Abstract
To compare the combination of intracervical Foley catheter and intravaginal misoprostol
administration versus intravaginal misoprostol administration-only for cervical ripening.
The Medline, EMBASE, ClinicalTrials.gov, PROSPERO, Scopus, and Cochrane Collaboration
databases were searched systematically. Randomized controlled trials that included
patients with a singleton viable fetus who underwent induction of labor that required
cervical ripening with an unfavorable cervix (Bishop ≤ 6) were eligible for inclusion.
Primary outcomes was time to delivery and rate of cesarean delivery. Thirteen trials
with 2978 subjects met the inclusion criteria. There was no difference in the incidence
of cesarean delivery between the two groups (RR, 0.90; 95 % CI, 0.72–1.14; I2 = 69 %). The combination group resulted in comparable time to delivery (MD −2.50 h;
95 % CI 0.38, −5.38; I2 = 97 %), shorter time to vaginal delivery (MD −3.49 h; 95 % CI −4.89, −2.09; I2 = 81 %), lower risk of neonatal intensive care unit (NICU) admission (RR 0.72, 95 %
CI 0.58–0.90, I2 = 0 %), meconium-stained fluid (RR 0.48, 95 % CI 0.31–0.73, I2 = 28 %), and tachysystole with fetal heart trace changes (RR 0.49, 95 % CI 0.27–0.86,
I2 = 43 %), compared with intravaginal misoprostol-only group. There was no statistical
difference in rates of terbutaline use, endometritis or chorioamnionitis between the
two groups. The combination of intravaginal misoprostol with intracervical Foley catheter
for cervical ripening is not associated with shorter time to delivery. However, the
combination group shows significant difference in shorter time to vaginal delivery,
NICU admission, meconium-stained fluid, and tachysystole with fetal heart trace changes.
Graphical abstract
Graphical Abstract
Abbreviations:
CI (Confidence Interval), IOL (Induction of labor), NICU (neonatal intensive care unit), PG (prostaglandin), PPH (postpartum hemorrhage), PRISMA (Preferred Reporting Items for Systematic Reviews and meta-Analyses), RCT (Randomised control trial), RR (Risk ratio)Keywords
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Article info
Publication history
Published online: December 20, 2022
Accepted:
December 17,
2022
Received in revised form:
November 3,
2022
Received:
June 13,
2022
Identification
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© 2022 Elsevier B.V. All rights reserved.
