Kavanagh J, Kelly A J, Thomas J
Evidence for Policy and Practice Information and Co-ordinating Centre, Social Science Research Unit, Institute of Education, University of London, 18 Woburn Square, London, UK, WC1H 0NR.
Cochrane Database Syst Rev. 2005 Jul 20;2005(3):CD003392. doi: 10.1002/14651858.CD003392.pub2.
Breast stimulation has been suggested as a means of inducing labour. It is a non-medical intervention allowing women greater control over the induction process. This is one of a series of reviews of methods of cervical ripening and labour induction using a standardised methodology.
To determine the effectiveness of breast stimulation for third trimester cervical ripening or induction of labour in comparison with placebo/no intervention or other methods of induction of labour.
The Cochrane Pregnancy and Childbirth Group Trials Register (March 2004) and bibliographies of relevant papers.
Clinical trials of breast stimulation for third trimester cervical ripening or labour induction.
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.
Six trials (719 women) were included. Analysis of trials comparing breast stimulation with no intervention found a significant reduction in the number of women not in labour at 72 hours (62.7% versus 93.6%, relative risk (RR) 0.67, 95% confidence interval (CI) 0.60 to 0.74). This result was not significant in women with an unfavourable cervix. A major reduction in the rate of postpartum haemorrhage was reported (0.7% versus 6%, RR 0.16, 95% CI 0.03 to 0.87). No significant difference was detected in the caesarean section rate (9% versus 10%, RR 0.90, 95% CI 0.38 to 2.12) or rates of meconium staining. There were no instances of uterine hyperstimulation. Three perinatal deaths were reported (1.8% versus 0%, RR 8.17, 95% CI 0.45 to 147.77). When comparing breast stimulation with oxytocin alone the analysis found no difference in caesarean section rates (28% versus 47%, RR 0.60, 95% CI 0.31 to 1.18). No difference was detected in the number of women not in labour after 72 hours (58.8% versus 25%, RR 2.35, 95% CI 1.00 to 5.54) or rates of meconium staining. There were four perinatal deaths (17.6% versus 5%, RR 3.53, 95% CI 0.40 to 30.88).
AUTHORS' CONCLUSIONS: Breast stimulation appears beneficial in relation to the number of women not in labour after 72 hours, and reduced postpartum haemorrhage rates. Until safety issues have been fully evaluated it should not be used in high-risk women. Further research is required to evaluate its safety, and should seek data on postpartum haemorrhage rates, number of women not in labour at 72 hours and maternal satisfaction.
乳房刺激已被提议作为引产的一种方法。它是一种非医学干预措施，能让女性对引产过程有更大的掌控权。这是一系列使用标准化方法对宫颈成熟和引产方法进行的综述之一。
与安慰剂/无干预措施或其他引产方法相比，确定乳房刺激对孕晚期宫颈成熟或引产的有效性。
考克兰妊娠与分娩组试验注册库（2004年3月）及相关论文的参考文献。
关于乳房刺激用于孕晚期宫颈成熟或引产的临床试验。
制定了一项策略来处理与引产相关的大量且复杂的试验数据。这涉及两阶段的数据提取方法。
纳入了6项试验（719名女性）。对比较乳房刺激与无干预措施的试验分析发现，72小时时未分娩的女性数量显著减少（62.7%对93.6%，相对危险度（RR）0.67，95%置信区间（CI）0.60至0.74）。对于宫颈条件不佳的女性，这一结果不显著。据报告产后出血率大幅降低（0.7%对6%，RR 0.16，95%CI 0.03至0.87）。剖宫产率（9%对10%，RR 0.90，95%CI 0.38至2.12）或胎粪污染率未检测到显著差异。未出现子宫过度刺激的情况。报告了3例围产期死亡（1.8%对0%，RR 8.17，95%CI 0.45至147.77）。当将乳房刺激与单独使用缩宫素进行比较时，分析发现剖宫产率无差异（28%对47%，RR 0.60，95%CI 0.31至1.18）。72小时后未分娩的女性数量（58.8%对25%，RR 2.35，95%CI 1.00至5.54）或胎粪污染率未检测到差异。有4例围产期死亡（17.6%对5%，RR 3.53，95%CI 0.40至30.88）。
乳房刺激在72小时后未分娩的女性数量及降低产后出血率方面似乎有益。在安全问题得到充分评估之前，不应在高危女性中使用。需要进一步研究以评估其安全性，并且应获取产后出血率、72小时未分娩女性数量及产妇满意度的数据。
