Comparison on efficacy and safety of seven different methods for labor induction: a network meta-analysis / 中华围产医学杂志

ABSTRACT

Objective With a network meta-analysis,to compare the effects and safety of seven clinically common-used induction methods.Methods Publications of randomized controlled trials between January 1,1980 and November 20,2011 were searched on Medline,Embase and Cochrane Central Register of Controlled Trials with the following terms including dinoprostone,misoprostol,Foley catheter,oxytocin and labor induction.A network meta analysis with both direct and indirect comparison was applied for 48 randomized controlled trials (19 819 participants) recruited,and the following seven induction methods applied in the publications were comparedoxytocin (intravenous,Ⅳ),vaginal dinoprostone,intracervical dinoprostone,oral misoprostol,vaginal misoprostol,sublingual misoprostol and foley catheter.The main outcomes were the proportion of vaginal delivery within 24 hours,cesarean section rate,uterine hyperstimulation rate and Apgar score＜7 at 5 min after birth.Medline,Embase and Cochrane Central Register of Controlled Trials were searched between January 1,1980 and November 20,2011.Results Foley catheter methods had the lowest cesarean section rate and the lowest uterine hyperstimulation rate.Vaginal misoprostol method had the highest number of vaginal delivery within 24 hours,but the highest uterine hyperstimulation rate.The lowest rate of neonatal Apgar score＜7 at 5 min was found in women using sublingual misoprostol,while the highest in those using vaginal Dinoprostone.Oxytocin (Ⅳ) method had the lowest number of vaginal delivery within 24 hours and the highest cesarean section rate.Conclusion Foley catheter method is the best available option for labor induction in terms of efficacy and safety,while the induction effect of oxytocin (Ⅳ) was not good enough.Vaginal misoprostol and vaginal dinoprostone methods had relative good induction effect but with obvious adverse effects.