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Meta-analysis of Foley catheter plus misoprostol versus misoprostol alone for cervical ripening
Wenhang Chen1, Jing Xue2, Laura Gaudet3
1Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, Changsha, China; OMNI Research Group, Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
Background:
The effectiveness of Foley catheter plus misoprostol for cervical ripening has not been convincingly shown in trials.
Objectives:
To summarize the evidence comparing Foley catheter plus misoprostol versus misoprostol alone for cervical ripening.
Search Strategy:
Embase, Medline, and Cochrane Collaboration databases were searched with the terms "Foley catheter," "misoprostol," "cervical ripening," and "labor induction."
Selection Criteria:
Randomized controlled trials comparing the methods of cervical ripening for delivery of a viable fetus were included.
Data Collection And Analysis:
Study characteristics, quality, and outcomes were recorded. Random-effects models were used to combine data.
Main Results:
Eight trials were included, with 1153 patients overall. In a pooled analysis of seven high-quality studies, the combination group had a decreased time to delivery (mean difference -2.36 hours, 95% confidence interval [CI] -4.07 to -0.66; P=0.007). Risk of chorioamnionitis was significantly increased in the combination group (risk ratio [RR] 2.07, 95% CI 1.04-4.13; P=0.04), and that of tachysystole with fetal heart rate changes was decreased (RR 0.58, 95% CI 0.38-0.91; P=0.02). Frequency of cesarean did not differ (P=0.77).
Conclusions:
The combined use of Foley catheter and misoprostol results in a reduced time to delivery, a reduced frequency tachysystole with fetal heart rate changes, and an increased incidence of chorioamnionitis.
