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Forest plot of comparison: 1 Nitric oxide donors versus placebo or no treatment, outcome: 1.1 Baseline cervical dilatation before the procedure.
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Figure 1

Forest plot of comparison: 1 Nitric oxide donors versus placebo or no treatment, outcome: 1.1 Baseline cervical dilatation before the procedure.

Forest plot of comparison: 1 Nitric oxide donors versus placebo or no treatment, outcome: 1.2 Cumulative force required to dilate cervix to 8 mm.
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Figure 2

Forest plot of comparison: 1 Nitric oxide donors versus placebo or no treatment, outcome: 1.2 Cumulative force required to dilate cervix to 8 mm.

Forest plot of comparison: 1 Nitric oxide donors versus placebo or no treatment, outcome: 1.3 Side effects: Headache.
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Figure 3

Forest plot of comparison: 1 Nitric oxide donors versus placebo or no treatment, outcome: 1.3 Side effects: Headache.

Forest plot of comparison: 1 Nitric oxide donors versus placebo or no treatment, outcome: 1.4 Side effect: Abdominal pain.
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Figure 4

Forest plot of comparison: 1 Nitric oxide donors versus placebo or no treatment, outcome: 1.4 Side effect: Abdominal pain.

Forest plot of comparison: 1 Nitric oxide donors versus placebo or no treatment, outcome: 1.6 Patient satisfaction.
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Figure 5

Forest plot of comparison: 1 Nitric oxide donors versus placebo or no treatment, outcome: 1.6 Patient satisfaction.

Forest plot of comparison: 1 Nitric oxide donors versus placebo or no treatment, outcome: 1.5 Side effect: Nausea/vomiting.
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Figure 6

Forest plot of comparison: 1 Nitric oxide donors versus placebo or no treatment, outcome: 1.5 Side effect: Nausea/vomiting.

Forest plot of comparison: 2 Nitric oxide donors versus prostaglandins, outcome: 2.1 Cumulative force required to dilate cervix to 8‐9 mm.
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Figure 7

Forest plot of comparison: 2 Nitric oxide donors versus prostaglandins, outcome: 2.1 Cumulative force required to dilate cervix to 8‐9 mm.

Forest plot of comparison: 2 Nitric oxide donors versus prostaglandins, outcome: 2.2 Baseline cervical dilatation before the procedure.
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Figure 8

Forest plot of comparison: 2 Nitric oxide donors versus prostaglandins, outcome: 2.2 Baseline cervical dilatation before the procedure.

Forest plot of comparison: 2 Nitric oxide donors versus prostaglandins, outcome: 2.11 Probability of reaching cervical ripening > 8 mm at 3 hours.
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Figure 9

Forest plot of comparison: 2 Nitric oxide donors versus prostaglandins, outcome: 2.11 Probability of reaching cervical ripening > 8 mm at 3 hours.

Forest plot of comparison: 2 Nitric oxide donors versus prostaglandins, outcome: 2.3 Side effect: Headache.
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Figure 10

Forest plot of comparison: 2 Nitric oxide donors versus prostaglandins, outcome: 2.3 Side effect: Headache.

Forest plot of comparison: 2 Nitric oxide donors versus prostaglandins, outcome: 2.6 Side effect: Palpitation.
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Figure 11

Forest plot of comparison: 2 Nitric oxide donors versus prostaglandins, outcome: 2.6 Side effect: Palpitation.

Forest plot of comparison: 2 Nitric oxide donors versus prostaglandins, outcome: 2.7 Side effect: Dizziness.
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Figure 12

Forest plot of comparison: 2 Nitric oxide donors versus prostaglandins, outcome: 2.7 Side effect: Dizziness.

Forest plot of comparison: 2 Nitric oxide donors versus prostaglandins, outcome: 2.4 Side effect: Abdominal pain.
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Figure 13

Forest plot of comparison: 2 Nitric oxide donors versus prostaglandins, outcome: 2.4 Side effect: Abdominal pain.

