Authors' reply re: A systematic review and network meta‐analysis comparing the use of Foley catheters, misoprostol and dinoprostone for cervical ripening in induction of labour

Abstract

Excessive, uterine activity is a maternal, neurological emergencyIrrespective of its source (misoprostol, oxytocin, prostaglandin E 2 ), excessive uterine activity may avulse the uterosacral ligaments from their origins at the sacrum, or, their insertions into the uterus (Figure 1).1 Their central neurovascular bundle contains the nerve supply to the uterus and fallopian tubes, with branches running across the mesosalpinx to the outer longitudinal muscle of the isthmus of the fallopian tube. Injuries to either set of nerves may result in infertility, ectopic pregnancy, chronic pelvic pain or, in the case of complete avulsion of the uterosacral ligaments, advanced painless adenomyosis (uterine weight 250-1000 g). 2-4The attenuated appearances of the uterosacral ligaments at laparoscopy are distinctive. Careful consideration of dosage regimens of uterotonic agents in all clinical settings may avoid these very serious complications, and, re-consideration of the role of mechanical methods of induction of labour, including laminaria and catheters, may be helpful. &