Mechanical methods for induction of labour

Marta Jozwiak; Kitty WM Bloemenkamp; Anthony J Kelly; Ben Willem J Mol; Olivier Irion; Michel Boulvain

doi:10.1002/14651858.CD001233.pub2

Scolaris Content Display Scolaris Content Display

Figure 1

Funnel plot of comparison: 2 Any mechanical method versus vaginal PGE2: all women, outcome: 2.3 Caesarean section.

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Figure 2

Funnel plot of comparison: 5 Any mechanical method versus intracervical PGE2: all women, outcome: 5.3 Caesarean section.

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Figure 3

Funnel plot of comparison: 14 Laminaria tent versus prostaglandins: all women (not prespecified), outcome: 14.2 Caesarean section.

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Figure 4

Funnel plot of comparison: 19 Balloon catheter (Foley or Atad) versus prostaglandins: all women (not prespecified), outcome: 19.3 Caesarean section.

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Analysis 1.1

Comparison 1 Any mechanical method versus placebo/no treatment: all women, Outcome 1 Vaginal delivery not achieved in 24 hours.

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Analysis 1.2

Comparison 1 Any mechanical method versus placebo/no treatment: all women, Outcome 2 Caesarean section.

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Analysis 1.3

Comparison 1 Any mechanical method versus placebo/no treatment: all women, Outcome 3 Cervix unfavourable/unchanged after 12‐24 hours.

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Analysis 1.4

Comparison 1 Any mechanical method versus placebo/no treatment: all women, Outcome 4 Uterine hyperstimulation without fetal heart rate changes.

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Analysis 1.5

Comparison 1 Any mechanical method versus placebo/no treatment: all women, Outcome 5 Epidural analgesia.

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Analysis 1.6

Comparison 1 Any mechanical method versus placebo/no treatment: all women, Outcome 6 Apgar score < 7 at 5 minutes.

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Analysis 1.7

Comparison 1 Any mechanical method versus placebo/no treatment: all women, Outcome 7 Post partum haemorrhage.

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Analysis 1.8

Comparison 1 Any mechanical method versus placebo/no treatment: all women, Outcome 8 Chorioamnionitis (not prespecified).

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Analysis 1.9

Comparison 1 Any mechanical method versus placebo/no treatment: all women, Outcome 9 Endometritis (not prespecified).

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Analysis 1.10

Comparison 1 Any mechanical method versus placebo/no treatment: all women, Outcome 10 Fetal distress (not prespecified).

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Analysis 2.1

Comparison 2 Any mechanical method versus vaginal PGE2: all women, Outcome 1 Vaginal delivery not achieved in 24 hours.

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Analysis 2.2

Comparison 2 Any mechanical method versus vaginal PGE2: all women, Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 2.3

Comparison 2 Any mechanical method versus vaginal PGE2: all women, Outcome 3 Caesarean section.

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Analysis 2.4

Comparison 2 Any mechanical method versus vaginal PGE2: all women, Outcome 4 Post partum haemorrhage.

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Analysis 2.5

Comparison 2 Any mechanical method versus vaginal PGE2: all women, Outcome 5 Serious maternal morbidity or death.

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Analysis 2.6

Comparison 2 Any mechanical method versus vaginal PGE2: all women, Outcome 6 Maternal side effects.

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Analysis 2.7

Comparison 2 Any mechanical method versus vaginal PGE2: all women, Outcome 7 Oxytocin augmentation.

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Analysis 2.8

Comparison 2 Any mechanical method versus vaginal PGE2: all women, Outcome 8 Uterine hyperstimulation without fetal heart rate changes.

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Analysis 2.9

Comparison 2 Any mechanical method versus vaginal PGE2: all women, Outcome 9 Serious neonatal morbidity/perinatal death.

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Analysis 2.10

Comparison 2 Any mechanical method versus vaginal PGE2: all women, Outcome 10 Epidural analgesia.

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Analysis 2.11

Comparison 2 Any mechanical method versus vaginal PGE2: all women, Outcome 11 Instrumental vaginal delivery.

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Analysis 2.12

Comparison 2 Any mechanical method versus vaginal PGE2: all women, Outcome 12 Meconium stained liquor.

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Analysis 2.13

Comparison 2 Any mechanical method versus vaginal PGE2: all women, Outcome 13 Apgar score < 7 at 5 minutes.

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Analysis 2.14

Comparison 2 Any mechanical method versus vaginal PGE2: all women, Outcome 14 Neonatal intensive care unit admission.

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Analysis 2.15

Comparison 2 Any mechanical method versus vaginal PGE2: all women, Outcome 15 Woman not satisfied.

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Analysis 2.16

Comparison 2 Any mechanical method versus vaginal PGE2: all women, Outcome 16 Perinatal death.

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Analysis 2.17

Comparison 2 Any mechanical method versus vaginal PGE2: all women, Outcome 17 Antibiotics during labour (not prespecified).

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Analysis 2.18

Comparison 2 Any mechanical method versus vaginal PGE2: all women, Outcome 18 Wound infection (not prespecified).

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Analysis 2.19

Comparison 2 Any mechanical method versus vaginal PGE2: all women, Outcome 19 pH < 7.10 (not prespecified).

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Analysis 2.20

Comparison 2 Any mechanical method versus vaginal PGE2: all women, Outcome 20 Fetal distress (not prespecified).

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Analysis 2.21

Comparison 2 Any mechanical method versus vaginal PGE2: all women, Outcome 21 Endometritis (not prespecified).

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Analysis 2.22

Comparison 2 Any mechanical method versus vaginal PGE2: all women, Outcome 22 Maternal fever during labour (not prespecified).

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Analysis 3.1

Comparison 3 Any mechanical method versus vaginal PGE2: all multiparae, Outcome 1 Vaginal delivery not achieved in 24 hours.

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Analysis 3.2

Comparison 3 Any mechanical method versus vaginal PGE2: all multiparae, Outcome 2 Oxytocin augmentation.

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Analysis 3.3

Comparison 3 Any mechanical method versus vaginal PGE2: all multiparae, Outcome 3 Caesarean section.

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Analysis 3.4

Comparison 3 Any mechanical method versus vaginal PGE2: all multiparae, Outcome 4 Meconium stained liquor.

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Analysis 3.5

Comparison 3 Any mechanical method versus vaginal PGE2: all multiparae, Outcome 5 Neonatal intensive care unit admission.

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Analysis 3.6

Comparison 3 Any mechanical method versus vaginal PGE2: all multiparae, Outcome 6 Uterine hyperstimulation without fetal heart rate changes.

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Analysis 3.7

Comparison 3 Any mechanical method versus vaginal PGE2: all multiparae, Outcome 7 Instrumental vaginal delivery.

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Analysis 4.1

Comparison 4 Any mechanical method versus vaginal PGE2: all primiparae, Outcome 1 Vaginal delivery not achieved in 24 hours.

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Analysis 4.2

Comparison 4 Any mechanical method versus vaginal PGE2: all primiparae, Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 4.3

Comparison 4 Any mechanical method versus vaginal PGE2: all primiparae, Outcome 3 Caesarean section.

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Analysis 4.4

Comparison 4 Any mechanical method versus vaginal PGE2: all primiparae, Outcome 4 Serious neonatal morbidity/perinatal death.

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Analysis 4.5

Comparison 4 Any mechanical method versus vaginal PGE2: all primiparae, Outcome 5 Serious maternal morbidity or death.

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Analysis 4.6

Comparison 4 Any mechanical method versus vaginal PGE2: all primiparae, Outcome 6 Antibiotics during labour (not presppecified).

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Analysis 4.7

Comparison 4 Any mechanical method versus vaginal PGE2: all primiparae, Outcome 7 Oxytocin augmentation.

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Analysis 4.8

Comparison 4 Any mechanical method versus vaginal PGE2: all primiparae, Outcome 8 Maternal fever during labour (not prespecified).

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Analysis 4.9

Comparison 4 Any mechanical method versus vaginal PGE2: all primiparae, Outcome 9 Uterine hyperstimulation without fetal heart rate changes.

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Analysis 4.10

Comparison 4 Any mechanical method versus vaginal PGE2: all primiparae, Outcome 10 Epidural analgesia.

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Analysis 4.11

Comparison 4 Any mechanical method versus vaginal PGE2: all primiparae, Outcome 11 Instrumental vaginal delivery.

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Analysis 4.12

Comparison 4 Any mechanical method versus vaginal PGE2: all primiparae, Outcome 12 Meconium stained liquor.

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Analysis 4.13

Comparison 4 Any mechanical method versus vaginal PGE2: all primiparae, Outcome 13 Apgar score < 7 at 5 minutes.

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Analysis 4.14

Comparison 4 Any mechanical method versus vaginal PGE2: all primiparae, Outcome 14 pH < 7.10 (not prespecified).

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Analysis 4.15

Comparison 4 Any mechanical method versus vaginal PGE2: all primiparae, Outcome 15 Endometritis (not prespecified).

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Analysis 4.16

Comparison 4 Any mechanical method versus vaginal PGE2: all primiparae, Outcome 16 Wound infection (not prespecified).

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Analysis 4.17

Comparison 4 Any mechanical method versus vaginal PGE2: all primiparae, Outcome 17 Post partum haemorrhage.

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Analysis 4.18

Comparison 4 Any mechanical method versus vaginal PGE2: all primiparae, Outcome 18 Fetal distress (not prespecified).

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Analysis 5.1

Comparison 5 Any mechanical method versus intracervical PGE2: all women, Outcome 1 Vaginal delivery not achieved in 24 hours.

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Analysis 5.2

Comparison 5 Any mechanical method versus intracervical PGE2: all women, Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 5.3

Comparison 5 Any mechanical method versus intracervical PGE2: all women, Outcome 3 Caesarean section.

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Analysis 5.4

Comparison 5 Any mechanical method versus intracervical PGE2: all women, Outcome 4 Serious neonatal morbidity/perinatal death.

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Analysis 5.5

Comparison 5 Any mechanical method versus intracervical PGE2: all women, Outcome 5 Serious maternal morbidity or death.

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Analysis 5.6

Comparison 5 Any mechanical method versus intracervical PGE2: all women, Outcome 6 Cervix unfavourable/unchanged after 12‐24 hours.

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Analysis 5.7

Comparison 5 Any mechanical method versus intracervical PGE2: all women, Outcome 7 Oxytocin augmentation.

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Analysis 5.8

Comparison 5 Any mechanical method versus intracervical PGE2: all women, Outcome 8 Uterine hyperstimulation without fetal heart rate changes.

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Analysis 5.9

Comparison 5 Any mechanical method versus intracervical PGE2: all women, Outcome 9 Uterine rupture.

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Analysis 5.10

Comparison 5 Any mechanical method versus intracervical PGE2: all women, Outcome 10 Epidural analgesia.

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Analysis 5.11

Comparison 5 Any mechanical method versus intracervical PGE2: all women, Outcome 11 Instrumental vaginal delivery.

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Analysis 5.12

Comparison 5 Any mechanical method versus intracervical PGE2: all women, Outcome 12 Meconium stained liquor.

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Analysis 5.13

Comparison 5 Any mechanical method versus intracervical PGE2: all women, Outcome 13 Apgar score < 7 at 5 minutes.

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Analysis 5.14

Comparison 5 Any mechanical method versus intracervical PGE2: all women, Outcome 14 Neonatal intensive care unit admission.

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Analysis 5.15

Comparison 5 Any mechanical method versus intracervical PGE2: all women, Outcome 15 Perinatal death.

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Analysis 5.16

Comparison 5 Any mechanical method versus intracervical PGE2: all women, Outcome 16 Maternal side effects.

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Analysis 5.17

Comparison 5 Any mechanical method versus intracervical PGE2: all women, Outcome 17 Post partum haemorrhage.

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Analysis 5.18

Comparison 5 Any mechanical method versus intracervical PGE2: all women, Outcome 18 Woman not satisfied.

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Analysis 5.19

Comparison 5 Any mechanical method versus intracervical PGE2: all women, Outcome 19 Chorioamnionitis (not prespecified).

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Analysis 5.20

Comparison 5 Any mechanical method versus intracervical PGE2: all women, Outcome 20 Endometritis (not prespecified).

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Analysis 5.21

Comparison 5 Any mechanical method versus intracervical PGE2: all women, Outcome 21 Fetal distress (not prespecified).

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Analysis 5.22

Comparison 5 Any mechanical method versus intracervical PGE2: all women, Outcome 22 Need for another method of induction (not prespecified).

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Analysis 5.23

Comparison 5 Any mechanical method versus intracervical PGE2: all women, Outcome 23 Neonatal infection (not prespecified).

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Analysis 6.1

Comparison 6 Any mechanical method versus intracervical PGE2: all primipare, Outcome 1 Oxytocin augmentation.

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Analysis 6.2

Comparison 6 Any mechanical method versus intracervical PGE2: all primipare, Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 6.3

Comparison 6 Any mechanical method versus intracervical PGE2: all primipare, Outcome 3 Caesarean section.

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Analysis 6.4

Comparison 6 Any mechanical method versus intracervical PGE2: all primipare, Outcome 4 Instrumental vaginal delivery.

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Analysis 7.1

Comparison 7 Any mechanical method versus intracervical PGE2: all multiparae, Outcome 1 Uterine hyperstimulation with FHR changes.

