Efficacy of pharmacological and mechanical cervical priming methods for induction of labour and their applicability for outpatient management: A systematic review of randomised controlled trials

Hiba Khan; Maria Amparo Buaki-Sogo; Philip Barlow; Robert Vardanyan; Anna Zatorska; George Miller; Arian Arjomandi Rad; Johann Malawana; Nishel M Shah

doi:10.1016/j.ejogrb.2023.05.037

Efficacy of pharmacological and mechanical cervical priming methods for induction of labour and their applicability for outpatient management: A systematic review of randomised controlled trials

Hiba Khan^*, Maria Amparo Buaki-Sogo, Philip Barlow, Robert Vardanyan, Anna Zatorska, George Miller, Arian Arjomandi Rad, Johann Malawana, Nishel M Shah

^*Corresponding author for this work

Research output: Contribution to journal › (Systematic) Review article › peer-review

Abstract

BACKGROUND: A systematic review to determine the efficacy and safety of prostaglandins (PG) and Foley catheter (FC) for cervical priming in the outpatient setting. Various methods are available to achieve cervical ripening prior to induction of labour (IOL). In this systematic review, we will report the literature to date, and investigate the efficacy and safety of using the Foley catheter balloon or prostaglandins for cervical ripening, comparing both methods with each other, and discuss the implications of these findings for midwifery led units.

METHODS: English peer-reviewed journals were systematically searched in the databases PubMed, MEDLINE, EMCARE, EMBASE and CINAHL, for studies investigating cervical ripening using the FC or PGs. Additional randomised controlled trials (RCTs) and non-RCTs were identified by a manual search. Search terms included: cervix dilatation effacement, cervix ripening, outpatient, ambulatory care, obstetric patients, pharmacological preparations, and Foley catheter. Only RCTs of FC versus PG or either intervention versus placebo or intervention in the in-patient Vs. outpatient setting were included. 15 RCTs were included.

RESULTS: The results of this review show that both FC and PG analogues are equally effective cervical ripening agents. When compared to FC, PGs lead to a reduced requirement for oxytocin augmentation and a shorter intervention to delivery interval. However, PG use is also associated with an increased risk of hyperstimulation, cardiotocographic monitoring abnormalities and negative neonatal outcomes.

CONCLUSIONS: FC cervical ripening is an effective method of outpatient cervical priming, which is safe, acceptable, and cost-effective and thus has a potential role in both resource-rich and resource-poor countries. With appropriate dosing, some PG analogues also appear to offer similar outcomes.

Original language	English
Pages (from-to)	80-92
Number of pages	13
Journal	European Journal of Obstetrics & Gynecology and Reproductive Biology
Volume	287
DOIs	https://doi.org/10.1016/j.ejogrb.2023.05.037
Publication status	Published - Aug 2023
Externally published	Yes

Keywords

Pregnancy
Female
Infant, Newborn
Humans
Dinoprostone
Outpatients
Cervix Uteri/physiology
Oxytocics
Labor, Induced/methods
Prostaglandins
Abortifacient Agents, Nonsteroidal
Cervical Ripening

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10.1016/j.ejogrb.2023.05.037

Cite this

Khan, H., Buaki-Sogo, M. A., Barlow, P., Vardanyan, R., Zatorska, A., Miller, G., Arjomandi Rad, A., Malawana, J., & Shah, N. M. (2023). Efficacy of pharmacological and mechanical cervical priming methods for induction of labour and their applicability for outpatient management: A systematic review of randomised controlled trials. European Journal of Obstetrics & Gynecology and Reproductive Biology, 287, 80-92. https://doi.org/10.1016/j.ejogrb.2023.05.037