Forest plot of comparison: 2 Nitric oxide donors versus prostaglandins, outcome: 2.5 Side effect: Vaginal bleeding.
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Figure 14

Forest plot of comparison: 2 Nitric oxide donors versus prostaglandins, outcome: 2.5 Side effect: Vaginal bleeding.

Forest plot of comparison: 2 Nitric oxide donors versus prostaglandins, outcome: 2.8 Side effect: Nausea/Vomiting.
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Figure 15

Forest plot of comparison: 2 Nitric oxide donors versus prostaglandins, outcome: 2.8 Side effect: Nausea/Vomiting.

Forest plot of comparison: 2 Nitric oxide donors versus prostaglandins, outcome: 2.10 Patient satisfaction.
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Figure 16

Forest plot of comparison: 2 Nitric oxide donors versus prostaglandins, outcome: 2.10 Patient satisfaction.

Forest plot of comparison: 2 Nitric oxide donors versus prostaglandins, outcome: 2.9 Intraoperative blood loss.
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Figure 17

Forest plot of comparison: 2 Nitric oxide donors versus prostaglandins, outcome: 2.9 Intraoperative blood loss.

Forest plot of comparison: 3 Nitric oxide donor versus nitric oxide donor and prostaglandin, outcome: 3.1 Cumulative force required to dilate cervix to 8 mm.
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Figure 18

Forest plot of comparison: 3 Nitric oxide donor versus nitric oxide donor and prostaglandin, outcome: 3.1 Cumulative force required to dilate cervix to 8 mm.

Forest plot of comparison: 3 Nitric oxide donor versus nitric oxide donor and prostaglandin, outcome: 3.2 Side effect: Headache.
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Figure 19

Forest plot of comparison: 3 Nitric oxide donor versus nitric oxide donor and prostaglandin, outcome: 3.2 Side effect: Headache.

Forest plot of comparison: 3 Nitric oxide donor versus nitric oxide donor and prostaglandin, outcome: 3.3 Side effect: Abdominal pain.
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Figure 20

Forest plot of comparison: 3 Nitric oxide donor versus nitric oxide donor and prostaglandin, outcome: 3.3 Side effect: Abdominal pain.

Forest plot of comparison: 3 Nitric oxide donor versus nitric oxide donor and prostaglandin, outcome: 3.4 Intraoperative blood loss.
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Figure 21

Forest plot of comparison: 3 Nitric oxide donor versus nitric oxide donor and prostaglandin, outcome: 3.4 Intraoperative blood loss.

Comparison 1 Nitric oxide donors versus placebo or no treatment, Outcome 1 Baseline cervical dilatation before the procedure.
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Analysis 1.1

Comparison 1 Nitric oxide donors versus placebo or no treatment, Outcome 1 Baseline cervical dilatation before the procedure.

Comparison 1 Nitric oxide donors versus placebo or no treatment, Outcome 2 Cumulative force required to dilate cervix to 8 mm.
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Analysis 1.2

Comparison 1 Nitric oxide donors versus placebo or no treatment, Outcome 2 Cumulative force required to dilate cervix to 8 mm.

Comparison 1 Nitric oxide donors versus placebo or no treatment, Outcome 3 Side effects: Headache.
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Analysis 1.3

Comparison 1 Nitric oxide donors versus placebo or no treatment, Outcome 3 Side effects: Headache.

Comparison 1 Nitric oxide donors versus placebo or no treatment, Outcome 4 Side effect: Abdominal pain.
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Analysis 1.4

Comparison 1 Nitric oxide donors versus placebo or no treatment, Outcome 4 Side effect: Abdominal pain.

Comparison 1 Nitric oxide donors versus placebo or no treatment, Outcome 5 Side effect: Nausea/vomiting.
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Analysis 1.5

Comparison 1 Nitric oxide donors versus placebo or no treatment, Outcome 5 Side effect: Nausea/vomiting.

Comparison 1 Nitric oxide donors versus placebo or no treatment, Outcome 6 Patient satisfaction.
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Analysis 1.6

Comparison 1 Nitric oxide donors versus placebo or no treatment, Outcome 6 Patient satisfaction.