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Analysis 7.2

Comparison 7 Any mechanical method versus intracervical PGE2: all multiparae, Outcome 2 Caesarean section.

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Analysis 7.3

Comparison 7 Any mechanical method versus intracervical PGE2: all multiparae, Outcome 3 Instrumental vaginal delivery.

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Analysis 8.1

Comparison 8 Any mechanical method versus vaginal misoprostol: all women, Outcome 1 Vaginal delivery not achieved in 24 hours.

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Analysis 8.2

Comparison 8 Any mechanical method versus vaginal misoprostol: all women, Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 8.3

Comparison 8 Any mechanical method versus vaginal misoprostol: all women, Outcome 3 Caesarean section.

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Analysis 8.4

Comparison 8 Any mechanical method versus vaginal misoprostol: all women, Outcome 4 Uterine hyperstimulation without FHR changes.

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Analysis 8.5

Comparison 8 Any mechanical method versus vaginal misoprostol: all women, Outcome 5 Serious maternal morbidity or death.

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Analysis 8.6

Comparison 8 Any mechanical method versus vaginal misoprostol: all women, Outcome 6 Maternal fever during labour (not prespecified).

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Analysis 8.7

Comparison 8 Any mechanical method versus vaginal misoprostol: all women, Outcome 7 Oxytocin augmentation.

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Analysis 8.8

Comparison 8 Any mechanical method versus vaginal misoprostol: all women, Outcome 8 Epidural analgesia.

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Analysis 8.9

Comparison 8 Any mechanical method versus vaginal misoprostol: all women, Outcome 9 Instrumental vaginal delivery.

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Analysis 8.10

Comparison 8 Any mechanical method versus vaginal misoprostol: all women, Outcome 10 Meconium stained liquor.

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Analysis 8.11

Comparison 8 Any mechanical method versus vaginal misoprostol: all women, Outcome 11 Apgar score < 7 at 5 minutes.

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Analysis 8.12

Comparison 8 Any mechanical method versus vaginal misoprostol: all women, Outcome 12 Neonatal intensive care unit admission.

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Analysis 8.13

Comparison 8 Any mechanical method versus vaginal misoprostol: all women, Outcome 13 Serious maternal complications.

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Analysis 8.14

Comparison 8 Any mechanical method versus vaginal misoprostol: all women, Outcome 14 Post partum haemorrhage.

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Analysis 8.15

Comparison 8 Any mechanical method versus vaginal misoprostol: all women, Outcome 15 Chorioamnionitis (not prespecified).

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Analysis 8.16

Comparison 8 Any mechanical method versus vaginal misoprostol: all women, Outcome 16 Endometritis (not prespecified).

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Analysis 8.17

Comparison 8 Any mechanical method versus vaginal misoprostol: all women, Outcome 17 Neonatal infection (not prespecified).

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Analysis 9.1

Comparison 9 Any mechanical method versus vaginal misoprostol: all primiparae, Outcome 1 Caesarean section.

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Analysis 10.1

Comparison 10 Any mechanical method versus vaginal misoprostol: all multiparae, Outcome 1 Caesarean section.

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Analysis 11.1

Comparison 11 Any mechanical method versus oral misoprostol: all women, Outcome 1 Caesarean section.

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Analysis 11.2

Comparison 11 Any mechanical method versus oral misoprostol: all women, Outcome 2 Uterine hyperstimulation without FHR changes.

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Analysis 11.3

Comparison 11 Any mechanical method versus oral misoprostol: all women, Outcome 3 Post partum haemorrhage.

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Analysis 12.1

Comparison 12 Any mechanical method versus oxytocin: all women, Outcome 1 Uterine hyperstimulation with FHR changes.

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Analysis 12.2

Comparison 12 Any mechanical method versus oxytocin: all women, Outcome 2 Meconium stained liquor.

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Analysis 12.3

Comparison 12 Any mechanical method versus oxytocin: all women, Outcome 3 Caesarean section.

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Analysis 12.4

Comparison 12 Any mechanical method versus oxytocin: all women, Outcome 4 Apgar score < 7 at 5 minutes.

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Analysis 12.5

Comparison 12 Any mechanical method versus oxytocin: all women, Outcome 5 Serious maternal morbidity or death.

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Analysis 12.6

Comparison 12 Any mechanical method versus oxytocin: all women, Outcome 6 Neonatal intensive care unit admission.

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Analysis 12.7

Comparison 12 Any mechanical method versus oxytocin: all women, Outcome 7 Uterine hyperstimulation without fetal heart rate changes.

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Analysis 12.8

Comparison 12 Any mechanical method versus oxytocin: all women, Outcome 8 Instrumental vaginal delivery.

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Analysis 12.9

Comparison 12 Any mechanical method versus oxytocin: all women, Outcome 9 Post partum haemorrhage.

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Analysis 13.1

Comparison 13 Any mechanical method versus oxytocin: all primiparae, Outcome 1 Caesarean section.

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Analysis 13.2

Comparison 13 Any mechanical method versus oxytocin: all primiparae, Outcome 2 Serious maternal morbidity or death.

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Analysis 13.3

Comparison 13 Any mechanical method versus oxytocin: all primiparae, Outcome 3 Uterine hyperstimulation without fetal heart rate changes.

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Analysis 13.4

Comparison 13 Any mechanical method versus oxytocin: all primiparae, Outcome 4 Instrumental vaginal delivery.

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Analysis 13.5

Comparison 13 Any mechanical method versus oxytocin: all primiparae, Outcome 5 Post partum haemorrhage.

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Analysis 14.1

Comparison 14 Laminaria tent versus prostaglandins: all women (not prespecified), Outcome 1 Uterine hyperstimulation with FHR changes.

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Analysis 14.2

Comparison 14 Laminaria tent versus prostaglandins: all women (not prespecified), Outcome 2 Caesarean section.

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Analysis 14.3

Comparison 14 Laminaria tent versus prostaglandins: all women (not prespecified), Outcome 3 Serious neonatal morbidity/perinatal death.

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Analysis 14.4

Comparison 14 Laminaria tent versus prostaglandins: all women (not prespecified), Outcome 4 Serious maternal morbidity or death.

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Analysis 14.5

Comparison 14 Laminaria tent versus prostaglandins: all women (not prespecified), Outcome 5 Cervix unfavourable/unchanged after 12‐24 hours.

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Analysis 14.6

Comparison 14 Laminaria tent versus prostaglandins: all women (not prespecified), Outcome 6 Oxytocin augmentation.

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Analysis 14.7

Comparison 14 Laminaria tent versus prostaglandins: all women (not prespecified), Outcome 7 Uterine hyperstimulation without fetal heart rate changes.

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Analysis 14.8

Comparison 14 Laminaria tent versus prostaglandins: all women (not prespecified), Outcome 8 Uterine rupture.

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Analysis 14.9

Comparison 14 Laminaria tent versus prostaglandins: all women (not prespecified), Outcome 9 Epidural analgesia.

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Analysis 14.10

Comparison 14 Laminaria tent versus prostaglandins: all women (not prespecified), Outcome 10 Instrumental vaginal delivery.

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Analysis 14.11

Comparison 14 Laminaria tent versus prostaglandins: all women (not prespecified), Outcome 11 Meconium stained liquor.

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Analysis 14.12

Comparison 14 Laminaria tent versus prostaglandins: all women (not prespecified), Outcome 12 Apgar score < 7 at 5 minutes.

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Analysis 14.13

Comparison 14 Laminaria tent versus prostaglandins: all women (not prespecified), Outcome 13 Neonatal intensive care unit admission.

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Analysis 14.14

Comparison 14 Laminaria tent versus prostaglandins: all women (not prespecified), Outcome 14 Perinatal death.

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Analysis 14.15

Comparison 14 Laminaria tent versus prostaglandins: all women (not prespecified), Outcome 15 Maternal side effects.

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Analysis 14.16

Comparison 14 Laminaria tent versus prostaglandins: all women (not prespecified), Outcome 16 Post partum haemorrhage.

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Analysis 14.17

Comparison 14 Laminaria tent versus prostaglandins: all women (not prespecified), Outcome 17 Chorioamnionitis.

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Analysis 14.18

Comparison 14 Laminaria tent versus prostaglandins: all women (not prespecified), Outcome 18 Endometritis.

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Analysis 14.19

Comparison 14 Laminaria tent versus prostaglandins: all women (not prespecified), Outcome 19 Fetal distress.

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Analysis 14.20

Comparison 14 Laminaria tent versus prostaglandins: all women (not prespecified), Outcome 20 Need for another method of induction.

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Analysis 14.21

Comparison 14 Laminaria tent versus prostaglandins: all women (not prespecified), Outcome 21 Neonatal infection.

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Analysis 15.1

Comparison 15 Laminaria tent and prostaglandins versus prostaglandins alone: all women (not prespecified), Outcome 1 Vaginal delivery not achieved in 24 hours.

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Analysis 15.2

Comparison 15 Laminaria tent and prostaglandins versus prostaglandins alone: all women (not prespecified), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 15.3

Comparison 15 Laminaria tent and prostaglandins versus prostaglandins alone: all women (not prespecified), Outcome 3 Oxytocin augmentation.

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Analysis 15.4

Comparison 15 Laminaria tent and prostaglandins versus prostaglandins alone: all women (not prespecified), Outcome 4 Serious neonatal morbidity/perinatal death.

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Analysis 15.5

Comparison 15 Laminaria tent and prostaglandins versus prostaglandins alone: all women (not prespecified), Outcome 5 Caesarean section.

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Analysis 15.6

Comparison 15 Laminaria tent and prostaglandins versus prostaglandins alone: all women (not prespecified), Outcome 6 Uterine hyperstimulation without fetal heart rate changes.

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Analysis 15.7

Comparison 15 Laminaria tent and prostaglandins versus prostaglandins alone: all women (not prespecified), Outcome 7 Epidural analgesia.

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Analysis 15.8

Comparison 15 Laminaria tent and prostaglandins versus prostaglandins alone: all women (not prespecified), Outcome 8 Instrumental vaginal delivery.

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Analysis 15.9

Comparison 15 Laminaria tent and prostaglandins versus prostaglandins alone: all women (not prespecified), Outcome 9 Neonatal intensive care unit admission.

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Analysis 15.10

Comparison 15 Laminaria tent and prostaglandins versus prostaglandins alone: all women (not prespecified), Outcome 10 Post partum haemorrhage.

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Analysis 15.11

Comparison 15 Laminaria tent and prostaglandins versus prostaglandins alone: all women (not prespecified), Outcome 11 Neonatal infection.

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Analysis 15.12

Comparison 15 Laminaria tent and prostaglandins versus prostaglandins alone: all women (not prespecified), Outcome 12 Chorioamnionitis or endometritis.

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Analysis 16.1

Comparison 16 Laminaria tent versus oxytocin (not prespecified), Outcome 1 Caesarean section.

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Analysis 17.1

Comparison 17 Laminaria and oxytocin versus oxytocin alone: all women (not prespecified), Outcome 1 Caesarean section.

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Analysis 17.2

Comparison 17 Laminaria and oxytocin versus oxytocin alone: all women (not prespecified), Outcome 2 Instrumental vaginal delivery.

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Analysis 17.3

Comparison 17 Laminaria and oxytocin versus oxytocin alone: all women (not prespecified), Outcome 3 Endometritis.

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Analysis 18.1

Comparison 18 Laminaria versus extra‐amniotic infusion: all women (not prespecified), Outcome 1 Caesarean section.

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Analysis 18.2

Comparison 18 Laminaria versus extra‐amniotic infusion: all women (not prespecified), Outcome 2 Epidural analgesia.

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Analysis 18.3

Comparison 18 Laminaria versus extra‐amniotic infusion: all women (not prespecified), Outcome 3 Apgar score <7 at 5 minutes.

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Analysis 18.4

Comparison 18 Laminaria versus extra‐amniotic infusion: all women (not prespecified), Outcome 4 Neonatal intensive care unit admission.

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Analysis 18.5

Comparison 18 Laminaria versus extra‐amniotic infusion: all women (not prespecified), Outcome 5 Post partum haemorrhage.

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Analysis 18.6

Comparison 18 Laminaria versus extra‐amniotic infusion: all women (not prespecified), Outcome 6 Chorioamnionitis.

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Analysis 18.7

Comparison 18 Laminaria versus extra‐amniotic infusion: all women (not prespecified), Outcome 7 Endometritis.

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Analysis 19.1

Comparison 19 Balloon catheter (Foley or Atad) versus prostaglandins: all women (not prespecified), Outcome 1 Vaginal delivery not achieved in 24 hours.

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Analysis 19.2

Comparison 19 Balloon catheter (Foley or Atad) versus prostaglandins: all women (not prespecified), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 19.3

Comparison 19 Balloon catheter (Foley or Atad) versus prostaglandins: all women (not prespecified), Outcome 3 Caesarean section.

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Analysis 19.4

Comparison 19 Balloon catheter (Foley or Atad) versus prostaglandins: all women (not prespecified), Outcome 4 Serious neonatal morbidity/perinatal death.

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Analysis 19.5

Comparison 19 Balloon catheter (Foley or Atad) versus prostaglandins: all women (not prespecified), Outcome 5 Serious maternal morbidity or death.

