry Portal (ICTRP) (23 November 2012) and bibliographies of relevant papers. Clinical trials comparing acupuncture 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. Two review authors independently assessed trials for inclusion, evaluated methodological quality and extracted data. |
| Results | The original review included three trials and seven trials were excluded. This updated review includes 14 trials, and excludes eight trials. Three trials previously excluded due to no clinically relevant outcomes are now included. Eight new trials were included, and four new trials were excluded. We included 14 trials with data reporting on 2220 women. Trials reported on three primary outcomes only caesarean section, serious neonatal morbidity and maternal mortality. No trial reported on vaginal delivery not achieved within 24 hours; and uterine hyperstimulation with fetal heart rate (FHR) changes. There was no difference in caesarean deliveries between acupuncture and the sham control (average risk ratio (RR) 0.95, 95% confidence interval (CI) 0.69 to 1.30, six trials, 654 women), and acupuncture versus usual care (average RR 0.69, 95% CI 0.40, 1.20, six trials, 361 women). There was no difference in neonatal seizures between acupuncture and the sham group (RR 1.01, 95% CI 0.06 to 16.04, one trial, 364 women).There was some evidence of a change in cervical maturation for women receiving acupuncture compared with the sham control, (mean difference (MD) 0.40. 95%CI 0.11 to 0.69, one trial, 125 women), and when compared with usual care (MD 1.30, 95% CI 0.11 to 2.49, one trial, 67 women). The length of labour was shorter in the usual care group compared with acupuncture (average standardised mean difference (SMD) 0.67, 95% CI 0.18 to 1.17, one trial 68 women). There were no other statistically significant differences between groups. Few studies reported on many clinically relevant outcomes. One trial was at a low risk of bias on all domains. |
| Conclusion | Overall, there have been few studies assessing the role of acupuncture for induction of labour. Before implications for clinical practice can be made there is a need for well-designed randomised controlled trials to evaluate the role of acupuncture to induce labour and for trials to assess clinically meaningful outcomes. |
1.2. Hall 2012 ☆
Hall HG, Mc Kenna LG, Griffiths DL. Complementary and alternative medicine for induction of labour. Women Birth 2012. [166593]
| Objectifs | Induction of labour is a common obstetric procedure. Some women are likely to turn to complementary and alternative medicine in order to avoid medical intervention. The aim of this paper is to examine the scientific evidence for the use of complementary and alternative medicine to stimulate labour. |
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| Méthodes | An initial search for relevant literature published from 2000 was undertaken using a range of databases. Articles were also identified by examining bibliographies. |
| Résultats | Most complementary and alternative medicines used for induction of labour are recommended on the basis of traditional knowledge, rather than scientific research. Currently, the clinical evidence is sparse and it is not possible to make firm conclusions regarding the effectiveness of these therapies. There is however some data to support the use of breast stimulation for induction of labour. Acupuncture and raspberry leaf may also be beneficial. Castor oil and evening primrose oil might not be effective and possibly increase the incidence of complications. There is no evidence from clinical trails to support homeopathy however, some women have found these remedies helpful. Blue cohosh may be harmful during pregnancy and should not be recommended for induction. Other complementary and alternative medicine (CAM) therapies may be useful but further investigation is needed. |
| Conclusions | More research is needed to establish the safety and efficacy of CAM modalities. Midwives should develop a good understanding of these therapies, including both the benefits and risks, so they can assist women to make appropriate decisions. |
1.3. Dowswell 2010 ∼
Dowswell T, Kelly AJ, Livio S, Norman JE, Alfirevic Z. Differents methods for the induction of labour in outpatient settings. Cochrane Database Syst Rev 2010;8. [142933].142933
| Objectifs | Induction of labour is carried out for a variety of indications and using a range of pharmacological, mechanical and other methods. For women at low risk, some methods of induction of labour may be suitable for use in outpatient settings. To examine pharmacological and mechanical interventions to induce labour in outpatient settings in terms of feasibility, effectiveness, maternal satisfaction, healthcare costs and, where information is available, safety. The review complements existing reviews on labour induction examining effectiveness and safety. |
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| Méthodes | Search strategy: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (December 2009) and reference lists of retrieved studies. Selection criteria: We included randomised controlled trials examining outpatient cervical ripening or induction of labour with pharmacological agents or mechanical methods. Data collection and analysis: Two authors independently extracted data and assessed eligible papers for risk of bias. We checked all data after entry into review manager software. |
