title: Meta-analysis of Foley catheter plus misoprostol versus misoprostol alone for cervical ripening.
abstract: BACKGROUND
  The effectiveness of Foley catheter plus misoprostol for cervical ripening has not been convincingly shown in trials.
  
  
  OBJECTIVE
  To summarize the evidence comparing Foley catheter plus misoprostol versus misoprostol alone for cervical ripening.
  
  
  METHODS
  Embase, Medline, and Cochrane Collaboration databases were searched with the terms "Foley catheter," "misoprostol," "cervical ripening," and "labor induction."
  
  
  METHODS
  Randomized controlled trials comparing the methods of cervical ripening for delivery of a viable fetus were included.
  
  
  METHODS
  Study characteristics, quality, and outcomes were recorded. Random-effects models were used to combine data.
  
  
  RESULTS
  Eight trials were included, with 1153 patients overall. In a pooled analysis of seven high-quality studies, the combination group had a decreased time to delivery (mean difference -2.36 hours, 95% confidence interval [CI] -4.07 to -0.66; P=0.007). Risk of chorioamnionitis was significantly increased in the combination group (risk ratio [RR] 2.07, 95% CI 1.04-4.13; P=0.04), and that of tachysystole with fetal heart rate changes was decreased (RR 0.58, 95% CI 0.38-0.91; P=0.02). Frequency of cesarean did not differ (P=0.77).
  
  
  CONCLUSIONS
  The combined use of Foley catheter and misoprostol results in a reduced time to delivery, a reduced frequency tachysystole with fetal heart rate changes, and an increased incidence of chorioamnionitis.
authors: Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, Changsha, China; OMNI Research Group, Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
authors: Wenhang
authors: W
authors: Chen
authors: OMNI Research Group, Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada; Department of Epidemiology, School of Public Health, Central South University, Changsha, China.
authors: Jing
authors: J
authors: Xue
authors: OMNI Research Group, Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
authors: Laura
authors: L
authors: Gaudet
authors: OMNI Research Group, Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada; Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada.
authors: Mark
authors: M
authors: Walker
authors: OMNI Research Group, Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada; Department of Epidemiology, School of Public Health, Central South University, Changsha, China; Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada. Electronic address: swwen@ohri.ca.
authors: Shi Wu
authors: SW
authors: Wen
mesh_terms: D020070:Cervical Ripening / Q000187:drug effects; D002821:Chorioamnionitis / Q000209:etiology; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D016595:Misoprostol / Q000008:administration & dosage* / Q000009:adverse effects; D010120:Oxytocics / Q000008:administration & dosage* / Q000009:adverse effects; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors; D014546:Urinary Catheterization / Q000009:adverse effects
chemical_list: D010120:Oxytocics; D016595:Misoprostol
keywords: Cervical ripening; Foley catheter; Labor induction; Misoprostol; Randomized controlled trials