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Meta-Analysis
. 2018 Nov;97(48):e13251.
doi: 10.1097/MD.0000000000013251.

Intracervical Foley catheter balloon versus dinoprostone insert for induction cervical ripening: A systematic review and meta-analysis of randomized controlled trials

Lixia Zhu  1 , Cong Zhang  2 , Fang Cao  3 , Qin Liu  1 , Xing Gu  1 , Jianhao Xu  4 , Jianqing Li  4
Affiliations
Meta-Analysis

Intracervical Foley catheter balloon versus dinoprostone insert for induction cervical ripening: A systematic review and meta-analysis of randomized controlled trials

Lixia Zhu et al. Medicine (Baltimore). 2018 Nov.

Abstract

Background: Successful labor induction depends on the cervical status at the time of induction. Currently, both a Foley catheter and a dinoprostone insert are used for effective cervical ripening. This study compared the efficacy and safety of the intracervical Foley catheter and dinoprostone insert for cervical ripening to achieve successful labor induction.

Methods: PubMed, Embase, and the Cochrane Library were searched from January 2000 to February 2017 for relevant articles. Only published randomized, controlled trials comparing the dinoprostone insert with the Foley catheter were included.

Results: Eight trials including 1191 women who received the intracervical Foley catheter balloon and 1199 who received the dinoprostone insert were used for this study. There was no significant difference between the 2 groups regarding the induction-to-delivery (I-D) interval in a random effect model (mean difference, 0.71 hours; 95% confidence interval [CI], -2.50 to 3.91; P = .67). The highly significant heterogeneity (I = 97%) could be explained by the subgroup analysis of the type of Foley catheter and balloon volume. There was no significant difference between the 2 methods regarding the cesarean delivery rate (relative risk, 0.91; 95% CI, 0.78-1.07; P = .24), Apgar score, or side effects, including maternal infection rate, postpartum hemorrhage, and hyperstimulation. No obvious publication bias was found.

Conclusions: According to the cesarean delivery rate, the intracervical Foley catheter balloon was as efficient as the dinoprostone insert. A moderate balloon volume (30 mL) and higher dose of dinoprostone (≥6 mg) were related to shorter I-D intervals. Additionally, there was no significant difference between the two methods regarding maternal or neonatal safety.

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Figures

Figure 1
Figure 1
Flow chart for the selection of records. The search strategy identified 552 citations. Titles and abstracts were reviewed. Forty-six potential articles were retrieved and evaluated. Finally, 8 randomized, controlled trials appeared to be eligible.
Figure 2
Figure 2
Risk of bias graph. The review authors’ judgments of each risk of bias item are presented as percentages.
Figure 3
Figure 3
Risk of bias summary. The review authors’ judgments of each risk of bias item for each included study.
Figure 4
Figure 4
Forest plot of the cesarean delivery rate. RR, relative risk.
Figure 5
Figure 5
Forest plot of the induction-to-delivery interval. MD, mean difference.
Figure 6
Figure 6
Funnel plot of the cesarean delivery rate.
Figure 7
Figure 7
Funnel plot of the induction-to-delivery interval.
See this image and copyright information in PMC

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