Abstract
Objective: To compare the effect of misoprostol combined with a cervical single or double-balloon catheter versus misoprostol alone for labor induction of singleton pregnancies with an unfavorable cervix.
Methods: Systematic review and meta-analysis of randomized controlled trials (RCTs) regarding the comparison of two schemes for labor induction of singleton cephalic pregnancies with a Bishop score ≤7 and no contraindication for vaginal delivery. Six research databases were searched for articles published in all languages up to 10 May 2018 comparing misoprostol (oral or vaginal) in combination with a cervical placed single or double balloon catheter versus misoprostol treatment alone. Random effects models and inverse variance were used for meta-analyses. Summary measures were mean differences (MDs) and risk ratios (RRs) with 95% confidence interval (CI). Risk of bias was evaluated with the Cochrane tool and publication bias was assessed with Begg’s and Egger’s tests.
Results: Fifteen RCTs reported predefined outcomes. Pooled analyses showed that the combined treatment (misoprostol + catheter) was associated with a shorter induction to delivery time interval (MD = −1.99 hours; 95% CI: −3.42, −0.56); in addition to fewer uterine hyperstimulations (RR = 0.39; 95% CI: 0.23, 0.67) and Neonatal Intensive Care Unit (NICU) admissions (RR = 0.75; 95% CI: 0.58, 0.97) as compared to misoprostol alone. There were no significant differences in RRs for tachysystole, chorioamnionitis, cesarean delivery rate, birthweight, and Apgar score at 5 minutes.
Conclusion: The combined use of misoprostol and a cervical balloon catheter reduces the intervention to delivery time interval and number of NICU admissions in women induced with an unfavorable cervix.
Acknowledgements
The authors would like to thank Dr. Samia Husain from Pakistan for providing additional revised information from a randomized controlled trial (RCT) [Citation29].
Disclosure statement
The authors declare having no conflicts of interest.