| Résultats | We included 28 studies with 2616 women examining different methods of induction of labour where women received treatment at home or were sent home after initial treatment and monitoring in hospital.Studies examined vaginal and intracervical PGE(2), vaginal and oral misoprostol, isosorbide mononitrate, mifepristone, oestrogens, and acupuncture. Overall, the results demonstrate that outpatient induction of labour is feasible and that important adverse events are rare. There was no strong evidence that agents used to induce labour in outpatient settings had an impact (positive or negative) on maternal or neonatal health. There was some evidence that, compared to placebo or no treatment, induction agents reduced the need for further interventions to induce labour, and shortened the interval from intervention to birth. We were unable to pool results on outcomes relating to progress in labour as studies tended to measure a very broad range of outcomes.There was no evidence that induction agents increased interventions in labour such as operative deliveries. Only two studies provided information on women's views about the induction process, and overall there was very little information on the costs to health service providers of different methods of labour induction in outpatient settings. |
| Conclusions | Induction of labour in outpatient settings appears feasible. We do not have sufficient evidence to know which induction methods are preferred by women, or the interventions that are most effective and safe to use in outpatient settings. |
1.4. Lim 2009 ☆☆
Lim CE et al. Effect of Acupuncture on Induction of Labor. J Altern Complement Med. 2009;15(11):1209-1214. [153169]
| Purpose | The objective of this study is to review the existing scientific evidence on the potential role of acupuncture on induction of labor during pregnancy. |
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| Methods | The Medline, EMBASE, Cochrane Central Register of Controlled Trials, AMED (Allied and Complementary Medicine), and NCCAM (The National Center for Complementary and Alternative Medicine) databases were searched to identify relevant monographs from 1970 to 2008. Inclusion criteria: These criteria included all available human acupuncture studies on pregnant women carrying a viable fetus due for third trimester induction of labor. Exclusion criteria: These criteria included studies not meeting the inclusion criteria, in languages other than English, or animal studies. |
| Results | Ten (10) studies on labor induction were identified (5 RCTs, 313 patients). The duration of labor as a result of acupuncture treatment ranged from 10 hours 20 minutes to 29.1 hours. All of the studies demonstrated labor induction by acupuncture treatment. However, because two randomized controlled trials reported that there was no statistically significant effect of acupuncture, these results are more suggestive than definitive. Furthermore, although the relationship between cervical ripening and interleukin-8 (IL-8), prostaglandin F2a (PGF2a), and b-endorphin is well documented in the literature, there is no evidence to suggest that acupuncture alters these mediators. Serum levels of IL8, b-endorphin, and PGF2a were not found to be significantly influenced by acupuncture. |
| Conclusion | Although the definitive role of acupuncture in inducing labor is still yet to be established, the existing studies suggest that acupuncture may be beneficial in labor induction. |
1.5. Smith 2004
Smith CA, Crowther CA. Acupuncture for induction of labour. Cochrane Database Syst Rev. 2004;CD002962. [115416]
| Objectives | This is one of a series of reviews of methods of cervical ripening and labour induction using standardised methodology. The use of complementary therapies is increasing and some women look to complementary therapies during pregnancy and childbirth to be used alongside conventional medical practice. Acupuncture involves the insertion of very fine needles into specific points of the body. The limited observational studies to date suggest acupuncture for induction of labour appears safe, has no known teratogenic effects, and may be effective. The evidence regarding the clinical effectiveness of this technique is limited. To determine the effects of acupuncture for third trimester cervical ripening or induction of labour. |
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| Methods | SEARCH STRATEGY: The Cochrane Pregnancy and Childbirth Group trials register (February 2003), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2003), PubMed (1966 to present), CISCOM (1960 to present), EMBASE (1980 to present) and bibliographies of relevant papers. SELECTION CRITERIA: Clinical trials comparing acupuncture 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. |
| Results | One trial of 56 women was included in the review. Data were not in a form that could be included in the meta-analysis. |
| Conclusions | There is a need for well-designed randomised controlled trials to evaluate the role of acupuncture to induce labour and for trials to assess clinically meaningful outcomes. |
1.6. Smith 2001 Ø
Smith CA ET AL. Acupuncture for induction of labour. Cochrane Database Syst Rev 2001. 1:CD002962. [94833].
