primary outcome:
Acupuncture or acupressure for induction of labour
Clinically relevant outcomes for trials of methods of cervical ripening/labour induction were prespecified by two authors of labour induction reviews (Justus Hofmeyr and Zarko Alfirevic) (Hofmeyr 2009). Differences were settled by discussion.Five primary outcomes were chosen as being most representative of the clinically important measures of effectiveness and complications. It was agreed that subgroup analyses would be limited to the primary outcomes:
(1) vaginal delivery not achieved within 24 hours;
(2) uterine hyperstimulation with fetal heart rate (FHR) changes;
(3) caesarean section;
(4) serious neonatal morbidity or perinatal death (e.g. seizures, birth asphyxia defined by trialists, neonatal encephalopathy, disability in childhood);
(5) serious maternal morbidity or death (e.g. uterine rupture, admission to intensive care unit, septicaemia).Perinatal and maternal morbidity and mortality are composite outcomes. This is not an ideal solution because some components are clearly less severe than others. It is possible for one intervention to cause more deaths but less severe morbidity. However, in the context of labour induction at term, this is unlikely. All these events will be rare, and a modest change in their incidence will be easier to detect if composite outcomes are presented. The incidence of individual components were explored as secondary outcomes (see below).Eight trials with 789 women reported on caesarean section and one trial with 364 women reported on serious neonatal morbidity. No trial reported on vaginal birth not achieved within 24 hours or uterine hyperstimulation with fetal heart rate (FHR) changes. Only one trial reported on maternal death, and recorded zero deaths in either group (Smith 2008). None of the other trials reported on serious maternal morbidity or death (e.g. uterine rupture, admission to intensive care unit, septicaemia).Eight trials with 760 women reported on caesarean section. No trial reported on serious neonatal morbidity; vaginal birth not achieved within 24 hours; uterine hyperstimulation with fetal heart rate (FHR) changes; and serious maternal morbidity or death (e.g. uterine rupture, admission to intensive care unit, septicaemia).One trial with 207 women reported on caesarean section. No trial reported on serious neonatal morbidity; vaginal delivery not achieved within 24 hours; uterine hyperstimulation with fetal heart rate (FHR) changes; and serious maternal morbidity or death (e.g. uterine rupture, admission to intensive care unit, septicaemia).Two trials reported on one primary outcome only: caesarean section. No trial reported on serious neonatal morbidity; vaginal delivery not achieved within 24 hours; uterine hyperstimulation with FHR changes; and serious maternal morbidity or death (e.g. uterine rupture, admission to intensive care unit, septicaemia).Two trials reported on one primary outcome only: caesarean section. No trial reported on serious neonatal morbidity; vaginal birth not achieved within 24 hours; uterine hyperstimulation with FHR changes; and serious maternal morbidity or death (e.g. uterine rupture, admission to intensive care unit, septicaemia).