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Analysis 19.6

Comparison 19 Balloon catheter (Foley or Atad) versus prostaglandins: all women (not prespecified), Outcome 6 Cervix unfavourable/unchanged after 12‐24 hours.

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Analysis 19.7

Comparison 19 Balloon catheter (Foley or Atad) versus prostaglandins: all women (not prespecified), Outcome 7 Oxytocin augmentation.

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Analysis 19.8

Comparison 19 Balloon catheter (Foley or Atad) versus prostaglandins: all women (not prespecified), Outcome 8 Uterine hyperstimulation without fetal heart rate changes.

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Analysis 19.9

Comparison 19 Balloon catheter (Foley or Atad) versus prostaglandins: all women (not prespecified), Outcome 9 Epidural analgesia.

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Analysis 19.10

Comparison 19 Balloon catheter (Foley or Atad) versus prostaglandins: all women (not prespecified), Outcome 10 Instrumental vaginal delivery.

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Analysis 19.11

Comparison 19 Balloon catheter (Foley or Atad) versus prostaglandins: all women (not prespecified), Outcome 11 Meconium stained liquor.

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Analysis 19.12

Comparison 19 Balloon catheter (Foley or Atad) versus prostaglandins: all women (not prespecified), Outcome 12 Apgar score < 7 at 5 minutes.

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Analysis 19.13

Comparison 19 Balloon catheter (Foley or Atad) versus prostaglandins: all women (not prespecified), Outcome 13 Neonatal intensive care unit admission.

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Analysis 19.14

Comparison 19 Balloon catheter (Foley or Atad) versus prostaglandins: all women (not prespecified), Outcome 14 Antibiotics during labour (not prespecified).

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Analysis 19.15

Comparison 19 Balloon catheter (Foley or Atad) versus prostaglandins: all women (not prespecified), Outcome 15 Perinatal death.

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Analysis 19.16

Comparison 19 Balloon catheter (Foley or Atad) versus prostaglandins: all women (not prespecified), Outcome 16 Maternal fever during labour (not prespecified).

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Analysis 19.17

Comparison 19 Balloon catheter (Foley or Atad) versus prostaglandins: all women (not prespecified), Outcome 17 Maternal side effects.

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Analysis 19.18

Comparison 19 Balloon catheter (Foley or Atad) versus prostaglandins: all women (not prespecified), Outcome 18 Wound infection (not prespecified).

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Analysis 19.19

Comparison 19 Balloon catheter (Foley or Atad) versus prostaglandins: all women (not prespecified), Outcome 19 Post partum haemorrhage.

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Analysis 19.20

Comparison 19 Balloon catheter (Foley or Atad) versus prostaglandins: all women (not prespecified), Outcome 20 Woman not satisfied.

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Analysis 19.21

Comparison 19 Balloon catheter (Foley or Atad) versus prostaglandins: all women (not prespecified), Outcome 21 Chorioamnionitis.

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Analysis 19.22

Comparison 19 Balloon catheter (Foley or Atad) versus prostaglandins: all women (not prespecified), Outcome 22 Endometritis.

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Analysis 19.23

Comparison 19 Balloon catheter (Foley or Atad) versus prostaglandins: all women (not prespecified), Outcome 23 Fetal distress.

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Analysis 19.24

Comparison 19 Balloon catheter (Foley or Atad) versus prostaglandins: all women (not prespecified), Outcome 24 Neonatal infection.

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Analysis 20.1

Comparison 20 Balloon catheter (Foley or Atad) and prostaglandins versus prostaglandins alone: all women (not prespecified), Outcome 1 Vaginal delivery not achieved in 24 hours.

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Analysis 20.2

Comparison 20 Balloon catheter (Foley or Atad) and prostaglandins versus prostaglandins alone: all women (not prespecified), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 20.3

Comparison 20 Balloon catheter (Foley or Atad) and prostaglandins versus prostaglandins alone: all women (not prespecified), Outcome 3 Caesarean section.

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Analysis 20.4

Comparison 20 Balloon catheter (Foley or Atad) and prostaglandins versus prostaglandins alone: all women (not prespecified), Outcome 4 Cervix unfavourable/unchanged after 12‐24 hours.

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Analysis 20.5

Comparison 20 Balloon catheter (Foley or Atad) and prostaglandins versus prostaglandins alone: all women (not prespecified), Outcome 5 Oxytocin augmentation.

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Analysis 20.6

Comparison 20 Balloon catheter (Foley or Atad) and prostaglandins versus prostaglandins alone: all women (not prespecified), Outcome 6 Uterine hyperstimulation without fetal heart rate changes.

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Analysis 20.7

Comparison 20 Balloon catheter (Foley or Atad) and prostaglandins versus prostaglandins alone: all women (not prespecified), Outcome 7 Epidural analgesia.

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Analysis 20.8

Comparison 20 Balloon catheter (Foley or Atad) and prostaglandins versus prostaglandins alone: all women (not prespecified), Outcome 8 Instrumental vaginal delivery.

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Analysis 20.9

Comparison 20 Balloon catheter (Foley or Atad) and prostaglandins versus prostaglandins alone: all women (not prespecified), Outcome 9 Meconium stained liquor.

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Analysis 20.10

Comparison 20 Balloon catheter (Foley or Atad) and prostaglandins versus prostaglandins alone: all women (not prespecified), Outcome 10 Apgar score < 7 at 5 minutes.

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Analysis 20.11

Comparison 20 Balloon catheter (Foley or Atad) and prostaglandins versus prostaglandins alone: all women (not prespecified), Outcome 11 Neonatal intensive care unit admission.

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Analysis 20.12

Comparison 20 Balloon catheter (Foley or Atad) and prostaglandins versus prostaglandins alone: all women (not prespecified), Outcome 12 Perinatal death.

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Analysis 20.13

Comparison 20 Balloon catheter (Foley or Atad) and prostaglandins versus prostaglandins alone: all women (not prespecified), Outcome 13 Woman not satisfied.

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Analysis 20.14

Comparison 20 Balloon catheter (Foley or Atad) and prostaglandins versus prostaglandins alone: all women (not prespecified), Outcome 14 Chorioamnionitis.

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Analysis 20.15

Comparison 20 Balloon catheter (Foley or Atad) and prostaglandins versus prostaglandins alone: all women (not prespecified), Outcome 15 Endometritis.

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Analysis 20.16

Comparison 20 Balloon catheter (Foley or Atad) and prostaglandins versus prostaglandins alone: all women (not prespecified), Outcome 16 Neonatal infection.

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Analysis 21.1

Comparison 21 Balloon catheter (Foley or Atad) versus oxytocin: all women (not prespecified), Outcome 1 Uterine hyperstimulation with FHR changes.

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Analysis 21.2

Comparison 21 Balloon catheter (Foley or Atad) versus oxytocin: all women (not prespecified), Outcome 2 Caesarean section.

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Analysis 21.3

Comparison 21 Balloon catheter (Foley or Atad) versus oxytocin: all women (not prespecified), Outcome 3 Serious maternal morbidity or death.

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Analysis 21.4

Comparison 21 Balloon catheter (Foley or Atad) versus oxytocin: all women (not prespecified), Outcome 4 Meconium stained liquor.

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Analysis 21.5

Comparison 21 Balloon catheter (Foley or Atad) versus oxytocin: all women (not prespecified), Outcome 5 Uterine hyperstimulation without FHR changes.

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Analysis 21.6

Comparison 21 Balloon catheter (Foley or Atad) versus oxytocin: all women (not prespecified), Outcome 6 Neonatal intensive care unit admission.

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Analysis 21.7

Comparison 21 Balloon catheter (Foley or Atad) versus oxytocin: all women (not prespecified), Outcome 7 Instrumental vaginal delivery.

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Analysis 21.8

Comparison 21 Balloon catheter (Foley or Atad) versus oxytocin: all women (not prespecified), Outcome 8 Apgar score < 7 at 5 minutes.

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Analysis 21.9

Comparison 21 Balloon catheter (Foley or Atad) versus oxytocin: all women (not prespecified), Outcome 9 Postpartum haemorrhage.

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Analysis 22.1

Comparison 22 Balloon catheter and oxytocin versus prostaglandins: all women (not pre‐specified), Outcome 1 Caesarean section.

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Analysis 22.2

Comparison 22 Balloon catheter and oxytocin versus prostaglandins: all women (not pre‐specified), Outcome 2 Uterine hyperstimulation without FHR changes.

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Analysis 22.3

Comparison 22 Balloon catheter and oxytocin versus prostaglandins: all women (not pre‐specified), Outcome 3 Epidural analgesia.

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Analysis 22.4

Comparison 22 Balloon catheter and oxytocin versus prostaglandins: all women (not pre‐specified), Outcome 4 Vaginal delivery not achieved in 24 hours.

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Analysis 22.5

Comparison 22 Balloon catheter and oxytocin versus prostaglandins: all women (not pre‐specified), Outcome 5 Uterine hyperstimulation with FHR changes.

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Analysis 22.6

Comparison 22 Balloon catheter and oxytocin versus prostaglandins: all women (not pre‐specified), Outcome 6 Serious neonatal morbidity/perinatal death.

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Analysis 22.7

Comparison 22 Balloon catheter and oxytocin versus prostaglandins: all women (not pre‐specified), Outcome 7 Meconium stained liquor.

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Analysis 22.8

Comparison 22 Balloon catheter and oxytocin versus prostaglandins: all women (not pre‐specified), Outcome 8 Apgar score < 7 at 5 minutes.

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Analysis 22.9

Comparison 22 Balloon catheter and oxytocin versus prostaglandins: all women (not pre‐specified), Outcome 9 Neonatal intensive care unit admission.

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Analysis 22.10

Comparison 22 Balloon catheter and oxytocin versus prostaglandins: all women (not pre‐specified), Outcome 10 Post partum blood transfusion.

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Analysis 23.1

Comparison 23 Extra‐amniotic infusion versus prostaglandins: all women (not prespecified), Outcome 1 Vaginal delivery not achieved in 24 hours.

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Analysis 23.2

Comparison 23 Extra‐amniotic infusion versus prostaglandins: all women (not prespecified), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 23.3

Comparison 23 Extra‐amniotic infusion versus prostaglandins: all women (not prespecified), Outcome 3 Caesarean section.

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Analysis 23.4

Comparison 23 Extra‐amniotic infusion versus prostaglandins: all women (not prespecified), Outcome 4 Serious maternal morbidity or death.

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Analysis 23.5

Comparison 23 Extra‐amniotic infusion versus prostaglandins: all women (not prespecified), Outcome 5 Cervix unfavourable/unchanged after 12‐24 hours.

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Analysis 23.6

Comparison 23 Extra‐amniotic infusion versus prostaglandins: all women (not prespecified), Outcome 6 Oxytocin augmentation.

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Analysis 23.7

Comparison 23 Extra‐amniotic infusion versus prostaglandins: all women (not prespecified), Outcome 7 Uterine hyperstimulation without fetal heart rate changes.

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Analysis 23.8

Comparison 23 Extra‐amniotic infusion versus prostaglandins: all women (not prespecified), Outcome 8 Epidural analgesia.

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Analysis 23.9

Comparison 23 Extra‐amniotic infusion versus prostaglandins: all women (not prespecified), Outcome 9 Instrumental vaginal delivery.

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Analysis 23.10

Comparison 23 Extra‐amniotic infusion versus prostaglandins: all women (not prespecified), Outcome 10 Meconium stained liquor.

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Analysis 23.11

Comparison 23 Extra‐amniotic infusion versus prostaglandins: all women (not prespecified), Outcome 11 Apgar score < 7 at 5 minutes.

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Analysis 23.12

Comparison 23 Extra‐amniotic infusion versus prostaglandins: all women (not prespecified), Outcome 12 Neonatal intensive care unit admission.

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Analysis 23.13

Comparison 23 Extra‐amniotic infusion versus prostaglandins: all women (not prespecified), Outcome 13 Post partum haemorrhage.

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Analysis 23.14

Comparison 23 Extra‐amniotic infusion versus prostaglandins: all women (not prespecified), Outcome 14 Woman not satisfied.

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Analysis 23.15

Comparison 23 Extra‐amniotic infusion versus prostaglandins: all women (not prespecified), Outcome 15 Chorioamnionitis.

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Analysis 23.16

Comparison 23 Extra‐amniotic infusion versus prostaglandins: all women (not prespecified), Outcome 16 Endometritis.

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Analysis 23.17

Comparison 23 Extra‐amniotic infusion versus prostaglandins: all women (not prespecified), Outcome 17 Neonatal infection.

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Analysis 24.1

Comparison 24 Extra‐amniotic infusion and oxytocin versus prostaglandin: all women (not prespecified), Outcome 1 Caesarean section.

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Analysis 24.2

Comparison 24 Extra‐amniotic infusion and oxytocin versus prostaglandin: all women (not prespecified), Outcome 2 Oxytocin augmentation.

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Analysis 24.3

Comparison 24 Extra‐amniotic infusion and oxytocin versus prostaglandin: all women (not prespecified), Outcome 3 Serious maternal morbidity or death.

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Analysis 24.4

Comparison 24 Extra‐amniotic infusion and oxytocin versus prostaglandin: all women (not prespecified), Outcome 4 Vaginal delivery not achieved in 24 hours.