@article{5e56fd15dd514bc58aa6f3ead6a73e3c,

title = "Efficacy of pharmacological and mechanical cervical priming methods for induction of labour and their applicability for outpatient management: A systematic review of randomised controlled trials",

abstract = "BACKGROUND: A systematic review to determine the efficacy and safety of prostaglandins (PG) and Foley catheter (FC) for cervical priming in the outpatient setting. Various methods are available to achieve cervical ripening prior to induction of labour (IOL). In this systematic review, we will report the literature to date, and investigate the efficacy and safety of using the Foley catheter balloon or prostaglandins for cervical ripening, comparing both methods with each other, and discuss the implications of these findings for midwifery led units.METHODS: English peer-reviewed journals were systematically searched in the databases PubMed, MEDLINE, EMCARE, EMBASE and CINAHL, for studies investigating cervical ripening using the FC or PGs. Additional randomised controlled trials (RCTs) and non-RCTs were identified by a manual search. Search terms included: cervix dilatation effacement, cervix ripening, outpatient, ambulatory care, obstetric patients, pharmacological preparations, and Foley catheter. Only RCTs of FC versus PG or either intervention versus placebo or intervention in the in-patient Vs. outpatient setting were included. 15 RCTs were included.RESULTS: The results of this review show that both FC and PG analogues are equally effective cervical ripening agents. When compared to FC, PGs lead to a reduced requirement for oxytocin augmentation and a shorter intervention to delivery interval. However, PG use is also associated with an increased risk of hyperstimulation, cardiotocographic monitoring abnormalities and negative neonatal outcomes.CONCLUSIONS: FC cervical ripening is an effective method of outpatient cervical priming, which is safe, acceptable, and cost-effective and thus has a potential role in both resource-rich and resource-poor countries. With appropriate dosing, some PG analogues also appear to offer similar outcomes.",

keywords = "Pregnancy, Female, Infant, Newborn, Humans, Dinoprostone, Outpatients, Cervix Uteri/physiology, Oxytocics, Labor, Induced/methods, Prostaglandins, Abortifacient Agents, Nonsteroidal, Cervical Ripening",

author = "Hiba Khan and Buaki-Sogo, {Maria Amparo} and Philip Barlow and Robert Vardanyan and Anna Zatorska and George Miller and {Arjomandi Rad}, Arian and Johann Malawana and Shah, {Nishel M}",

year = "2023",

month = aug,

doi = "10.1016/j.ejogrb.2023.05.037",

language = "English",

volume = "287",

pages = "80--92",

journal = "European Journal of Obstetrics & Gynecology and Reproductive Biology",

issn = "0301-2115",

publisher = "Elsevier",

}

Khan, H, Buaki-Sogo, MA, Barlow, P, Vardanyan, R, Zatorska, A, Miller, G, Arjomandi Rad, A, Malawana, J & Shah, NM 2023, 'Efficacy of pharmacological and mechanical cervical priming methods for induction of labour and their applicability for outpatient management: A systematic review of randomised controlled trials', European Journal of Obstetrics & Gynecology and Reproductive Biology, vol. 287, pp. 80-92. https://doi.org/10.1016/j.ejogrb.2023.05.037

Efficacy of pharmacological and mechanical cervical priming methods for induction of labour and their applicability for outpatient management: A systematic review of randomised controlled trials. / Khan, Hiba; Buaki-Sogo, Maria Amparo; Barlow, Philip et al.
In: European Journal of Obstetrics & Gynecology and Reproductive Biology, Vol. 287, 08.2023, p. 80-92.

Research output: Contribution to journal › (Systematic) Review article › peer-review

TY - JOUR

T1 - Efficacy of pharmacological and mechanical cervical priming methods for induction of labour and their applicability for outpatient management

