Labour Induction With Prostaglandins: A Systematic Review and Network Meta-Analysis

摘要

Prostaglandins are a widely used method of labor induction. Individual studies have compared different prostaglandins, dosages, and routes of treatment, but there have not been single studies that have compared them all simultaneously. The current study uses network meta-analysis to compare multiple prostaglandins as well as dosages and route of treatment to estimate which treatment is best for a range of obstetric outcomes. A search of the Cochrane Pregnancy and Childbirth Group's Database of Trials was used to find eligible trials. To be eligible, trials had to be randomized clinical trials comparing a prostaglandin or prostaglandin analog versus a placebo or different prostaglandin, or comparing 2 different forms or doses of 1 prostaglandin, specifically examining the impact on labor induction or cervical ripening in the third trimester. Only trials exclusively studying women with a viable fetus were included. The 12 types of prostaglandin or prostaglandin analog included were intracervical prostaglandin E-2; vaginal misoprostol tablet or sustained-release pessary; oral misoprostol tablet; vaginal prostaglandin E-2 as tablets, gel, pessary, or sustained-release pessary; prostaglandin F-2a gel; and oral misoprostol solution. Outcomes included serious maternal morbidity or death, serious neonatal morbidity or perinatal death, vaginal delivery not achieved within 24 hours, uterine hyperstimulation with fetal heart rate changes, and cesarean delivery.