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Analysis 24.5

Comparison 24 Extra‐amniotic infusion and oxytocin versus prostaglandin: all women (not prespecified), Outcome 5 Uterine hyperstimulation with FHR changes.

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Analysis 24.6

Comparison 24 Extra‐amniotic infusion and oxytocin versus prostaglandin: all women (not prespecified), Outcome 6 Uterine hyperstimulation without FHR changes.

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Analysis 24.7

Comparison 24 Extra‐amniotic infusion and oxytocin versus prostaglandin: all women (not prespecified), Outcome 7 Meconium stained liquor.

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Analysis 24.8

Comparison 24 Extra‐amniotic infusion and oxytocin versus prostaglandin: all women (not prespecified), Outcome 8 Neonatal intensive care unit admission.

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Analysis 24.9

Comparison 24 Extra‐amniotic infusion and oxytocin versus prostaglandin: all women (not prespecified), Outcome 9 Chorioamnionitis (not prespecified).

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Analysis 24.10

Comparison 24 Extra‐amniotic infusion and oxytocin versus prostaglandin: all women (not prespecified), Outcome 10 Apgar score < 7 at 5 minutes.

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Analysis 24.11

Comparison 24 Extra‐amniotic infusion and oxytocin versus prostaglandin: all women (not prespecified), Outcome 11 Post partum haemorrhage.

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Comparison 1. Any mechanical method versus placebo/no treatment: all women

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Vaginal delivery not achieved in 24 hours Show forest plot	1	48	Risk Ratio (M‐H, Fixed, 95% CI)	0.90 [0.64, 1.26]

1.1 Laminaria tent	1	48	Risk Ratio (M‐H, Fixed, 95% CI)	0.90 [0.64, 1.26]
2 Caesarean section Show forest plot	6	416	Risk Ratio (M‐H, Fixed, 95% CI)	1.00 [0.76, 1.30]

2.1 Laminaria tent	5	372	Risk Ratio (M‐H, Fixed, 95% CI)	0.98 [0.74, 1.30]
2.2 Balloon catheter	1	44	Risk Ratio (M‐H, Fixed, 95% CI)	1.17 [0.47, 2.92]
3 Cervix unfavourable/unchanged after 12‐24 hours Show forest plot	2	139	Risk Ratio (M‐H, Fixed, 95% CI)	0.07 [0.03, 0.19]

3.1 Laminaria tent	1	12	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.2 Balloon catheter	1	127	Risk Ratio (M‐H, Fixed, 95% CI)	0.07 [0.03, 0.19]
4 Uterine hyperstimulation without fetal heart rate changes Show forest plot	1	44	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

4.1 Balloon catheter	1	44	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5 Epidural analgesia Show forest plot	1	240	Risk Ratio (M‐H, Fixed, 95% CI)	0.38 [0.08, 1.85]

5.1 Laminaria tent	1	240	Risk Ratio (M‐H, Fixed, 95% CI)	0.38 [0.08, 1.85]
6 Apgar score < 7 at 5 minutes Show forest plot	2	284	Risk Ratio (M‐H, Fixed, 95% CI)	0.38 [0.08, 1.85]

6.1 Laminaria tent	1	240	Risk Ratio (M‐H, Fixed, 95% CI)	0.38 [0.08, 1.85]
6.2 Balloon catheter	1	44	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
7 Post partum haemorrhage Show forest plot	1	240	Risk Ratio (M‐H, Fixed, 95% CI)	0.46 [0.09, 2.31]

7.1 Laminaria tent	1	240	Risk Ratio (M‐H, Fixed, 95% CI)	0.46 [0.09, 2.31]
8 Chorioamnionitis (not prespecified) Show forest plot	1	240	Risk Ratio (M‐H, Fixed, 95% CI)	0.76 [0.22, 2.63]

8.1 Laminaria tent	1	240	Risk Ratio (M‐H, Fixed, 95% CI)	0.76 [0.22, 2.63]
9 Endometritis (not prespecified) Show forest plot	2	288	Risk Ratio (M‐H, Fixed, 95% CI)	0.85 [0.37, 1.99]

9.1 Laminaria tent	2	288	Risk Ratio (M‐H, Fixed, 95% CI)	0.85 [0.37, 1.99]
10 Fetal distress (not prespecified) Show forest plot	1	52	Risk Ratio (M‐H, Fixed, 95% CI)	0.86 [0.06, 12.98]

10.1 Laminaria tent	1	52	Risk Ratio (M‐H, Fixed, 95% CI)	0.86 [0.06, 12.98]

Comparison 1. Any mechanical method versus placebo/no treatment: all women

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Comparison 2. Any mechanical method versus vaginal PGE2: all women

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Vaginal delivery not achieved in 24 hours Show forest plot	3		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

1.1 Balloon catheter	2	477	Risk Ratio (M‐H, Random, 95% CI)	1.97 [0.43, 8.95]
1.2 Extra‐amniotic infusion	1	109	Risk Ratio (M‐H, Random, 95% CI)	1.74 [1.21, 2.49]
2 Uterine hyperstimulation with FHR changes Show forest plot	8	1203	Risk Ratio (M‐H, Fixed, 95% CI)	0.16 [0.06, 0.39]

2.1 Laminaria tent	3	188	Risk Ratio (M‐H, Fixed, 95% CI)	0.11 [0.02, 0.60]
2.2 Balloon catheter	3	794	Risk Ratio (M‐H, Fixed, 95% CI)	0.17 [0.05, 0.63]
2.3 Extra‐amniotic infusion	2	221	Risk Ratio (M‐H, Fixed, 95% CI)	0.23 [0.03, 2.07]
3 Caesarean section Show forest plot	17	1894	Risk Ratio (M‐H, Fixed, 95% CI)	1.07 [0.91, 1.25]

3.1 Laminaria tent	5	263	Risk Ratio (M‐H, Fixed, 95% CI)	0.91 [0.56, 1.48]
3.2 Balloon catheter	10	1410	Risk Ratio (M‐H, Fixed, 95% CI)	1.04 [0.86, 1.25]
3.3 Extra‐amniotic infusion	2	221	Risk Ratio (M‐H, Fixed, 95% CI)	1.35 [0.94, 1.96]
4 Post partum haemorrhage Show forest plot	3	543	Risk Ratio (M‐H, Fixed, 95% CI)	0.61 [0.30, 1.22]

4.1 Balloon catheter	3	543	Risk Ratio (M‐H, Fixed, 95% CI)	0.61 [0.30, 1.22]
5 Serious maternal morbidity or death Show forest plot	2	88	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

5.1 Laminaria tent	1	28	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5.2 Balloon catheter	1	60	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
6 Maternal side effects Show forest plot	1	28	Risk Ratio (M‐H, Fixed, 95% CI)	0.29 [0.01, 6.60]

6.1 Laminaria tent	1	28	Risk Ratio (M‐H, Fixed, 95% CI)	0.29 [0.01, 6.60]
7 Oxytocin augmentation Show forest plot	3		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

7.1 Balloon catheter	2		Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
7.2 Extra‐amniotic infusion	1		Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
8 Uterine hyperstimulation without fetal heart rate changes Show forest plot	11	1152	Risk Ratio (M‐H, Random, 95% CI)	0.37 [0.12, 1.11]

8.1 Laminaria tent	3	180	Risk Ratio (M‐H, Random, 95% CI)	0.22 [0.09, 0.49]
8.2 Balloon catheter	6	751	Risk Ratio (M‐H, Random, 95% CI)	0.50 [0.05, 5.50]
8.3 Extra‐amniotic infusion	2	221	Risk Ratio (M‐H, Random, 95% CI)	0.24 [0.03, 2.10]
9 Serious neonatal morbidity/perinatal death Show forest plot	1	330	Risk Ratio (M‐H, Fixed, 95% CI)	0.17 [0.01, 4.24]

10 Epidural analgesia Show forest plot	4	911	Risk Ratio (M‐H, Random, 95% CI)	1.03 [0.90, 1.17]

10.1 Laminaria tent	1	80	Risk Ratio (M‐H, Random, 95% CI)	0.91 [0.74, 1.13]
10.2 Balloon catheter	2	719	Risk Ratio (M‐H, Random, 95% CI)	1.09 [0.90, 1.31]
10.3 Extra‐amniotic infusion	1	112	Risk Ratio (M‐H, Random, 95% CI)	1.0 [0.97, 1.04]
11 Instrumental vaginal delivery Show forest plot	7	1097	Risk Ratio (M‐H, Fixed, 95% CI)	0.79 [0.64, 0.98]

11.1 Laminaria tent	1	80	Risk Ratio (M‐H, Fixed, 95% CI)	0.71 [0.43, 1.17]
11.2 Balloon catheter	5	908	Risk Ratio (M‐H, Fixed, 95% CI)	0.84 [0.66, 1.08]
11.3 Extra‐amniotic infusion	1	109	Risk Ratio (M‐H, Fixed, 95% CI)	0.58 [0.30, 1.14]
12 Meconium stained liquor Show forest plot	4	728	Risk Ratio (M‐H, Fixed, 95% CI)	0.78 [0.55, 1.09]

12.1 Laminaria tent	1	80	Risk Ratio (M‐H, Fixed, 95% CI)	0.14 [0.01, 2.68]
12.2 Balloon catheter	2	536	Risk Ratio (M‐H, Fixed, 95% CI)	0.79 [0.56, 1.13]
12.3 Extra‐amniotic infusion	1	112	Risk Ratio (M‐H, Fixed, 95% CI)	3.0 [0.12, 72.10]
13 Apgar score < 7 at 5 minutes Show forest plot	5	388	Risk Ratio (M‐H, Fixed, 95% CI)	4.25 [0.21, 86.51]

13.1 Laminaria tent	2	160	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
13.2 Balloon catheter	2	119	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
13.3 Extra‐amniotic infusion	1	109	Risk Ratio (M‐H, Fixed, 95% CI)	4.25 [0.21, 86.51]
14 Neonatal intensive care unit admission Show forest plot	3	648	Risk Ratio (M‐H, Fixed, 95% CI)	0.90 [0.49, 1.64]

14.1 Balloon catheter	2	536	Risk Ratio (M‐H, Fixed, 95% CI)	0.76 [0.38, 1.53]
14.2 Extra‐amniotic infusion	1	112	Risk Ratio (M‐H, Fixed, 95% CI)	1.5 [0.45, 5.03]
15 Woman not satisfied Show forest plot	1	109	Risk Ratio (M‐H, Fixed, 95% CI)	0.56 [0.10, 3.25]

15.1 Extra‐amniotic infusion	1	109	Risk Ratio (M‐H, Fixed, 95% CI)	0.56 [0.10, 3.25]
16 Perinatal death Show forest plot	2	134	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

16.1 Laminaria tent	1	80	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
16.2 Balloon catheter	1	54	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
17 Antibiotics during labour (not prespecified) Show forest plot	1	330	Risk Ratio (M‐H, Fixed, 95% CI)	1.43 [0.89, 2.29]

17.1 Balloon catheter	1	330	Risk Ratio (M‐H, Fixed, 95% CI)	1.43 [0.89, 2.29]
18 Wound infection (not prespecified) Show forest plot	1	330	Risk Ratio (M‐H, Fixed, 95% CI)	0.52 [0.11, 2.54]

18.1 Balloon catheter	1	330	Risk Ratio (M‐H, Fixed, 95% CI)	0.52 [0.11, 2.54]
19 pH < 7.10 (not prespecified) Show forest plot	1	330	Risk Ratio (M‐H, Fixed, 95% CI)	0.65 [0.26, 1.60]

19.1 Balloon catheter	1	330	Risk Ratio (M‐H, Fixed, 95% CI)	0.65 [0.26, 1.60]
20 Fetal distress (not prespecified) Show forest plot	5	329	Risk Ratio (M‐H, Fixed, 95% CI)	0.64 [0.35, 1.17]

21 Endometritis (not prespecified) Show forest plot	2	442	Risk Ratio (M‐H, Fixed, 95% CI)	1.14 [0.26, 5.02]

21.1 Balloon catheter	2	442	Risk Ratio (M‐H, Fixed, 95% CI)	1.14 [0.26, 5.02]
22 Maternal fever during labour (not prespecified) Show forest plot	2	719	Risk Ratio (M‐H, Fixed, 95% CI)	0.96 [0.64, 1.46]

22.1 Balloon catheter	2	719	Risk Ratio (M‐H, Fixed, 95% CI)	0.96 [0.64, 1.46]

Comparison 2. Any mechanical method versus vaginal PGE2: all women

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Comparison 3. Any mechanical method versus vaginal PGE2: all multiparae

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Vaginal delivery not achieved in 24 hours Show forest plot	1	147	Risk Ratio (M‐H, Fixed, 95% CI)	4.38 [1.74, 10.98]

1.1 Balloon catheter	1	147	Risk Ratio (M‐H, Fixed, 95% CI)	4.38 [1.74, 10.98]
2 Oxytocin augmentation Show forest plot	1	147	Risk Ratio (M‐H, Fixed, 95% CI)	2.43 [1.46, 4.05]

