title: Labour induction with prostaglandins: a systematic review and network meta-analysis.
abstract: OBJECTIVE
  To assess the effectiveness and safety of prostaglandins used for labour induction.
  
  
  METHODS
  Systematic review with Bayesian network meta-analysis
  
  
  METHODS
  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.
  
  
  METHODS
  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 (<50 µg) (odds ratio 0.65 (0.49 to 0.83)), with an absolute probability of event of 15% (3% to 40%).
  
  
  CONCLUSIONS
  Low dose(<50 µg) titrated oral misoprostol solution had the lowest probability of caesarean section, whereas vaginal misprostol (≥50 µg) had the highest probability of achieving a vaginal delivery within 24 hours. These findings have important implications for a series of current national and international guidelines for induction of labour and future research in this area.
  
  
  BACKGROUND
  PROSPERO 2013:CRD42013005116.
authors: Centre for Women's Health Research, University of Liverpool and Liverpool Women's Hospital, Liverpool L8 7SS, UK zarko@liv.ac.uk.
authors: Zarko
authors: Z
authors: Alfirevic
authors: School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK.
authors: Edna
authors: E
authors: Keeney
authors: Centre for Women's Health Research, University of Liverpool and Liverpool Women's Hospital, Liverpool L8 7SS, UK.
authors: Therese
authors: T
authors: Dowswell
authors: School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK.
authors: Nicky J
authors: NJ
authors: Welton
authors: School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK.
authors: Sofia
authors: S
authors: Dias
authors: Centre for Women's Health Research, University of Liverpool and Liverpool Women's Hospital, Liverpool L8 7SS, UK.
authors: Leanne V
authors: LV
authors: Jones
authors: Centre for Women's Health Research, University of Liverpool and Liverpool Women's Hospital, Liverpool L8 7SS, UK.
authors: Kate
authors: K
authors: Navaratnam
authors: School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK.
authors: Deborah M
authors: DM
authors: Caldwell
mesh_terms: D001499:Bayes Theorem; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007751:Labor, Induced / Q000379:methods*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011263:Pregnancy Trimester, Third; D011453:Prostaglandins / Q000008:administration & dosage*
chemical_list: D011453:Prostaglandins
references: Obstet Gynecol. 1998 May;91(5 Pt 2):828-30
references: 9572178
references: BMJ. 2012 Oct 09;345:e6226
references: 23048010
references: Cochrane Database Syst Rev. 2009 Oct 07;(4):CD007848
references: 19821440
references: Stat Med. 1996 Dec 30;15(24):2733-49
references: 8981683
references: Med Decis Making. 2013 Jul;33(5):607-17
references: 23104435
references: Lancet. 2007 Sep 15;370(9591):937-48
references: 17869634
references: Stat Med. 2004 Oct 30;23(20):3105-24
references: 15449338
references: Am J Obstet Gynecol. 2010 Jun;202(6):624.e1-9
references: 20430362
references: BMJ. 2008 Mar 15;336(7644):601-5
references: 18316340
references: PLoS Med. 2013;10(5):e1001454
references: 23723742
references: Lancet. 2009 Feb 28;373(9665):746-58
references: 19185342
references: PLoS One. 2013 Oct 03;8(10):e76654
references: 24098547
references: Med Decis Making. 2013 Jul;33(5):641-56
references: 23804508
references: Health Technol Assess. 2005 Jul;9(26):1-134, iii-iv
references: 16014203
references: J Clin Epidemiol. 2014 Feb;67(2):138-43
references: 24090930
references: J Matern Fetal Neonatal Med. 2012 Oct;25(10):1965-9
references: 22372421
references: Semin Perinatol. 2012 Oct;36(5):336-43
references: 23009965
references: BMJ. 2005 Oct 15;331(7521):897-900
references: 16223826
references: Obes Rev. 2011 Aug;12(8):602-21
references: 21438991
references: BMC Pregnancy Childbirth. 2011 Oct 27;11:84
references: 22032440
references: Int J Gynaecol Obstet. 2013 May;121(2):186-9
references: 23433680