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Systematic review to investigate the safety of induction and augmentation of labour among pregnant women with iron-deficiency anaemia
  1. Kathryn Bunch1,
  2. Nia Roberts2,
  3. Marian Knight1,
  4. Manisha Nair1
  1. 1 National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
  2. 2 Bodleian Health Care Libraries, University of Oxford, Knowledge Centre, Oxford, UK
  1. Correspondence to Dr Manisha Nair; manisha.nair{at}


Objective To conduct a systematic review to investigate the safety of induction and/or augmentation of labour compared with spontaneous-onset normal labour among pregnant women with iron-deficiency anaemia.

Design Systematic review.

Setting Studies from all countries, worldwide.

Population Pregnant women with iron-deficiency anaemia at labour and delivery.

Intervention Any intervention related to induction and/or augmentation of labour.

Outcome measures Primary: Postpartum haemorrhage (PPH), heart failure and maternal death. Secondary: Emergency caesarean section, hysterectomy, admission to intensive care unit.

Method We searched 10 databases, including Medline and Embase, from database inception to 1 October 2018. We included all study designs except cross-sectional studies without a comparator group, case reports, case series, ecological studies, and expert opinion. The searches were conducted by a healthcare librarian and two authors independently screened and reviewed the studies. We used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approachto ascertain risk of bias and conducted a narrative synthesis.

Results We identified 3217 journal articles, 223 conference papers, 45 dissertations and 218 registered trials. Ten articles were included for full-text review and only one was found to fulfil the eligibility criteria. This was a retrospective cohort study from India, which showed that pregnant women with moderate and severe anaemia could have an increased risk of PPH if they underwent induction and/or augmentation of labour, but the evidence was weak (graded as ‘high risk of bias’).

Conclusion The best approach is to prevent anaemia, but a large number of women in low-to-middle-income countries present with severe anaemia during labour. In such women, appropriate peripartum management could prevent complications and death. Our review showed that at present we do not know if induction and augmentation of labour is safe in pregnant women with iron-deficiency anaemia and further research is required.

PROSPERO registration number CRD42015032421.

  • pregnant women
  • anaemia
  • induction of labour
  • augmentation of labour
  • post-partum haemorrhage

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  • Patient consent for publication Not required.

  • Contributors KB reviewed the literature, extracted information from studies and edited the paper; NR conducted the searches and edited the paper; MK was the third reviewer and edited the paper; MN developed the concept for the systematic review, reviewed the literature, extracted information from studies and wrote the first draft of the paper.

  • Funding The work was funded by a Medical Research Council (MRC) Career Development Award ( for Manisha Nair (Grant Ref: MR/P022030/1). The funder had no role in study design, data collection, data analysis, data interpretation or writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data sharing is not applicable to this article as no datasets were generated or analysed during the review.

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