2.1 Balloon catheter	1	147	Risk Ratio (M‐H, Fixed, 95% CI)	2.43 [1.46, 4.05]
3 Caesarean section Show forest plot	3	190	Risk Ratio (M‐H, Fixed, 95% CI)	1.19 [0.62, 2.29]

3.1 Laminaria tent	1	10	Risk Ratio (M‐H, Fixed, 95% CI)	0.5 [0.06, 3.91]
3.2 Balloon catheter	2	180	Risk Ratio (M‐H, Fixed, 95% CI)	1.31 [0.65, 2.63]
4 Meconium stained liquor Show forest plot	1	147	Risk Ratio (M‐H, Fixed, 95% CI)	0.90 [0.46, 1.76]

4.1 Balloon catheter	1	147	Risk Ratio (M‐H, Fixed, 95% CI)	0.90 [0.46, 1.76]
5 Neonatal intensive care unit admission Show forest plot	1	147	Risk Ratio (M‐H, Fixed, 95% CI)	1.25 [0.40, 3.92]

5.1 Balloon catheter	1	147	Risk Ratio (M‐H, Fixed, 95% CI)	1.25 [0.40, 3.92]
6 Uterine hyperstimulation without fetal heart rate changes Show forest plot	1	10	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

6.1 Laminaria tent	1	10	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
7 Instrumental vaginal delivery Show forest plot	1	33	Risk Ratio (M‐H, Fixed, 95% CI)	0.35 [0.02, 8.08]

7.1 Balloon catheter	1	33	Risk Ratio (M‐H, Fixed, 95% CI)	0.35 [0.02, 8.08]

Comparison 3. Any mechanical method versus vaginal PGE2: all multiparae

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Comparison 4. Any mechanical method versus vaginal PGE2: all primiparae

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Vaginal delivery not achieved in 24 hours Show forest plot	1	330	Risk Ratio (M‐H, Fixed, 95% CI)	1.01 [0.83, 1.23]

1.1 Balloon catheter	1	330	Risk Ratio (M‐H, Fixed, 95% CI)	1.01 [0.83, 1.23]
2 Uterine hyperstimulation with FHR changes Show forest plot	2	410	Risk Ratio (M‐H, Fixed, 95% CI)	0.10 [0.01, 0.68]

2.1 Laminaria tent	1	80	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 7.95]
2.2 Balloon catheter	1	330	Risk Ratio (M‐H, Fixed, 95% CI)	0.05 [0.00, 0.85]
3 Caesarean section Show forest plot	6	777	Risk Ratio (M‐H, Fixed, 95% CI)	1.02 [0.83, 1.26]

3.1 Laminaria tent	2	90	Risk Ratio (M‐H, Fixed, 95% CI)	0.82 [0.37, 1.79]
3.2 Balloon catheter	4	687	Risk Ratio (M‐H, Fixed, 95% CI)	1.04 [0.84, 1.29]
4 Serious neonatal morbidity/perinatal death Show forest plot	1	330	Risk Ratio (M‐H, Fixed, 95% CI)	0.17 [0.01, 4.24]

4.1 Balloon catheter	1	330	Risk Ratio (M‐H, Fixed, 95% CI)	0.17 [0.01, 4.24]
5 Serious maternal morbidity or death Show forest plot	1	60	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

5.1 Balloon catheter	1	60	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
6 Antibiotics during labour (not presppecified) Show forest plot	1	330	Risk Ratio (M‐H, Fixed, 95% CI)	1.43 [0.89, 2.29]

6.1 Balloon catheter	1	330	Risk Ratio (M‐H, Fixed, 95% CI)	1.43 [0.89, 2.29]
7 Oxytocin augmentation Show forest plot	1	60	Risk Ratio (M‐H, Fixed, 95% CI)	0.07 [0.00, 1.12]

7.1 Balloon catheter	1	60	Risk Ratio (M‐H, Fixed, 95% CI)	0.07 [0.00, 1.12]
8 Maternal fever during labour (not prespecified) Show forest plot	1	330	Risk Ratio (M‐H, Fixed, 95% CI)	0.96 [0.59, 1.58]

8.1 Balloon catheter	1	330	Risk Ratio (M‐H, Fixed, 95% CI)	0.96 [0.59, 1.58]
9 Uterine hyperstimulation without fetal heart rate changes Show forest plot	4	480	Risk Ratio (M‐H, Fixed, 95% CI)	0.14 [0.04, 0.45]

9.1 Laminaria tent	2	90	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 7.95]
9.2 Balloon catheter	2	390	Risk Ratio (M‐H, Fixed, 95% CI)	0.12 [0.03, 0.43]
10 Epidural analgesia Show forest plot	2	410	Risk Ratio (M‐H, Fixed, 95% CI)	0.99 [0.90, 1.09]

10.1 Laminaria tent	1	80	Risk Ratio (M‐H, Fixed, 95% CI)	0.91 [0.74, 1.13]
10.2 Balloon catheter	1	330	Risk Ratio (M‐H, Fixed, 95% CI)	1.01 [0.91, 1.13]
11 Instrumental vaginal delivery Show forest plot	4	512	Risk Ratio (M‐H, Fixed, 95% CI)	0.81 [0.60, 1.09]

11.1 Laminaria tent	1	80	Risk Ratio (M‐H, Fixed, 95% CI)	0.71 [0.43, 1.17]
11.2 Balloon catheter	3	432	Risk Ratio (M‐H, Fixed, 95% CI)	0.85 [0.59, 1.22]
12 Meconium stained liquor Show forest plot	1	80	Risk Ratio (M‐H, Fixed, 95% CI)	0.14 [0.01, 2.68]

12.1 Laminaria tent	1	80	Risk Ratio (M‐H, Fixed, 95% CI)	0.14 [0.01, 2.68]
13 Apgar score < 7 at 5 minutes Show forest plot	1	80	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

13.1 Laminaria tent	1	80	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
14 pH < 7.10 (not prespecified) Show forest plot	1	330	Risk Ratio (M‐H, Fixed, 95% CI)	0.65 [0.26, 1.60]

14.1 Balloon catheter	1	330	Risk Ratio (M‐H, Fixed, 95% CI)	0.65 [0.26, 1.60]
15 Endometritis (not prespecified) Show forest plot	1	330	Risk Ratio (M‐H, Fixed, 95% CI)	0.78 [0.13, 4.61]

15.1 Balloon catheter	1	330	Risk Ratio (M‐H, Fixed, 95% CI)	0.78 [0.13, 4.61]
16 Wound infection (not prespecified) Show forest plot	1	330	Risk Ratio (M‐H, Fixed, 95% CI)	0.52 [0.11, 2.54]

16.1 Balloon catheter	1	330	Risk Ratio (M‐H, Fixed, 95% CI)	0.52 [0.11, 2.54]
17 Post partum haemorrhage Show forest plot	2	390	Risk Ratio (M‐H, Fixed, 95% CI)	0.59 [0.29, 1.20]

17.1 Balloon catheter	2	390	Risk Ratio (M‐H, Fixed, 95% CI)	0.59 [0.29, 1.20]
18 Fetal distress (not prespecified) Show forest plot	2	140	Risk Ratio (M‐H, Fixed, 95% CI)	0.5 [0.19, 1.33]

18.1 Laminaria tent	1	80	Risk Ratio (M‐H, Fixed, 95% CI)	0.5 [0.19, 1.33]
18.2 Balloon catheter	1	60	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 4. Any mechanical method versus vaginal PGE2: all primiparae

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Comparison 5. Any mechanical method versus intracervical PGE2: all women

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Vaginal delivery not achieved in 24 hours Show forest plot	2		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

1.1 Balloon catheter	2		Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
2 Uterine hyperstimulation with FHR changes Show forest plot	6	797	Risk Ratio (M‐H, Fixed, 95% CI)	0.21 [0.04, 1.20]

2.1 Laminaria tent	2	350	Risk Ratio (M‐H, Fixed, 95% CI)	0.17 [0.02, 1.42]
2.2 Balloon catheter	4	447	Risk Ratio (M‐H, Fixed, 95% CI)	0.37 [0.02, 8.90]
3 Caesarean section Show forest plot	14	1784	Risk Ratio (M‐H, Fixed, 95% CI)	1.07 [0.92, 1.25]

3.1 Laminaria tent	5	920	Risk Ratio (M‐H, Fixed, 95% CI)	1.16 [0.93, 1.45]
3.2 Balloon catheter	7	709	Risk Ratio (M‐H, Fixed, 95% CI)	1.00 [0.81, 1.24]
3.3 Extra‐amniotic infusion	2	155	Risk Ratio (M‐H, Fixed, 95% CI)	0.91 [0.46, 1.84]
4 Serious neonatal morbidity/perinatal death Show forest plot	2	285	Risk Ratio (M‐H, Fixed, 95% CI)	1.71 [0.23, 12.66]

4.1 Laminaria tent	1	185	Risk Ratio (M‐H, Fixed, 95% CI)	3.16 [0.13, 76.70]
4.2 Balloon catheter	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	1.0 [0.06, 15.55]
5 Serious maternal morbidity or death Show forest plot	1	185	Risk Ratio (M‐H, Fixed, 95% CI)	0.35 [0.01, 8.52]

5.1 Laminaria tent	1	185	Risk Ratio (M‐H, Fixed, 95% CI)	0.35 [0.01, 8.52]
6 Cervix unfavourable/unchanged after 12‐24 hours Show forest plot	5		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only

6.1 Laminaria tent	2	218	Odds Ratio (M‐H, Fixed, 95% CI)	0.52 [0.23, 1.17]
6.2 Balloon catheter	2	219	Odds Ratio (M‐H, Fixed, 95% CI)	0.94 [0.53, 1.65]
6.3 Extra‐amniotic infusion	1	85	Odds Ratio (M‐H, Fixed, 95% CI)	0.05 [0.00, 0.84]
7 Oxytocin augmentation Show forest plot	2	255	Risk Ratio (M‐H, Fixed, 95% CI)	1.36 [1.16, 1.60]

7.1 Laminaria tent	1	185	Risk Ratio (M‐H, Fixed, 95% CI)	1.41 [1.21, 1.64]
7.2 Extra‐amniotic infusion	1	70	Risk Ratio (M‐H, Fixed, 95% CI)	1.1 [0.54, 2.25]
8 Uterine hyperstimulation without fetal heart rate changes Show forest plot	6		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

8.1 Laminaria tent	2	601	Risk Ratio (M‐H, Random, 95% CI)	0.17 [0.02, 1.39]
8.2 Balloon catheter	4	454	Risk Ratio (M‐H, Random, 95% CI)	2.34 [0.81, 6.75]
9 Uterine rupture Show forest plot	1	185	Risk Ratio (M‐H, Fixed, 95% CI)	0.35 [0.01, 8.52]

9.1 Laminaria tent	1	185	Risk Ratio (M‐H, Fixed, 95% CI)	0.35 [0.01, 8.52]
10 Epidural analgesia Show forest plot	1	149	Risk Ratio (M‐H, Fixed, 95% CI)	0.91 [0.81, 1.02]

10.1 Balloon catheter	1	149	Risk Ratio (M‐H, Fixed, 95% CI)	0.91 [0.81, 1.02]
11 Instrumental vaginal delivery Show forest plot	6	646	Risk Ratio (M‐H, Fixed, 95% CI)	1.01 [0.70, 1.47]

11.1 Laminaria tent	3	424	Risk Ratio (M‐H, Fixed, 95% CI)	1.05 [0.65, 1.69]
11.2 Balloon catheter	2	137	Risk Ratio (M‐H, Fixed, 95% CI)	1.09 [0.58, 2.07]
11.3 Extra‐amniotic infusion	1	85	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.04, 3.01]
12 Meconium stained liquor Show forest plot	1	118	Risk Ratio (M‐H, Fixed, 95% CI)	1.17 [0.42, 3.26]

12.1 Balloon catheter	1	118	Risk Ratio (M‐H, Fixed, 95% CI)	1.17 [0.42, 3.26]
13 Apgar score < 7 at 5 minutes Show forest plot	3	345	Risk Ratio (M‐H, Random, 95% CI)	1.80 [0.14, 23.73]

13.1 Laminaria tent	1	185	Risk Ratio (M‐H, Random, 95% CI)	5.28 [0.63, 44.30]
13.2 Balloon catheter	1	75	Risk Ratio (M‐H, Random, 95% CI)	0.36 [0.02, 8.57]
13.3 Extra‐amniotic infusion	1	85	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
14 Neonatal intensive care unit admission Show forest plot	2	259	Risk Ratio (M‐H, Fixed, 95% CI)	1.58 [0.58, 4.33]

14.1 Laminaria tent	2	259	Risk Ratio (M‐H, Fixed, 95% CI)	1.58 [0.58, 4.33]
15 Perinatal death Show forest plot	2	285	Risk Ratio (M‐H, Fixed, 95% CI)	1.71 [0.23, 12.66]

15.1 Laminaria tent	1	185	Risk Ratio (M‐H, Fixed, 95% CI)	3.16 [0.13, 76.70]
15.2 Balloon catheter	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	1.0 [0.06, 15.55]
16 Maternal side effects Show forest plot	4	494	Risk Ratio (M‐H, Random, 95% CI)	0.51 [0.08, 3.49]

