Combination of Foley and prostaglandins versus Foley and oxytocin for cervical ripening: a network meta-analysis

Abstract

BACKGROUND: Trial and meta-analysis data revealed a reduction in time to delivery for Foley and prostaglandins or Foley and oxytocin vs Foley alone. However, there are limited data for the comparison of the 2 combination methods against each other. OBJECTIVE: This study aimed to determine whether Foley and prostaglandins or Foley and oxytocin decrease the time to vaginal delivery using a network meta-analysis. STUDY DESIGN: A network meta-analysis (PROSPERO CRD42018081948) was performed comparing Foley and prostaglandins (prostaglandin E1 or prostaglandin E2) vs Foley and oxytocin for cervical ripening. Foley alone and prostaglandins alone were used as nodes for indirect comparison. Database searches were performed from inception to March 2020 with data abstracted from published manuscripts. Eligibility criteria included randomized trials comparing Foley and oxytocin with Foley and prostaglandins (misoprostol or dinoprostone). Trials that compared Foley catheter or prostaglandins with a combination of Foley and prostaglandins or Foley and concurrent oxytocin were also included. Nulliparous and multiparous women were analyzed together. Foley catheters of any catheter material or size and >24 weeks' gestational age with a live fetus were included. Quasi-randomized, cohorts, and other combination methods for cervical ripening were not included. Prostaglandin E1 and prostaglandin E2 combined methods were analyzed separately in a planned subanalysis. The primary outcome was the mean time from induction to vaginal delivery in hours. Secondary outcomes included time from induction to delivery, delivery within 24 hours, cesarean delivery, chorioamnionitis, endometritis, epidural use, tachysystole, postpartum hemorrhage, meconium, neonatal intensive care unit admission, and 5minute appearance, pulse, grimace, activity, and respiration score of <7. Data were analyzed as a network meta-analysis using multivariate meta-regression.RESULTS: A total of 30 randomized controlled trials with a total of 6465 women were considered eligible for inclusion in this network metaanalysis. When compared with Foley alone, the use of Foley-oxytocin reduced the time to vaginal delivery by 4.2 hours (mean duration, e4.2 hours; 95% confidence interval, e6.5 to e1.9). Foley-prostaglandins reduced the time to vaginal delivery compared with Foley but did not meet statistical significance (mean duration, e2.9 hours; 95% confidence interval, e5.7 to 0.0; P¼.05). When compared head-to-head, there was no difference in the time to vaginal delivery between Foley-prostaglandins and Foley-oxytocin (mean duration, 1.3 hours; 95% confidence interval, e2.0 to 4.7). There was no difference in the rate of cesarean delivery, chorioamnionitis, epidural, tachysystole, postpartum hemorrhage, meconium, neonatal intensive care unit admissions, or 5-minute appearance, pulse, grimace, activity, and respiration score of <7 for Foley-prostaglandins vs Foley-oxytocin, although the rate of endometritis was high for Foley-prostaglandins. In the subanalysis by prostaglandin...

Concurrent administration of oxytocin with Foley catheter versus Misoprostol for induction of labor: A systematic review and meta-analysis

“…Interestingly, the mechanical methods were associated with lower rates of tachysystoles and the rates of cesarean sections were comparable to the pharmacological methods (27). Similar to what has been found in our review, the mechanical methods were found to be associated with a short period of induction of labor and no difference was found between concurrent Foley catheter and oxytocin vs. Misoprostol and Foley catheter (28).…”

Intracervical Foley catheter with and without oxytocin for labor induction with Bishop score ≤3: a secondary analysis

“…It has been suggested that parity may affect how effective this combined intervention is. 7−9 The primary trial 4 and the trial by Levine and colleagues 6 did not find that parity played a role in decreasing the time to delivery with the combination of a Foley catheter and oxytocin administration. This remains true because the time to delivery adjusted for parity status, first Bishop score, and BMI remained shorter in the Foley with oxytocin group in our study.…”

Is Unfavourable Cervix prior to Labor Induction Risk for Adverse Obstetrical Outcome in Time of Universal Ripening Agents Usage? Single Center Retrospective Observational Study

“…It seems that Cook's balloon catheter, invented in the early 90's, may be more effective in preinduction cervical ripening compared to Foley's catheter and PGE2 prostaglandin [ 14 , 15 ]. Studies indicate that the combination of mechanical method with vaginal prostaglandins does not bring additional benefits such as reduction time to vaginal delivery or reduction in cesarean section rate [ 16 ].…”