Topical Dinoprostone vs. Foley's Catheter: A Systematic Review and Meta-Analysis of Cervical Ripening Approaches

Background and aim: Labor induction is increasing in obstetric practice. In women with an unfavorable cervix, cervical ripening is required for successful induction. We conducted this review to compare the effectiveness and tolerance of two interventions used for cervical ripening, topical prostaglandin E2 (dinoprostone) and transcervical Foley's catheter. Methods: We systematically searched four biomedical databases on 15 November 2024, for relevant studies. The studies' eligibility was determined after screening their titles, abstracts, and full texts. We extracted relevant data from the studies included. RevMan software V5.4 was used to conduct the random-effect meta-analysis. Misoprostol was excluded from this review due to variability in dosing protocols and inconsistent reporting across studies. A review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration number: CRD420251026183. Results: This review included 41 studies that in total enrolled 12,877 women (6722 for Foley's catheter and 6155 for dinoprostone). The efficacy of the two interventions was comparable as evidenced by the similarity in the induction to delivery time, Bishop score change, the rate of vaginal delivery within 24 h, and the risk of induction failure. Foley's catheter was linked with lower risks of caesarian delivery (RR = 0.84, p = 0.006), uterine hyperstimulation (RR = 0.39, p < 0.001), postpartum hemorrhage (RR = 0.76, p = 0.03), and a 1-min Apgar score < 7 (RR = 0.75, p = 0.02). However, it was associated with an extra need for oxytocin augmentation (RR = 1.18, p < 0.001). The risks of instrumental delivery, intrapartum pyrexia, postpartum infection, meconium passage, umbilical cord arterial pH < 7.1, a 5-min Apgar score < 7, and neonatal intensive care requirement were comparable for the two interventions. Conclusions: In comparison with dinoprostone, Foley's catheter is equally effective and well tolerated. We recommend Foley's catheter use for women with a previous caesarian delivery and in low-resource settings.