Misoprostol combined with cervical single or double balloon catheters versus misoprostol alone for labor induction of singleton pregnancies: a meta-analysis of randomized trials

Ornat, Lía; Alonso-Ventura, Vanesa; Chedraui, Peter; Pérez‐López, Faustino R.

doi:10.1080/14767058.2019.1574741

Cited by 27 publications

(31 citation statements)

References 34 publications

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“…Among the mechanical methods, the most popular is the Foley catheter 89, 90 , either alone 91 or in association with oxytocin 92– 96 , or misoprostol 97, 98 , and with different balloon volumes 99, 100 . The combination of mechanical and pharmacological methods used simultaneously does not show clear benefits in terms of mode of delivery: the use of the Foley catheter with oxytocin increases the rate of delivery within 24 hours in nulliparas 95, 96 , while the association of Foley and misoprostol 101 reduces the intervention to delivery time interval and the number of uterine hyperstimulations, in both cases without influencing cesarean delivery rates.…”

Section: Methods Of Inductionmentioning

confidence: 99%

Recent advances in the induction of labor

Marconi

2019

F1000Res

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The rate of labor induction is steadily increasing and, in industrialized countries, approximately one out of four pregnant women has their labor induced. Induction of labor should be considered when the benefits of prompt vaginal delivery outweigh the maternal and/or fetal risks of waiting for the spontaneous onset of labor. However, this procedure is not free of risks, which include an increase in operative vaginal or caesarean delivery and excessive uterine activity with risk of fetal heart rate abnormalities. A search for “Induction of Labor” retrieves more than 18,000 citations from 1844 to the present day. The aim of this review is to summarize the controversies concerning the indications, the methods, and the tools for evaluating the success of the procedure, with an emphasis on the scientific evidence behind each.

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Section: Methods Of Inductionmentioning

confidence: 99%

Recent advances in the induction of labor

Marconi

2019

F1000Res

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“…Recently another group published a similar systematic review and metaanalysis that was not registered previously at the PROSPERO registry. 23 However, our study differs in several points. First, we discriminate between time to delivery and time to vaginal delivery.…”

Section: Comparison With Existing Literaturementioning

confidence: 76%

Maternal and neonatal outcomes with mechanical cervical dilation plus misoprostol compared to misoprostol alone for cervical ripening; a systematic review of literature and metaanalysis

Nasioudis

Kim

Schoen

et al. 2019

American Journal of Obstetrics & Gynecology MFM

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This is a practice-changing manuscript, if you have not changed your practice yet in terms of using a double-agent for cervical ripening to start induction of labor. This meta-analysis of randomized controlled trials shows that using both a balloon catheter, like a Foley, AND misoprostol, for induction is associated with not only a shorter labor by over 3 hours, but also with several neonatal benefits, compared to misoprostol alone. Using either balloon alone, or misoprostol alone, unless one of the agents is either not insertable or contraindicated, seems now like substandard care given these data. If misoprostol is contraindicated, a balloon and oxytocin 'double-agent' combination can be used instead.

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“…We also found that the postimplementation group had significantly fewer NICU admissions, a result that is congruent with multiple studies that used similar doses of misoprostol in combination with the cervical Foley. 21 22 A recent meta-analysis of eleven randomized controlled trials found that the combination of misoprostol and the cervical Foley was associated with a reduced risk of NICU admission (relative risk [RR] = 0.75, 95% CI: 0.58–0.97, p = 0.03) compared with either method alone. 21 To our knowledge, there were no other significant changes in NICU admission criteria to explain this finding.…”

Section: Discussionmentioning

confidence: 99%

Implementation of Evidence-Based Cervical Ripening Protocol: Outcomes and Next Steps

Zakama

Sobhani

Lamar

et al. 2020

AJP Rep

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Objective A prominent randomized controlled trial demonstrated that low-dose misoprostol with the concurrent cervical Foley shortened the median time to delivery when compared with either method alone. Our study aims to address implementation of this protocol and evaluate its impact on time to delivery. Study Design This was a retrospective before-and-after study of nulliparous women who delivered nonanomalous, term, singletons at the University of California San Francisco (UCSF) in two separate 2-year periods before and after changes in UCSF's cervical ripening protocol. The primary outcome was time from first misoprostol dose to delivery. Results A total of 1,496 women met inclusion criteria, with 698 in the preimplementation group and 798 in the postimplementation group. There were no statistically significant differences in time to delivery (29 vs. 30 hours, p = 0.69), rate of cesarean delivery (30 vs. 26%, p = 0.09), or cesarean delivery for fetal indications (11 vs. 8%, p = 0.15) between the groups. Conclusion Implementing evidence-based low-dose misoprostol with the concurrent cervical Foley did not change the time to delivery, time to vaginal-delivery, or likelihood of vaginal delivery in our population. This may be due to differences in labor management practices and incomplete fidelity to the protocol. Real-world effectiveness of these interventions will vary and should be considered when choosing an induction method.

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Misoprostol combined with cervical single or double balloon catheters versus misoprostol alone for labor induction of singleton pregnancies: a meta-analysis of randomized trials

Cited by 27 publications

References 34 publications

Recent advances in the induction of labor

Recent advances in the induction of labor

Maternal and neonatal outcomes with mechanical cervical dilation plus misoprostol compared to misoprostol alone for cervical ripening; a systematic review of literature and metaanalysis

Implementation of Evidence-Based Cervical Ripening Protocol: Outcomes and Next Steps

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