16.1 Laminaria tent	1	165	Risk Ratio (M‐H, Random, 95% CI)	0.20 [0.01, 4.15]
16.2 Balloon catheter	3	329	Risk Ratio (M‐H, Random, 95% CI)	0.62 [0.06, 6.80]
17 Post partum haemorrhage Show forest plot	3	339	Risk Ratio (M‐H, Fixed, 95% CI)	0.91 [0.40, 2.11]

17.1 Laminaria tent	2	239	Risk Ratio (M‐H, Fixed, 95% CI)	1.14 [0.46, 2.81]
17.2 Balloon catheter	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	0.2 [0.01, 4.06]
18 Woman not satisfied Show forest plot	1	118	Risk Ratio (M‐H, Fixed, 95% CI)	3.5 [0.76, 16.16]

18.1 Balloon catheter	1	118	Risk Ratio (M‐H, Fixed, 95% CI)	3.5 [0.76, 16.16]
19 Chorioamnionitis (not prespecified) Show forest plot	2	192	Risk Ratio (M‐H, Fixed, 95% CI)	1.53 [0.45, 5.24]

19.1 Laminaria tent	1	74	Risk Ratio (M‐H, Fixed, 95% CI)	3.17 [0.35, 29.06]
19.2 Balloon catheter	1	118	Risk Ratio (M‐H, Fixed, 95% CI)	1.0 [0.21, 4.75]
20 Endometritis (not prespecified) Show forest plot	4	693	Risk Ratio (M‐H, Random, 95% CI)	0.34 [0.11, 1.04]

20.1 Laminaria tent	2	490	Risk Ratio (M‐H, Random, 95% CI)	0.30 [0.08, 1.09]
20.2 Balloon catheter	1	118	Risk Ratio (M‐H, Random, 95% CI)	1.0 [0.06, 15.61]
20.3 Extra‐amniotic infusion	1	85	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
21 Fetal distress (not prespecified) Show forest plot	2	211	Risk Ratio (M‐H, Fixed, 95% CI)	0.63 [0.32, 1.24]

21.1 Balloon catheter	2	211	Risk Ratio (M‐H, Fixed, 95% CI)	0.63 [0.32, 1.24]
22 Need for another method of induction (not prespecified) Show forest plot	1	185	Risk Ratio (M‐H, Fixed, 95% CI)	1.41 [1.21, 1.64]

22.1 Laminaria tent	1	185	Risk Ratio (M‐H, Fixed, 95% CI)	1.41 [1.21, 1.64]
23 Neonatal infection (not prespecified) Show forest plot	3	619	Risk Ratio (M‐H, Fixed, 95% CI)	2.45 [1.18, 5.07]

23.1 Laminaria tent	1	416	Risk Ratio (M‐H, Fixed, 95% CI)	2.20 [1.03, 4.69]
23.2 Balloon catheter	1	118	Risk Ratio (M‐H, Fixed, 95% CI)	7.0 [0.37, 132.61]
23.3 Extra‐amniotic infusion	1	85	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 5. Any mechanical method versus intracervical PGE2: all women

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Comparison 6. Any mechanical method versus intracervical PGE2: all primipare

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Oxytocin augmentation Show forest plot	1	70	Risk Ratio (M‐H, Fixed, 95% CI)	1.1 [0.54, 2.25]

1.1 Extra‐amniotic infusion	1	70	Risk Ratio (M‐H, Fixed, 95% CI)	1.1 [0.54, 2.25]
2 Uterine hyperstimulation with FHR changes Show forest plot	1	53	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

2.1 Balloon catheter	1	53	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3 Caesarean section Show forest plot	4	279	Risk Ratio (M‐H, Fixed, 95% CI)	0.96 [0.62, 1.48]

3.1 Laminaria tent	1	116	Risk Ratio (M‐H, Fixed, 95% CI)	1.15 [0.62, 2.13]
3.2 Balloon catheter	2	93	Risk Ratio (M‐H, Fixed, 95% CI)	1.26 [0.61, 2.59]
3.3 Extra‐amniotic infusion	1	70	Risk Ratio (M‐H, Fixed, 95% CI)	0.25 [0.06, 1.09]
4 Instrumental vaginal delivery Show forest plot	2	156	Risk Ratio (M‐H, Fixed, 95% CI)	1.18 [0.73, 1.91]

4.1 Laminaria tent	1	116	Risk Ratio (M‐H, Fixed, 95% CI)	1.21 [0.72, 2.01]
4.2 Balloon catheter	1	40	Risk Ratio (M‐H, Fixed, 95% CI)	1.0 [0.23, 4.37]

Comparison 6. Any mechanical method versus intracervical PGE2: all primipare

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Comparison 7. Any mechanical method versus intracervical PGE2: all multiparae

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Uterine hyperstimulation with FHR changes Show forest plot	1	53	Risk Ratio (M‐H, Fixed, 95% CI)	0.30 [0.01, 7.02]

1.1 Balloon catheter	1	53	Risk Ratio (M‐H, Fixed, 95% CI)	0.30 [0.01, 7.02]
2 Caesarean section Show forest plot	3	157	Risk Ratio (M‐H, Random, 95% CI)	1.15 [0.39, 3.43]

2.1 Laminaria tent	1	69	Risk Ratio (M‐H, Random, 95% CI)	1.28 [0.45, 3.65]
2.2 Balloon catheter	2	88	Risk Ratio (M‐H, Random, 95% CI)	1.57 [0.10, 23.76]
3 Instrumental vaginal delivery Show forest plot	2	104	Risk Ratio (M‐H, Random, 95% CI)	0.96 [0.15, 6.37]

3.1 Laminaria tent	1	69	Risk Ratio (M‐H, Random, 95% CI)	1.83 [0.36, 9.36]
3.2 Balloon catheter	1	35	Risk Ratio (M‐H, Random, 95% CI)	0.24 [0.01, 4.57]

Comparison 7. Any mechanical method versus intracervical PGE2: all multiparae

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Comparison 8. Any mechanical method versus vaginal misoprostol: all women

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Vaginal delivery not achieved in 24 hours Show forest plot	4	594	Risk Ratio (M‐H, Fixed, 95% CI)	1.17 [0.94, 1.44]

1.1 Balloon catheter	3	471	Risk Ratio (M‐H, Fixed, 95% CI)	1.24 [0.97, 1.58]
1.2 Extra‐amniotic infusion	1	123	Risk Ratio (M‐H, Fixed, 95% CI)	0.98 [0.64, 1.49]
2 Uterine hyperstimulation with FHR changes Show forest plot	9		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

2.1 Balloon catheter	7	1268	Risk Ratio (M‐H, Fixed, 95% CI)	0.29 [0.16, 0.51]
2.2 Extra‐amniotic infusion	2	347	Risk Ratio (M‐H, Fixed, 95% CI)	0.84 [0.35, 2.01]
3 Caesarean section Show forest plot	11		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

3.1 Balloon catheter	9	1588	Risk Ratio (M‐H, Fixed, 95% CI)	1.01 [0.86, 1.19]
3.2 Extra‐amniotic infusion	2	371	Risk Ratio (M‐H, Fixed, 95% CI)	1.53 [1.05, 2.24]
4 Uterine hyperstimulation without FHR changes Show forest plot	5	680	Risk Ratio (M‐H, Fixed, 95% CI)	0.35 [0.24, 0.53]

4.1 Balloon catheter	5	680	Risk Ratio (M‐H, Fixed, 95% CI)	0.35 [0.24, 0.53]
5 Serious maternal morbidity or death Show forest plot	2	335	Risk Ratio (M‐H, Fixed, 95% CI)	0.90 [0.13, 6.15]

5.1 Balloon catheter	1	87	Risk Ratio (M‐H, Fixed, 95% CI)	0.28 [0.01, 6.80]
5.2 Extra‐amniotic infusion	1	248	Risk Ratio (M‐H, Fixed, 95% CI)	2.81 [0.12, 68.41]
6 Maternal fever during labour (not prespecified) Show forest plot	1	397	Risk Ratio (M‐H, Fixed, 95% CI)	0.77 [0.38, 1.54]

6.1 Balloon catheter	1	397	Risk Ratio (M‐H, Fixed, 95% CI)	0.77 [0.38, 1.54]
7 Oxytocin augmentation Show forest plot	4	406	Risk Ratio (M‐H, Random, 95% CI)	1.44 [1.12, 1.85]

7.1 Balloon catheter	4	406	Risk Ratio (M‐H, Random, 95% CI)	1.44 [1.12, 1.85]
8 Epidural analgesia Show forest plot	4	859	Risk Ratio (M‐H, Random, 95% CI)	1.03 [0.87, 1.23]

8.1 Balloon catheter	3	611	Risk Ratio (M‐H, Random, 95% CI)	1.00 [0.80, 1.25]
8.2 Extra‐amniotic infusion	1	248	Risk Ratio (M‐H, Random, 95% CI)	1.14 [0.95, 1.37]
9 Instrumental vaginal delivery Show forest plot	2	645	Risk Ratio (M‐H, Fixed, 95% CI)	0.85 [0.57, 1.28]

9.1 Balloon catheter	1	397	Risk Ratio (M‐H, Fixed, 95% CI)	0.88 [0.56, 1.40]
9.2 Extra‐amniotic infusion	1	248	Risk Ratio (M‐H, Fixed, 95% CI)	0.75 [0.31, 1.84]
10 Meconium stained liquor Show forest plot	8	1525	Risk Ratio (M‐H, Fixed, 95% CI)	0.78 [0.60, 1.02]

10.1 Balloon catheter	7	1277	Risk Ratio (M‐H, Fixed, 95% CI)	0.73 [0.55, 0.98]
10.2 Extra‐amniotic infusion	1	248	Risk Ratio (M‐H, Fixed, 95% CI)	1.05 [0.56, 1.97]
11 Apgar score < 7 at 5 minutes Show forest plot	6	900	Risk Ratio (M‐H, Random, 95% CI)	0.83 [0.26, 2.66]

11.1 Balloon catheter	5	777	Risk Ratio (M‐H, Random, 95% CI)	1.24 [0.50, 3.09]
11.2 Extra‐amniotic infusion	1	123	Risk Ratio (M‐H, Random, 95% CI)	0.09 [0.01, 1.64]
12 Neonatal intensive care unit admission Show forest plot	7	1160	Risk Ratio (M‐H, Fixed, 95% CI)	1.00 [0.65, 1.53]

12.1 Balloon catheter	6	1037	Risk Ratio (M‐H, Fixed, 95% CI)	0.93 [0.57, 1.51]
12.2 Extra‐amniotic infusion	1	123	Risk Ratio (M‐H, Fixed, 95% CI)	1.31 [0.52, 3.29]
13 Serious maternal complications Show forest plot	1	121	Odds Ratio (M‐H, Fixed, 95% CI)	2.59 [0.48, 13.90]

13.1 Balloon catheter	1	121	Odds Ratio (M‐H, Fixed, 95% CI)	2.59 [0.48, 13.90]
14 Post partum haemorrhage Show forest plot	2	368	Risk Ratio (M‐H, Random, 95% CI)	1.11 [0.29, 4.20]

14.1 Balloon catheter	1	120	Risk Ratio (M‐H, Random, 95% CI)	0.6 [0.15, 2.40]
14.2 Extra‐amniotic infusion	1	248	Risk Ratio (M‐H, Random, 95% CI)	2.34 [0.46, 11.85]
15 Chorioamnionitis (not prespecified) Show forest plot	3	474	Risk Ratio (M‐H, Fixed, 95% CI)	1.45 [0.87, 2.40]

15.1 Balloon catheter	1	103	Risk Ratio (M‐H, Fixed, 95% CI)	1.51 [0.38, 6.00]
15.2 Extra‐amniotic infusion	2	371	Risk Ratio (M‐H, Fixed, 95% CI)	1.44 [0.84, 2.48]
16 Endometritis (not prespecified) Show forest plot	5	834	Risk Ratio (M‐H, Fixed, 95% CI)	1.27 [0.55, 2.92]

16.1 Balloon catheter	3	463	Risk Ratio (M‐H, Fixed, 95% CI)	1.38 [0.42, 4.49]
16.2 Extra‐amniotic infusion	2	371	Risk Ratio (M‐H, Fixed, 95% CI)	1.17 [0.36, 3.78]
17 Neonatal infection (not prespecified) Show forest plot	3	584	Risk Ratio (M‐H, Fixed, 95% CI)	1.04 [0.33, 3.31]

17.1 Balloon catheter	2	336	Risk Ratio (M‐H, Fixed, 95% CI)	1.06 [0.30, 3.81]
17.2 Extra‐amniotic infusion	1	248	Risk Ratio (M‐H, Fixed, 95% CI)	0.94 [0.06, 14.82]

Comparison 8. Any mechanical method versus vaginal misoprostol: all women

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Comparison 9. Any mechanical method versus vaginal misoprostol: all primiparae

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Caesarean section Show forest plot	1	255	Risk Ratio (M‐H, Fixed, 95% CI)	0.82 [0.59, 1.13]

1.1 Balloon catheter	1	255	Risk Ratio (M‐H, Fixed, 95% CI)	0.82 [0.59, 1.13]

Comparison 9. Any mechanical method versus vaginal misoprostol: all primiparae

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Comparison 10. Any mechanical method versus vaginal misoprostol: all multiparae