Comparison 2 Nitric oxide donors versus prostaglandins, Outcome 1 Cumulative force required to dilate cervix to 8‐9 mm.
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Analysis 2.1

Comparison 2 Nitric oxide donors versus prostaglandins, Outcome 1 Cumulative force required to dilate cervix to 8‐9 mm.

Comparison 2 Nitric oxide donors versus prostaglandins, Outcome 2 Baseline cervical dilatation before the procedure.
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Analysis 2.2

Comparison 2 Nitric oxide donors versus prostaglandins, Outcome 2 Baseline cervical dilatation before the procedure.

Comparison 2 Nitric oxide donors versus prostaglandins, Outcome 3 Probability of reaching cervical ripening > 8 mm at 3 hours.
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Analysis 2.3

Comparison 2 Nitric oxide donors versus prostaglandins, Outcome 3 Probability of reaching cervical ripening > 8 mm at 3 hours.

Comparison 2 Nitric oxide donors versus prostaglandins, Outcome 4 Side effect: Headache.
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Analysis 2.4

Comparison 2 Nitric oxide donors versus prostaglandins, Outcome 4 Side effect: Headache.

Comparison 2 Nitric oxide donors versus prostaglandins, Outcome 5 Side effect: Palpitation.
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Analysis 2.5

Comparison 2 Nitric oxide donors versus prostaglandins, Outcome 5 Side effect: Palpitation.

Comparison 2 Nitric oxide donors versus prostaglandins, Outcome 6 Side effect: Dizziness.
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Analysis 2.6

Comparison 2 Nitric oxide donors versus prostaglandins, Outcome 6 Side effect: Dizziness.

Comparison 2 Nitric oxide donors versus prostaglandins, Outcome 7 Side effect: Abdominal pain.
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Analysis 2.7

Comparison 2 Nitric oxide donors versus prostaglandins, Outcome 7 Side effect: Abdominal pain.

Comparison 2 Nitric oxide donors versus prostaglandins, Outcome 8 Side effect: Vaginal bleeding.
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Analysis 2.8

Comparison 2 Nitric oxide donors versus prostaglandins, Outcome 8 Side effect: Vaginal bleeding.

Comparison 2 Nitric oxide donors versus prostaglandins, Outcome 9 Side effect: Nausea/Vomiting.
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Analysis 2.9

Comparison 2 Nitric oxide donors versus prostaglandins, Outcome 9 Side effect: Nausea/Vomiting.

Comparison 2 Nitric oxide donors versus prostaglandins, Outcome 10 Patient satisfaction.
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Analysis 2.10

Comparison 2 Nitric oxide donors versus prostaglandins, Outcome 10 Patient satisfaction.

Comparison 2 Nitric oxide donors versus prostaglandins, Outcome 11 Intraoperative blood loss.
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Analysis 2.11

Comparison 2 Nitric oxide donors versus prostaglandins, Outcome 11 Intraoperative blood loss.

Comparison 3 Nitric oxide donor versus nitric oxide donor and prostaglandin, Outcome 1 Cumulative force required to dilate cervix to 8 mm.
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Analysis 3.1

Comparison 3 Nitric oxide donor versus nitric oxide donor and prostaglandin, Outcome 1 Cumulative force required to dilate cervix to 8 mm.

Comparison 3 Nitric oxide donor versus nitric oxide donor and prostaglandin, Outcome 2 Side effect: Headache.
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Analysis 3.2

Comparison 3 Nitric oxide donor versus nitric oxide donor and prostaglandin, Outcome 2 Side effect: Headache.

Comparison 3 Nitric oxide donor versus nitric oxide donor and prostaglandin, Outcome 3 Side effect: Abdominal pain.
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Analysis 3.3

Comparison 3 Nitric oxide donor versus nitric oxide donor and prostaglandin, Outcome 3 Side effect: Abdominal pain.