| Background | This is one of a series of reviews of methods of cervical ripening and labour induction using standardised methodology. The use of complementary therapies is rising and some women look to complementary therapies during pregnancy and childbirth to be used alongside conventional medical practice. Acupuncture involves the insertion of very fine needles into specific points of the body. The limited observational studies to date suggest acupuncture for induction of labour appears safe, has no known teratogenic effects, and may be effective. The evidence regarding the clinical effectiveness of this technique is limited. |
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| Objectives | To determine the effects of acupuncture for third trimester cervical ripening or induction of labour. |
| Methods | Search strategy: The Cochrane Pregnancy and Childbirth Group trials register, the Cochrane Controlled Trials Register and bibliographies of relevant papers. Selection criteria: The criteria for inclusion included the following: (1) clinical trials comparing acupuncture 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 involves a two-stage method of data extraction. The initial data extraction is 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 | No trials met the inclusion criteria for the systematic review. |
| Reviewer's conclusions | There is a need for a well designed randomised controlled trial to evaluate the role of acupuncture to induce labour. |
2. Recommandation de bonne pratique
2.1. World Health Organization (WHO) 2014
World Health Organization. WHO recommendations for augmentation of labour. Geneva: World Health Organization. 2014. 57p. [169136].
| Recommendation No. 8: Pain relief for preventing delay and reducing the use of augmentation in labour is not recommended. (Weak recommendation, very low quality of evidence) [acupuncture and acupressure], |
2.2. Collège National des Gynécologues et Obstétriciens Français (CNGOF, France) 2011
Grossesse prolongée - Terme dépassé. CNGOF - Collège National des Gynécologues et Obstétriciens Français. 2011. 14p. [165391].
| Les données actuelles ne retrouvent pas d’efficacité de l’acupuncture pour déclencher le travail à terme ou lorsque la grossesse est prolongée (grade C). |
2.3. National Institute for Health and Clinical Excellence (NICE, UK) 2011
National Institute for Health and Clinical Excellence (NICE). Caesarean section. London (UK): National Institute for Health and Clinical Excellence (NICE). 2011; 57p. [167576].
| No influence on likelihood of CS (Caesarean section): Women should be informed that the effects on the likelihood of CS of complementary therapies used during labour (such as acupuncture, aromatherapy, hypnosis, herbal products, nutritional supplements, homeopathic medicines, and Chinese medicines) have not been properly evaluated and further research is needed before such interventions can be recommended. [2004] |
2.4. National Institute for Health and Clinical Excellence (NICE, UK) 2008
National Collaborating Centre for Women's and Children's Health. Induction of labour. London (UK): National Institute for Health and Clinical Excellence (NICE). 2008. 32P. [165269].
| Healthcare professionals should inform women that the available evidence does not support the following methods for induction of labour: herbal supplements, acupuncture, homeopathy, castor oil, hot baths, enemas, sexual intercourse., herbal supplements. |
2.5. Haute Autorité de Santé (HAS, France) 2008
Recommandation de bonne pratique : Déclenchement artificiel du travail à partir de 37 semaines d'aménorrhée. Paris: Haute Autorité de Santé (HAS). 2008. Argumentaire ; Recommandation.
| Les données disponibles ne permettent pas de conclure sur l’intérêt de l’utilisation de l’acupuncture ou l’homéopathie pour induire le travail. |