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Caesarean section Show forest plot	1	37	Risk Ratio (M‐H, Fixed, 95% CI)	4.57 [0.61, 34.28]

1.1 Balloon catheter	1	37	Risk Ratio (M‐H, Fixed, 95% CI)	4.57 [0.61, 34.28]

Comparison 10. Any mechanical method versus vaginal misoprostol: all multiparae

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Comparison 11. Any mechanical method versus oral misoprostol: all women

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Caesarean section Show forest plot	1	151	Risk Ratio (M‐H, Fixed, 95% CI)	1.14 [0.50, 2.60]

1.1 Balloon catheter	1	151	Risk Ratio (M‐H, Fixed, 95% CI)	1.14 [0.50, 2.60]
2 Uterine hyperstimulation without FHR changes Show forest plot	1	151	Risk Ratio (M‐H, Fixed, 95% CI)	0.09 [0.00, 1.51]

2.1 Balloon catheter	1	151	Risk Ratio (M‐H, Fixed, 95% CI)	0.09 [0.00, 1.51]
3 Post partum haemorrhage Show forest plot	1	151	Risk Ratio (M‐H, Fixed, 95% CI)	0.47 [0.04, 5.05]

3.1 Balloon catheter	1	151	Risk Ratio (M‐H, Fixed, 95% CI)	0.47 [0.04, 5.05]

Comparison 11. Any mechanical method versus oral misoprostol: all women

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Comparison 12. Any mechanical method versus oxytocin: all women

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Uterine hyperstimulation with FHR changes Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.2 [0.01, 4.11]

1.1 Balloon catheter	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.2 [0.01, 4.11]
2 Meconium stained liquor Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.54 [0.22, 1.29]

2.1 Balloon catheter	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.54 [0.22, 1.29]
3 Caesarean section Show forest plot	5	398	Risk Ratio (M‐H, Fixed, 95% CI)	0.62 [0.42, 0.90]

3.1 Laminaria tent	2	73	Risk Ratio (M‐H, Fixed, 95% CI)	0.83 [0.36, 1.89]
3.2 Balloon catheter	3	325	Risk Ratio (M‐H, Fixed, 95% CI)	0.57 [0.38, 0.88]
4 Apgar score < 7 at 5 minutes Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 8.09]

4.1 Balloon catheter	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 8.09]
5 Serious maternal morbidity or death Show forest plot	1	60	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

5.1 Balloon catheter	1	60	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
6 Neonatal intensive care unit admission Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.6 [0.15, 2.44]

6.1 Balloon catheter	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.6 [0.15, 2.44]
7 Uterine hyperstimulation without fetal heart rate changes Show forest plot	1	60	Risk Ratio (M‐H, Fixed, 95% CI)	0.5 [0.05, 5.22]

7.1 Balloon catheter	1	60	Risk Ratio (M‐H, Fixed, 95% CI)	0.5 [0.05, 5.22]
8 Instrumental vaginal delivery Show forest plot	1	60	Risk Ratio (M‐H, Fixed, 95% CI)	1.2 [0.41, 3.51]

8.1 Balloon catheter	1	60	Risk Ratio (M‐H, Fixed, 95% CI)	1.2 [0.41, 3.51]
9 Post partum haemorrhage Show forest plot	1	60	Risk Ratio (M‐H, Fixed, 95% CI)	1.0 [0.22, 4.56]

9.1 Balloon catheter	1	60	Risk Ratio (M‐H, Fixed, 95% CI)	1.0 [0.22, 4.56]

Comparison 12. Any mechanical method versus oxytocin: all women

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Comparison 13. Any mechanical method versus oxytocin: all primiparae

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Caesarean section Show forest plot	1	60	Risk Ratio (M‐H, Fixed, 95% CI)	0.43 [0.12, 1.50]

1.1 Balloon catheter	1	60	Risk Ratio (M‐H, Fixed, 95% CI)	0.43 [0.12, 1.50]
2 Serious maternal morbidity or death Show forest plot	1	60	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

2.1 Balloon catheter	1	60	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3 Uterine hyperstimulation without fetal heart rate changes Show forest plot	1	60	Risk Ratio (M‐H, Fixed, 95% CI)	0.5 [0.05, 5.22]

3.1 Balloon catheter	1	60	Risk Ratio (M‐H, Fixed, 95% CI)	0.5 [0.05, 5.22]
4 Instrumental vaginal delivery Show forest plot	1	60	Risk Ratio (M‐H, Fixed, 95% CI)	1.2 [0.41, 3.51]

4.1 Balloon catheter	1	60	Risk Ratio (M‐H, Fixed, 95% CI)	1.2 [0.41, 3.51]
5 Post partum haemorrhage Show forest plot	1	60	Risk Ratio (M‐H, Fixed, 95% CI)	1.0 [0.22, 4.56]

5.1 Balloon catheter	1	60	Risk Ratio (M‐H, Fixed, 95% CI)	1.0 [0.22, 4.56]

Comparison 13. Any mechanical method versus oxytocin: all primiparae

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Comparison 14. Laminaria tent versus prostaglandins: all women (not prespecified)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Uterine hyperstimulation with FHR changes Show forest plot	5	538	Risk Ratio (M‐H, Fixed, 95% CI)	0.13 [0.04, 0.48]

2 Caesarean section Show forest plot	11	1397	Risk Ratio (M‐H, Fixed, 95% CI)	1.11 [0.92, 1.32]

3 Serious neonatal morbidity/perinatal death Show forest plot	1	185	Risk Ratio (M‐H, Fixed, 95% CI)	3.16 [0.13, 76.70]

4 Serious maternal morbidity or death Show forest plot	2	213	Risk Ratio (M‐H, Fixed, 95% CI)	0.35 [0.01, 8.52]

5 Cervix unfavourable/unchanged after 12‐24 hours Show forest plot	2	218	Risk Ratio (M‐H, Fixed, 95% CI)	0.56 [0.27, 1.15]

6 Oxytocin augmentation Show forest plot	1	185	Risk Ratio (M‐H, Fixed, 95% CI)	1.41 [1.21, 1.64]

7 Uterine hyperstimulation without fetal heart rate changes Show forest plot	5	781	Risk Ratio (M‐H, Fixed, 95% CI)	0.21 [0.10, 0.45]

8 Uterine rupture Show forest plot	1	185	Risk Ratio (M‐H, Fixed, 95% CI)	0.35 [0.01, 8.52]

9 Epidural analgesia Show forest plot	1	80	Risk Ratio (M‐H, Fixed, 95% CI)	0.91 [0.74, 1.13]

10 Instrumental vaginal delivery Show forest plot	4	504	Risk Ratio (M‐H, Fixed, 95% CI)	0.90 [0.64, 1.28]

11 Meconium stained liquor Show forest plot	1	80	Risk Ratio (M‐H, Fixed, 95% CI)	0.14 [0.01, 2.68]

12 Apgar score < 7 at 5 minutes Show forest plot	3	345	Risk Ratio (M‐H, Fixed, 95% CI)	5.28 [0.63, 44.30]

13 Neonatal intensive care unit admission Show forest plot	2	259	Risk Ratio (M‐H, Fixed, 95% CI)	1.58 [0.58, 4.33]

14 Perinatal death Show forest plot	2	265	Risk Ratio (M‐H, Fixed, 95% CI)	3.16 [0.13, 76.70]

15 Maternal side effects Show forest plot	2	193	Risk Ratio (M‐H, Fixed, 95% CI)	0.24 [0.03, 2.08]

16 Post partum haemorrhage Show forest plot	2	239	Risk Ratio (M‐H, Fixed, 95% CI)	1.14 [0.46, 2.81]

17 Chorioamnionitis Show forest plot	1	74	Risk Ratio (M‐H, Fixed, 95% CI)	3.17 [0.35, 29.06]

18 Endometritis Show forest plot	2	490	Risk Ratio (M‐H, Fixed, 95% CI)	0.24 [0.11, 0.50]

19 Fetal distress Show forest plot	3	215	Risk Ratio (M‐H, Fixed, 95% CI)	0.67 [0.36, 1.22]

20 Need for another method of induction Show forest plot	1	185	Risk Ratio (M‐H, Fixed, 95% CI)	1.41 [1.21, 1.64]

21 Neonatal infection Show forest plot	1	416	Risk Ratio (M‐H, Fixed, 95% CI)	2.20 [1.03, 4.69]

Comparison 14. Laminaria tent versus prostaglandins: all women (not prespecified)

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Comparison 15. Laminaria tent and prostaglandins versus prostaglandins alone: all women (not prespecified)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Vaginal delivery not achieved in 24 hours Show forest plot	1	39	Risk Ratio (M‐H, Fixed, 95% CI)	0.84 [0.53, 1.33]

2 Uterine hyperstimulation with FHR changes Show forest plot	1	44	Risk Ratio (M‐H, Fixed, 95% CI)	0.26 [0.01, 5.12]

3 Oxytocin augmentation Show forest plot	1	44	Risk Ratio (M‐H, Fixed, 95% CI)	0.95 [0.64, 1.41]

4 Serious neonatal morbidity/perinatal death Show forest plot	1	44	Risk Ratio (M‐H, Fixed, 95% CI)	0.26 [0.01, 5.12]

5 Caesarean section Show forest plot	4	223	Risk Ratio (M‐H, Fixed, 95% CI)	1.37 [0.88, 2.15]

6 Uterine hyperstimulation without fetal heart rate changes Show forest plot	1	39	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

7 Epidural analgesia Show forest plot	1	39	Risk Ratio (M‐H, Fixed, 95% CI)	0.98 [0.77, 1.24]

8 Instrumental vaginal delivery Show forest plot	2	78	Risk Ratio (M‐H, Fixed, 95% CI)	0.56 [0.22, 1.45]

9 Neonatal intensive care unit admission Show forest plot	1	44	Risk Ratio (M‐H, Fixed, 95% CI)	0.26 [0.01, 5.12]

10 Post partum haemorrhage Show forest plot	1	39	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

11 Neonatal infection Show forest plot	1	39	Risk Ratio (M‐H, Fixed, 95% CI)	8.61 [0.51, 145.67]

12 Chorioamnionitis or endometritis Show forest plot	3	122	Risk Ratio (M‐H, Fixed, 95% CI)	3.02 [1.21, 7.58]

Comparison 15. Laminaria tent and prostaglandins versus prostaglandins alone: all women (not prespecified)

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Comparison 16. Laminaria tent versus oxytocin (not prespecified)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Caesarean section Show forest plot	2	73	Risk Ratio (M‐H, Fixed, 95% CI)	0.83 [0.36, 1.89]

Comparison 16. Laminaria tent versus oxytocin (not prespecified)

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Comparison 17. Laminaria and oxytocin versus oxytocin alone: all women (not prespecified)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Caesarean section Show forest plot	1	46	Risk Ratio (M‐H, Fixed, 95% CI)	0.27 [0.03, 2.26]

2 Instrumental vaginal delivery Show forest plot	1	46	Risk Ratio (M‐H, Fixed, 95% CI)	0.55 [0.11, 2.69]

3 Endometritis Show forest plot	1	46	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 17. Laminaria and oxytocin versus oxytocin alone: all women (not prespecified)

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Comparison 18. Laminaria versus extra‐amniotic infusion: all women (not prespecified)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Caesarean section Show forest plot	2	386	Risk Ratio (M‐H, Fixed, 95% CI)	1.16 [0.85, 1.59]

2 Epidural analgesia Show forest plot	1	334	Risk Ratio (M‐H, Fixed, 95% CI)	0.95 [0.86, 1.06]

3 Apgar score <7 at 5 minutes Show forest plot	1	52	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 7.82]

4 Neonatal intensive care unit admission Show forest plot	1	52	Risk Ratio (M‐H, Fixed, 95% CI)	0.67 [0.21, 2.09]

5 Post partum haemorrhage Show forest plot	1	52	Risk Ratio (M‐H, Fixed, 95% CI)	3.0 [0.13, 70.42]

6 Chorioamnionitis Show forest plot	1	52	Risk Ratio (M‐H, Fixed, 95% CI)	1.4 [0.51, 3.85]

7 Endometritis Show forest plot	1	52	Risk Ratio (M‐H, Fixed, 95% CI)	1.0 [0.07, 15.15]

Comparison 18. Laminaria versus extra‐amniotic infusion: all women (not prespecified)

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Comparison 19. Balloon catheter (Foley or Atad) versus prostaglandins: all women (not prespecified)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Vaginal delivery not achieved in 24 hours Show forest plot	7	1142	Risk Ratio (M‐H, Random, 95% CI)	1.26 [0.94, 1.68]

2 Uterine hyperstimulation with FHR changes Show forest plot	9	1931	Risk Ratio (M‐H, Fixed, 95% CI)	0.19 [0.08, 0.43]

3 Caesarean section Show forest plot	21	3202	Risk Ratio (M‐H, Fixed, 95% CI)	1.01 [0.90, 1.13]

4 Serious neonatal morbidity/perinatal death Show forest plot	2	430	Risk Ratio (M‐H, Fixed, 95% CI)	0.45 [0.07, 3.03]

5 Serious maternal morbidity or death Show forest plot	2	147	Risk Ratio (M‐H, Fixed, 95% CI)	0.28 [0.01, 6.80]

6 Cervix unfavourable/unchanged after 12‐24 hours Show forest plot	2	219	Risk Ratio (M‐H, Fixed, 95% CI)	0.96 [0.70, 1.34]