Comparison 3 Nitric oxide donor versus nitric oxide donor and prostaglandin, Outcome 4 Intraoperative blood loss.
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Analysis 3.4

Comparison 3 Nitric oxide donor versus nitric oxide donor and prostaglandin, Outcome 4 Intraoperative blood loss.

Comparison 1. Nitric oxide donors versus placebo or no treatment

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Baseline cervical dilatation before the procedure Show forest plot

3

168

Mean Difference (IV, Fixed, 95% CI)

0.30 [0.01, 0.58]

2 Cumulative force required to dilate cervix to 8 mm Show forest plot

3

153

Mean Difference (IV, Fixed, 95% CI)

‐4.29 [‐9.92, 1.35]

3 Side effects: Headache Show forest plot

3

165

Risk Ratio (M‐H, Fixed, 95% CI)

1.73 [0.86, 3.46]

4 Side effect: Abdominal pain Show forest plot

2

117

Risk Ratio (M‐H, Fixed, 95% CI)

0.87 [0.50, 1.50]

5 Side effect: Nausea/vomiting Show forest plot

3

165

Risk Ratio (M‐H, Fixed, 95% CI)

2.62 [1.07, 6.45]

6 Patient satisfaction Show forest plot

1

84

Risk Ratio (M‐H, Fixed, 95% CI)

0.95 [0.84, 1.07]

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Comparison 1. Nitric oxide donors versus placebo or no treatment
Comparison 2. Nitric oxide donors versus prostaglandins

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Cumulative force required to dilate cervix to 8‐9 mm Show forest plot

5

429

Mean Difference (IV, Fixed, 95% CI)

13.12 [9.72, 16.52]

2 Baseline cervical dilatation before the procedure Show forest plot

4

386

Mean Difference (IV, Fixed, 95% CI)

‐0.73 [‐1.01, ‐0.45]

3 Probability of reaching cervical ripening > 8 mm at 3 hours Show forest plot

1

60

Risk Ratio (M‐H, Fixed, 95% CI)

6.67 [2.21, 20.09]

4 Side effect: Headache Show forest plot

5

507

Risk Ratio (M‐H, Fixed, 95% CI)

5.13 [3.29, 8.00]

5 Side effect: Palpitation Show forest plot

4

447

Risk Ratio (M‐H, Fixed, 95% CI)

3.43 [1.64, 7.15]

6 Side effect: Dizziness Show forest plot

3

327

Risk Ratio (M‐H, Fixed, 95% CI)

3.29 [1.46, 7.41]

7 Side effect: Abdominal pain Show forest plot

5

507

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.25, 0.44]

8 Side effect: Vaginal bleeding Show forest plot

4

447

Risk Ratio (M‐H, Fixed, 95% CI)

0.14 [0.07, 0.27]

9 Side effect: Nausea/Vomiting Show forest plot

5

507

Risk Ratio (M‐H, Fixed, 95% CI)

1.17 [0.94, 1.46]

10 Patient satisfaction Show forest plot

1

84

Risk Ratio (M‐H, Fixed, 95% CI)

1.09 [0.92, 1.28]

11 Intraoperative blood loss Show forest plot

4

393

Mean Difference (IV, Fixed, 95% CI)

33.59 [24.50, 42.67]

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Comparison 2. Nitric oxide donors versus prostaglandins
Comparison 3. Nitric oxide donor versus nitric oxide donor and prostaglandin

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Cumulative force required to dilate cervix to 8 mm Show forest plot

1

44

Mean Difference (IV, Fixed, 95% CI)

14.5 [0.50, 28.50]

2 Side effect: Headache Show forest plot

1

44

Risk Ratio (M‐H, Fixed, 95% CI)

0.88 [0.38, 2.00]

3 Side effect: Abdominal pain Show forest plot

1

44

Risk Ratio (M‐H, Fixed, 95% CI)

0.14 [0.02, 1.07]

4 Intraoperative blood loss Show forest plot

1

44

Mean Difference (IV, Fixed, 95% CI)

‐50.0 [‐164.19, 64.19]

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Comparison 3. Nitric oxide donor versus nitric oxide donor and prostaglandin