Labour induction with prostaglandins: a systematic review and network meta-analysis

Alfirevic, Zarko ORCID: 0000-0001-9276-518X, Keeney, Edna, Dowswell, Therese, Welton, Nicky J, Dias, Sofia, Jones, Leanne, Navaratnam, Kate and Caldwell, Deborah
(2015) Labour induction with prostaglandins: a systematic review and network meta-analysis. BMJ: British Medical Journal, 350 (7994). h217-.

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Abstract OBJECTIVES: To assess the effectiveness and safety of prostaglandins used for labour induction. DESIGN: Systematic review with Bayesian network meta-analysis DATA SOURCES: The Cochrane Pregnancy and Childbirth Group's Database of Trials (which incorporates the results of a broad generic search for all pregnancy and postpartum trials). Sources included are CENTRAL, Medline, Embase, NHS Economic Evaluation Database, CINAHL, relevant journals, conference proceedings, and registries of ongoing trials. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised clinical trials of prostaglandin or prostaglandin analogues used for third trimester cervical ripening or labour induction versus placebo or no treatment, alternative prostaglandin dose or administration, or a different type of prostaglandin. We included studies recruiting women with a viable fetus, but had no other restrictions relating to indication for labour induction or language of publication. Outcomes assessed were serious neonatal morbidity (trialist defined) or perinatal death; serious maternal morbidity (trialist defined) or death; vaginal delivery not achieved within 24 hours, caesarean section, and uterine hyperstimulation with fetal heart rate changes. RESULTS: 280 randomised clinical trials were included (48 068 women) in the review. Maternal and neonatal mortality and serious morbidity were rarely reported and are summarized narratively. Unresolved inconsistency was observed for the hyperstimulation outcome. Relative to placebo, the odds of failing to achieve a vaginal delivery were lowest for vaginal misoprostol (≥50 µg) (odds ratio 0.06 (95% credible interval 0.02 to 0.12)), with a 39% absolute probability of event (95% credible interval 1% to 94%). Compared with placebo, odds of caesarean section were lowest for titrated oral misoprostol solution (

Item Type: Article
Additional Information: © BMJ Publishing Group Ltd 2015. Cite as: BMJ 2015;350:h217
Uncontrolled Keywords: Humans, Prostaglandins, Pregnancy Outcome, Labor, Induced, Bayes Theorem, Pregnancy, Pregnancy Trimester, Third, Dose-Response Relationship, Drug, Infant, Newborn, Female
Depositing User: Symplectic Admin
Date Deposited: 22 Dec 2015 10:06
Last Modified: 16 Dec 2022 16:53
DOI: 10.1136/bmj.h217
Publisher's Statement : This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
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