Methods of induction of labour: a network meta-analysis

Area of Science:

• Obstetrics and Gynecology
• Reproductive Medicine
• Clinical Trials Research

Background:

• Induction of labour (IoL) is employed when pregnancy risks exceed benefits, with over 10 methods available.
• The optimal and safest IoL method remains unclear, necessitating comparative analysis.

Purpose of the Study:

• To compare the benefits and harms of various cervical ripening and IoL methods.
• To rank these methods for initiation of labour at or beyond term.

Main Methods:

• A systematic review and network meta-analysis (NMA) of 106 randomized controlled trials (RCTs) involving 30,348 women.
• Included methods were those recommended by international guidelines or previous Cochrane reviews.
• Analyses were stratified for women with and without previous caesarean sections, focusing on critical outcomes like delivery failure and caesarean rates.

Main Results:

• For women without previous C-sections, no IoL method demonstrated clear superiority over vaginal misoprostol (≤ 50 μg) in reducing failure to achieve vaginal delivery or caesarean section due to non-reassuring fetal status.
• Nitric oxide donors, osmotic cervical dilators, balloon catheters, and oral misoprostol (≤ 50 μg) likely reduce uterine hyperstimulation with changes in fetal heart rate compared to vaginal misoprostol.
• Evidence for women with previous C-sections was limited.

Conclusions:

• For women without previous C-sections, vaginal misoprostol (≤ 50 μg) serves as a benchmark, with no method showing significant advantages for key delivery outcomes.
• Certain methods, including nitric oxide donors and osmotic cervical dilators, appear safer regarding uterine hyperstimulation.
• Further research is needed to clarify optimal IoL strategies, especially for women with prior caesarean sections.