A network meta-analysis «Alfirevic Z, Keeney E, Dowswell T et al. Which method is best for the induction of labour? A systematic review, network meta-analysis and cost-effectiveness analysis. Health Technol Assess 2016;20(65)»2 assessed the relative effectiveness, safety and cost-effectiveness of labour induction methods. 611 trials were included. The interventions most likely to achieve vaginal delivery within 24 hours were intravenous oxytocin with amniotomy (posterior rank 2; 95% credible intervals (CI) 1 to 9) and higher-dose (≥ 50 µg) vaginal misoprostol (rank 3; 95% CI 1 to 6) (table «Interventions for failure to achieve vaginal delivery within 24 hours »1). Compared with placebo, several treatments reduced the odds of caesarean section, but there were considerable uncertainty in treatment rankings. For uterine hyperstimulation, double-balloon catheter had the highest probability of being among the best 3 treatments, whereas vaginal misoprostol (≥ 50 µg) was most likely to increase the odds of excessive uterine activity.
| Active intervention vs placebo | Odds ratio | 95% CI |
|---|---|---|
| i.v. oxytocin with amniotomy | 0.05 | 0.07 to 0.32 |
| Vaginal misoprostol ≥ 50 μg | 0.09 | 0.06 to 0.24 |
| Titrated (low-dose) oral misoprostol solution | 0.10 | 0.07 to 0.29 |
| Vaginal misoprostol < 50 μg | 0.11 | 0.09 to 0.32 |
| Buccal/sublingual misoprostol | 0.11 | 0.05 to 0.19 |
| Vaginal PGE2 pessary (normal release) | 0.11 | 0.04 to 0.16 |
| Oral misoprostol tablet ≥ 50 μg | 0.16 | 0.05 to 0.20 |
| Double-balloon or Cook’s catheter | 0.18 | 0.01 to 0.16 |
| Foley catheter | 0.19 | 0.09 to 0.46 |
| Oral misoprostol tablet < 50 μg | 0.22 | 0.07 to 0.39 |
A Cochrane review «Amniotomy alone for induction of labour»1 «Bricker L, Luckas M. Amniotomy alone for induction of labour. Cochrane Database Syst Rev 2000;(4):CD002862 [Review content assessed as up-to-date: 31 January 2007]. »1 included 2 studies with a total of 310 subjects. No conclusions could be drawn from comparisons of amniotomy alone versus no intervention, or amniotomy alone versus oxytocin alone. One trial compared amniotomy alone with a single dose of vaginal prostaglandins for women with a favourable cervix, and found a significant increase in he need for oxytocin augmentation in the amniotomy alone group (44% versus 15%, RR 2.85, 95% CI 1.82 to 4.46).