T2 - A systematic review of randomised controlled trials

AU - Khan, Hiba

AU - Buaki-Sogo, Maria Amparo

AU - Barlow, Philip

AU - Vardanyan, Robert

AU - Zatorska, Anna

AU - Miller, George

AU - Arjomandi Rad, Arian

AU - Malawana, Johann

AU - Shah, Nishel M

PY - 2023/8

Y1 - 2023/8

N2 - BACKGROUND: A systematic review to determine the efficacy and safety of prostaglandins (PG) and Foley catheter (FC) for cervical priming in the outpatient setting. Various methods are available to achieve cervical ripening prior to induction of labour (IOL). In this systematic review, we will report the literature to date, and investigate the efficacy and safety of using the Foley catheter balloon or prostaglandins for cervical ripening, comparing both methods with each other, and discuss the implications of these findings for midwifery led units.METHODS: English peer-reviewed journals were systematically searched in the databases PubMed, MEDLINE, EMCARE, EMBASE and CINAHL, for studies investigating cervical ripening using the FC or PGs. Additional randomised controlled trials (RCTs) and non-RCTs were identified by a manual search. Search terms included: cervix dilatation effacement, cervix ripening, outpatient, ambulatory care, obstetric patients, pharmacological preparations, and Foley catheter. Only RCTs of FC versus PG or either intervention versus placebo or intervention in the in-patient Vs. outpatient setting were included. 15 RCTs were included.RESULTS: The results of this review show that both FC and PG analogues are equally effective cervical ripening agents. When compared to FC, PGs lead to a reduced requirement for oxytocin augmentation and a shorter intervention to delivery interval. However, PG use is also associated with an increased risk of hyperstimulation, cardiotocographic monitoring abnormalities and negative neonatal outcomes.CONCLUSIONS: FC cervical ripening is an effective method of outpatient cervical priming, which is safe, acceptable, and cost-effective and thus has a potential role in both resource-rich and resource-poor countries. With appropriate dosing, some PG analogues also appear to offer similar outcomes.

AB - BACKGROUND: A systematic review to determine the efficacy and safety of prostaglandins (PG) and Foley catheter (FC) for cervical priming in the outpatient setting. Various methods are available to achieve cervical ripening prior to induction of labour (IOL). In this systematic review, we will report the literature to date, and investigate the efficacy and safety of using the Foley catheter balloon or prostaglandins for cervical ripening, comparing both methods with each other, and discuss the implications of these findings for midwifery led units.METHODS: English peer-reviewed journals were systematically searched in the databases PubMed, MEDLINE, EMCARE, EMBASE and CINAHL, for studies investigating cervical ripening using the FC or PGs. Additional randomised controlled trials (RCTs) and non-RCTs were identified by a manual search. Search terms included: cervix dilatation effacement, cervix ripening, outpatient, ambulatory care, obstetric patients, pharmacological preparations, and Foley catheter. Only RCTs of FC versus PG or either intervention versus placebo or intervention in the in-patient Vs. outpatient setting were included. 15 RCTs were included.RESULTS: The results of this review show that both FC and PG analogues are equally effective cervical ripening agents. When compared to FC, PGs lead to a reduced requirement for oxytocin augmentation and a shorter intervention to delivery interval. However, PG use is also associated with an increased risk of hyperstimulation, cardiotocographic monitoring abnormalities and negative neonatal outcomes.CONCLUSIONS: FC cervical ripening is an effective method of outpatient cervical priming, which is safe, acceptable, and cost-effective and thus has a potential role in both resource-rich and resource-poor countries. With appropriate dosing, some PG analogues also appear to offer similar outcomes.

KW - Pregnancy

KW - Female

KW - Infant, Newborn

KW - Humans

KW - Dinoprostone

KW - Outpatients

KW - Cervix Uteri/physiology

KW - Oxytocics

KW - Labor, Induced/methods

KW - Prostaglandins

KW - Abortifacient Agents, Nonsteroidal

KW - Cervical Ripening

U2 - 10.1016/j.ejogrb.2023.05.037

DO - 10.1016/j.ejogrb.2023.05.037

M3 - (Systematic) Review article

C2 - 37300982

SN - 0301-2115

VL - 287

SP - 80

EP - 92

JO - European Journal of Obstetrics & Gynecology and Reproductive Biology

JF - European Journal of Obstetrics & Gynecology and Reproductive Biology

ER -

Khan H, Buaki-Sogo MA, Barlow P, Vardanyan R, Zatorska A, Miller G et al. Efficacy of pharmacological and mechanical cervical priming methods for induction of labour and their applicability for outpatient management: A systematic review of randomised controlled trials. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2023 Aug;287:80-92. doi: 10.1016/j.ejogrb.2023.05.037

Efficacy of pharmacological and mechanical cervical priming methods for induction of labour and their applicability for outpatient management: A systematic review of randomised controlled trials

Abstract

Keywords

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