Intravaginal misoprostol versus Foley catheter balloon for induction of labor: A systematic literature review, meta-analysis, meta-regression, and trial sequential analysis

Abstract

Induction of labor is a common procedure in obstetrics. Numerous methods (both mechanical and pharmacological) are used for induction, however, there is lack of consensus for a safe effective means. Objective: The aim of this review was to compare intravaginal Misoprostol to Foley catheter balloon for induction of labor and cervical ripening in uncomplicated pregnancy, with regards to safety and effectiveness. Method: We systematically searched MEDLINE and EMBASE for randomized controlled trials comparing both means. Included studies were assessed for risk of bias and certainty of evidence using GRADE methodology. Results were presented as forest plots of odds ratio or mean difference. Predefined subgroup analyses and meta regression were conducted to account for heterogeneity, and the conclusiveness of results was evaluated in a trial sequential analysis (TSA).Results: 19 studies were identified, the primary outcome of caesarean section showed a 20% reduction in odd of CS with Misoprostol [OR = 0.8 (95% CI: 0.67 – 0.96; p = 0.02), secondary outcomes of NICU admission and APGAR score < 7 at 5 minutes were not different between both groups, while Misoprostol induced group had a lower intervention to delivery interval and a higher incidence of maternal tachysystole. Quality of evidence was downgraded low to Very low for the different outcomes, and results were deemed inconclusive by TSA.Conclusion: Low quality inconclusive evidence suggest decreased likelihood of CS with intravaginal Misoprostol induction compared to Foley catheter balloon.