5RESEARCH IMPLICATIONS

The participants in the technical consultation identified important knowledge gaps that need to be addressed through primary research. In general, in these guidelines, the weak recommendations are based on evidence of “very low quality” or “low quality”, indicating that further research is needed. Conversely, strong recommendations are based on “moderate-quality” or “high-quality” evidence, suggesting that further research is not a priority. Overall, the participants in the technical consultation placed a high value on implementation research related to induction of labour and noted that, with the exception of research on the comparison between oral and vaginal misoprostol 25 μg, research on alternative doses and routes of misoprostol for induction of labour should not be regarded as a priority. In addition, the participants agreed that the questions below should be considered by the international community as high-priority topics for research:

  1. What risks (for both the mother and the fetus) are associated with induction of labour and, in terms of those risks, how does induction of labour compare with elective caesarean section? What is the role of caesarean section in the management of women in whom induction of labour has failed?
  2. In under-resourced settings with weak health systems and staff shortages, how can effective monitoring of women be ensured during induction of labour?
  3. How can the Bishop score be used in selecting the method of induction of labour in clinical practice?
  4. In settings where reliable gestational age determination is problematic, what should be the policy for labour induction at term and post term?
  5. In uncomplicated gestational diabetes, at what gestational age should labour be induced, if at all?
  6. Should induction of labour be offered to women with an uncomplicated twin pregnancy at or near term?
  7. Regarding the combination of amniotomy and oxytocin for induction of labour, how long after, and based on what indicators, should amniotomy be performed?
  8. What is the best regimen for oral misoprostol that would give superior results to those achieved with vaginal misoprostol 25 μg?
  9. With regard to the technique of using the balloon catheter, what should be: (i) the ideal size of the balloon; (ii) the volume of the bulb; and (iii) the ideal pulling force during traction? In addition, how long should the traction be applied and what is relationship between balloon use and maternal infection? Additional research comparing the balloon catheter use with placebo is needed to consolidate (or not) the recommendation on induction of labour using balloon catheters.
  10. What is role of calcium channel blockers and atosiban in the treatment of uterine hyperstimulation?