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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.

Original publication




Journal article


BMJ Open

Publication Date





anaemia, augmentation of labour, induction of labour, post-partum haemorrhage, pregnant women, Anemia, Iron-Deficiency, Female, Humans, Labor, Induced, Postpartum Hemorrhage, Pregnancy, Pregnancy Complications, Hematologic