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

Abstract

Background Various methods are used for cervical ripening during the induction of labour. It is still debatable which of these methods of treatment is optimal.Objective To compare treatment techniques for cervical ripening in the induction of labour.Search strategy Medline, Embase, and the Cochrane Collaboration databases were searched using the keywords 'cervical ripening', 'labour induced', 'misoprostol', 'dinoprostone', and 'Foley catheter'.Selection criteria Randomised controlled trials (RCTs) of cervical ripening during the induction of labour, evaluating rates of failure to achieve vaginal delivery within 24 hours, incidence of uterine hyperstimulation with fetal heart rate (FHR) changes, and rates of caesarean section. Studies including women with prelabour rupture of membranes were excluded.Data collection and analysis Outcome data were collected and analysed through pairwise meta-analysis and network metaanalysis within a Bayesian framework.Main results A total of 96 RCTs (17 387 women) were included in the meta-analysis. Vaginal misoprostol was the most effective cervical ripening method to achieve vaginal delivery within 24 hours, but had the highest incidence of uterine hyperstimulation with FHR changes. The use of a Foley catheter to induce labour was associated with the lowest rate of uterine hyperstimulation accompanied by FHR changes. The caesarean section rate was lowest using oral misoprostol for the induction of labour.Author's conclusions No method of labour induction demonstrated overall superiority when considering all three clinical outcomes. Decisions regarding the choice of induction method will depend upon the relative preference for effecting vaginal delivery within 24 hours, minimising the incidence of uterine hyperstimulation with adverse FHR changes and avoiding caesarean section.Keywords Cervical ripening, dinoprostone, Foley catheter, induction of labour, misoprostol.Tweetable abstract Oral misoprostol for the induction of labour is safer than vaginal misoprostol and has the lowest rate of caesarean section.

Induction of Labor with Dinoprostone Vaginal Insert; Is it Safe and Effective in Term Pregnancy with Premature Rupture of Membranes?

“…5 A retrospective study that included cases with PROM emphasized that no difference was found in neonatal outcome between two PG E2 forms (gel and vaginal insert form). Also, it was reported that there was no statistical difference in terms of operative vaginal delivery between two groups.…”

“…1,4 In the absence of any contraindication to vaginal delivery, active management can be carried out by induction of labor via using pharmacological or nonpharmacological methods. 5,6 Oxytocin is the most common pharmacological agent used traditionally for induction of labor in women with PROM.…”

“…Among these prostaglandin preparations only dinoprostone is approved by the Food and Drug Administration to be used for cervical ripenning and induction of labor in live pregnancies. 5 The issue which agent should be preferred in term PROM, and which one of them is more appropriate than the others to avoid adverse maternal or neonatal obstetric outcome is contraversial in the literature. [7][8][9][10][11][12][13] Dinoprostone has been slowly taking the place of oxytocin in clinical practice.…”

Cervical ripening and induction of labour: Inpatient or outpatient, oral misoprostol or Foley catheter?

“…It is more effective than amniotomy with intravenous oxytocin which can result in increased caesarean delivery, especially if the cervix is 'not ripe' [6][7][8][9]. Doses ranging from 20-200µg, with frequencies varying from hourly to six hourly and the administration of up to 12 doses of 50 µg over four days have been reported.…”

“…Doses ranging from 20-200µg, with frequencies varying from hourly to six hourly and the administration of up to 12 doses of 50 µg over four days have been reported. A starting dose of 20 µg of oral misoprostol in solution, titrated against uterine contractions and administered hourly in increasing doses of up to 60 µg, is currently thought to be a safe, cost effective method for induction of labour [6][7][8][9][10]. The hourly dosing regimen has been calculated according to the pharmacokinetics of oral misoprostol.…”