7 Oxytocin augmentation Show forest plot	6	613	Risk Ratio (M‐H, Random, 95% CI)	1.51 [1.15, 1.97]

8 Uterine hyperstimulation without fetal heart rate changes Show forest plot	11	1578	Risk Ratio (M‐H, Random, 95% CI)	0.78 [0.26, 2.33]

9 Epidural analgesia Show forest plot	4	1178	Risk Ratio (M‐H, Random, 95% CI)	1.00 [0.87, 1.16]

10 Instrumental vaginal delivery Show forest plot	6	1208	Risk Ratio (M‐H, Fixed, 95% CI)	0.99 [0.79, 1.24]

11 Meconium stained liquor Show forest plot	6	1389	Risk Ratio (M‐H, Fixed, 95% CI)	0.79 [0.60, 1.04]

12 Apgar score < 7 at 5 minutes Show forest plot	5	694	Risk Ratio (M‐H, Fixed, 95% CI)	0.67 [0.14, 3.20]

13 Neonatal intensive care unit admission Show forest plot	4	1031	Risk Ratio (M‐H, Fixed, 95% CI)	0.81 [0.46, 1.42]

14 Antibiotics during labour (not prespecified) Show forest plot	1	330	Odds Ratio (M‐H, Fixed, 95% CI)	1.56 [0.87, 2.79]

15 Perinatal death Show forest plot	2	154	Risk Ratio (M‐H, Fixed, 95% CI)	1.0 [0.06, 15.55]

16 Maternal fever during labour (not prespecified) Show forest plot	2	918	Risk Ratio (M‐H, Fixed, 95% CI)	0.92 [0.62, 1.35]

17 Maternal side effects Show forest plot	3	329	Risk Ratio (M‐H, Fixed, 95% CI)	0.96 [0.37, 2.47]

18 Wound infection (not prespecified) Show forest plot	2	570	Risk Ratio (M‐H, Fixed, 95% CI)	1.01 [0.37, 2.77]

19 Post partum haemorrhage Show forest plot	4	716	Risk Ratio (M‐H, Fixed, 95% CI)	0.55 [0.28, 1.06]

20 Woman not satisfied Show forest plot	1	118	Risk Ratio (M‐H, Fixed, 95% CI)	3.5 [0.76, 16.16]

21 Chorioamnionitis Show forest plot	2	232	Risk Ratio (M‐H, Fixed, 95% CI)	1.0 [0.21, 4.75]

22 Endometritis Show forest plot	4	802	Risk Ratio (M‐H, Fixed, 95% CI)	1.10 [0.30, 4.07]

23 Fetal distress Show forest plot	5	437	Risk Ratio (M‐H, Fixed, 95% CI)	0.82 [0.47, 1.40]

24 Neonatal infection Show forest plot	3	454	Risk Ratio (M‐H, Fixed, 95% CI)	1.68 [0.56, 5.05]

Comparison 19. Balloon catheter (Foley or Atad) versus prostaglandins: all women (not prespecified)

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Comparison 20. Balloon catheter (Foley or Atad) and prostaglandins versus prostaglandins alone: all women (not prespecified)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Vaginal delivery not achieved in 24 hours Show forest plot	3	698	Risk Ratio (M‐H, Random, 95% CI)	0.45 [0.28, 0.71]

2 Uterine hyperstimulation with FHR changes Show forest plot	3	509	Risk Ratio (M‐H, Fixed, 95% CI)	0.53 [0.35, 0.78]

3 Caesarean section Show forest plot	8	1295	Risk Ratio (M‐H, Fixed, 95% CI)	0.92 [0.79, 1.08]

4 Cervix unfavourable/unchanged after 12‐24 hours Show forest plot	2	249	Risk Ratio (M‐H, Fixed, 95% CI)	0.46 [0.32, 0.65]

5 Oxytocin augmentation Show forest plot	5	871	Risk Ratio (M‐H, Fixed, 95% CI)	1.11 [1.02, 1.21]

6 Uterine hyperstimulation without fetal heart rate changes Show forest plot	7		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

7 Epidural analgesia Show forest plot	4	744	Risk Ratio (M‐H, Fixed, 95% CI)	1.17 [1.05, 1.30]

8 Instrumental vaginal delivery Show forest plot	1	127	Risk Ratio (M‐H, Fixed, 95% CI)	1.26 [0.77, 2.04]

9 Meconium stained liquor Show forest plot	5	900	Risk Ratio (M‐H, Fixed, 95% CI)	0.75 [0.50, 1.12]

10 Apgar score < 7 at 5 minutes Show forest plot	1	127	Risk Ratio (M‐H, Fixed, 95% CI)	1.91 [0.18, 20.51]

11 Neonatal intensive care unit admission Show forest plot	3	451	Risk Ratio (M‐H, Fixed, 95% CI)	0.79 [0.55, 1.15]

12 Perinatal death Show forest plot	1	127	Risk Ratio (M‐H, Fixed, 95% CI)	0.19 [0.01, 3.90]

13 Woman not satisfied Show forest plot	1	120	Risk Ratio (M‐H, Fixed, 95% CI)	3.39 [0.73, 15.64]

14 Chorioamnionitis Show forest plot	4	529	Risk Ratio (M‐H, Fixed, 95% CI)	2.97 [1.35, 6.53]

15 Endometritis Show forest plot	4	417	Risk Ratio (M‐H, Fixed, 95% CI)	1.46 [0.69, 3.06]

16 Neonatal infection Show forest plot	1	120	Risk Ratio (M‐H, Fixed, 95% CI)	4.84 [0.24, 98.71]

Comparison 20. Balloon catheter (Foley or Atad) and prostaglandins versus prostaglandins alone: all women (not prespecified)

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Comparison 21. Balloon catheter (Foley or Atad) versus oxytocin: all women (not prespecified)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Uterine hyperstimulation with FHR changes Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.2 [0.01, 4.11]

2 Caesarean section Show forest plot	3	325	Risk Ratio (M‐H, Fixed, 95% CI)	0.57 [0.38, 0.88]

3 Serious maternal morbidity or death Show forest plot	1	60	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

4 Meconium stained liquor Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.54 [0.22, 1.29]

5 Uterine hyperstimulation without FHR changes Show forest plot	1	60	Risk Ratio (M‐H, Fixed, 95% CI)	0.5 [0.05, 5.22]

6 Neonatal intensive care unit admission Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.6 [0.15, 2.44]

7 Instrumental vaginal delivery Show forest plot	1	60	Risk Ratio (M‐H, Fixed, 95% CI)	1.2 [0.41, 3.51]

8 Apgar score < 7 at 5 minutes Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 8.09]

9 Postpartum haemorrhage Show forest plot	1	60	Risk Ratio (M‐H, Fixed, 95% CI)	1.0 [0.22, 4.56]

Comparison 21. Balloon catheter (Foley or Atad) versus oxytocin: all women (not prespecified)

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Comparison 22. Balloon catheter and oxytocin versus prostaglandins: all women (not pre‐specified)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Caesarean section Show forest plot	1	162	Risk Ratio (M‐H, Fixed, 95% CI)	0.82 [0.52, 1.28]

2 Uterine hyperstimulation without FHR changes Show forest plot	1	162	Risk Ratio (M‐H, Fixed, 95% CI)	0.73 [0.38, 1.40]

3 Epidural analgesia Show forest plot	1	162	Risk Ratio (M‐H, Fixed, 95% CI)	1.07 [0.90, 1.27]

4 Vaginal delivery not achieved in 24 hours Show forest plot	1	162	Risk Ratio (M‐H, Fixed, 95% CI)	0.52 [0.37, 0.74]

5 Uterine hyperstimulation with FHR changes Show forest plot	1	162	Risk Ratio (M‐H, Fixed, 95% CI)	0.27 [0.06, 1.27]

6 Serious neonatal morbidity/perinatal death Show forest plot	1	162	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

7 Meconium stained liquor Show forest plot	1	162	Risk Ratio (M‐H, Fixed, 95% CI)	0.70 [0.34, 1.43]

8 Apgar score < 7 at 5 minutes Show forest plot	1	162	Risk Ratio (M‐H, Fixed, 95% CI)	0.95 [0.20, 4.58]

9 Neonatal intensive care unit admission Show forest plot	1	162	Risk Ratio (M‐H, Fixed, 95% CI)	0.80 [0.44, 1.45]

10 Post partum blood transfusion Show forest plot	1	162	Risk Ratio (M‐H, Fixed, 95% CI)	1.43 [0.25, 8.32]

Comparison 22. Balloon catheter and oxytocin versus prostaglandins: all women (not pre‐specified)

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Comparison 23. Extra‐amniotic infusion versus prostaglandins: all women (not prespecified)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Vaginal delivery not achieved in 24 hours Show forest plot	2	232	Risk Ratio (M‐H, Random, 95% CI)	1.32 [0.75, 2.31]

2 Uterine hyperstimulation with FHR changes Show forest plot	4	568	Risk Ratio (M‐H, Fixed, 95% CI)	0.66 [0.30, 1.46]

3 Caesarean section Show forest plot	6	747	Risk Ratio (M‐H, Random, 95% CI)	1.37 [0.90, 2.08]

4 Serious maternal morbidity or death Show forest plot	1	248	Risk Ratio (M‐H, Fixed, 95% CI)	2.81 [0.12, 68.41]

5 Cervix unfavourable/unchanged after 12‐24 hours Show forest plot	1	85	Risk Ratio (M‐H, Fixed, 95% CI)	0.06 [0.00, 0.97]

6 Oxytocin augmentation Show forest plot	2	179	Risk Ratio (M‐H, Random, 95% CI)	3.53 [0.23, 53.58]

7 Uterine hyperstimulation without fetal heart rate changes Show forest plot	2	221	Risk Ratio (M‐H, Fixed, 95% CI)	0.23 [0.03, 2.07]

8 Epidural analgesia Show forest plot	2	360	Risk Ratio (M‐H, Random, 95% CI)	1.06 [0.71, 1.60]

9 Instrumental vaginal delivery Show forest plot	3	442	Risk Ratio (M‐H, Fixed, 95% CI)	0.61 [0.36, 1.03]

10 Meconium stained liquor Show forest plot	2	360	Risk Ratio (M‐H, Fixed, 95% CI)	1.11 [0.60, 2.05]

11 Apgar score < 7 at 5 minutes Show forest plot	3	317	Risk Ratio (M‐H, Random, 95% CI)	0.61 [0.01, 26.52]

12 Neonatal intensive care unit admission Show forest plot	2	235	Risk Ratio (M‐H, Fixed, 95% CI)	1.38 [0.66, 2.87]

13 Post partum haemorrhage Show forest plot	1	248	Risk Ratio (M‐H, Fixed, 95% CI)	2.34 [0.46, 11.85]

14 Woman not satisfied Show forest plot	1	109	Risk Ratio (M‐H, Fixed, 95% CI)	0.56 [0.10, 3.25]

15 Chorioamnionitis Show forest plot	3	483	Risk Ratio (M‐H, Fixed, 95% CI)	1.62 [0.96, 2.72]

16 Endometritis Show forest plot	4	568	Risk Ratio (M‐H, Fixed, 95% CI)	1.33 [0.45, 3.96]

17 Neonatal infection Show forest plot	2	333	Risk Ratio (M‐H, Fixed, 95% CI)	0.94 [0.06, 14.82]

Comparison 23. Extra‐amniotic infusion versus prostaglandins: all women (not prespecified)

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Comparison 24. Extra‐amniotic infusion and oxytocin versus prostaglandin: all women (not prespecified)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Caesarean section Show forest plot	3	551	Risk Ratio (M‐H, Fixed, 95% CI)	1.03 [0.75, 1.42]

2 Oxytocin augmentation Show forest plot	2	400	Risk Ratio (M‐H, Fixed, 95% CI)	2.16 [1.86, 2.51]

3 Serious maternal morbidity or death Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

4 Vaginal delivery not achieved in 24 hours Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.44 [0.28, 0.67]

5 Uterine hyperstimulation with FHR changes Show forest plot	2	351	Risk Ratio (M‐H, Fixed, 95% CI)	1.10 [0.46, 2.61]

6 Uterine hyperstimulation without FHR changes Show forest plot	2		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

7 Meconium stained liquor Show forest plot	2	351	Risk Ratio (M‐H, Fixed, 95% CI)	0.86 [0.48, 1.53]

8 Neonatal intensive care unit admission Show forest plot	2	351	Risk Ratio (M‐H, Fixed, 95% CI)	0.80 [0.43, 1.48]

9 Chorioamnionitis (not prespecified) Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.65 [0.32, 1.31]

10 Apgar score < 7 at 5 minutes Show forest plot	1	151	Risk Ratio (M‐H, Fixed, 95% CI)	2.96 [0.12, 71.55]

11 Post partum haemorrhage Show forest plot	1	151	Risk Ratio (M‐H, Fixed, 95% CI)	0.14 [0.01, 2.68]

Comparison 24. Extra‐amniotic infusion and oxytocin versus prostaglandin: all women (not prespecified)

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