Vaginal prostaglandin (PGE2 and PGF2a) for induction of labour at term

Anthony J Kelly; Sidra Malik; Lee Smith; Josephine Kavanagh; Jane Thomas

doi:10.1002/14651858.CD003101.pub2

Scolaris Content Display Scolaris Content Display

Figure 1

Forest plot of comparison: 1 (1.1) PGE2 (all regimens) vs placebo/no treatment (all women), outcome: 1.2 Uterine hyperstimulation with FHR changes.

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Figure 2

Forest plot of comparison: 31 (4.1) PGE2 gel vs PGE2 tablet (all women), outcome: 31.3 Caesarean section.

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Figure 3

Forest plot of comparison: 47 (7.1) PGE2 (controlled release) vs all PGE2 delivery systems (all women), outcome: 47.2 Uterine hyperstimulation with FHR changes.

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Figure 4

Forest plot of comparison: 47 (7.1) PGE2 (controlled release) vs all PGE2 delivery systems (all women), outcome: 47.7 Oxytocin augmentation.

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Figure 5

Forest plot of comparison: 47 (7.1) PGE2 (controlled release) vs all PGE2 delivery systems (all women), outcome: 47.8 Uterine hyperstimulation without FHR changes.

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Figure 6

Forest plot of comparison: 47 (7.1) PGE2 (controlled release) vs all PGE2 delivery systems (all women), outcome: 47.11 Instrumental vaginal delivery.

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Figure 7

Forest plot of comparison: 48 (7.2) PGE2 (controlled release) vs all PGE2 delivery systems (all women, unfavourable cervix), outcome: 48.11 Instrumental vaginal delivery.

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Figure 8

Funnel plot of comparison: 1 (1.1) PGE2 (all regimens) vs placebo/no treatment (all women), outcome: 1.13 Apgar score < 7 at 5 minutes.

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Analysis 1.1

Comparison 1 (1.1) PGE2 (all regimens) vs placebo/no treatment (all women), Outcome 1 Vaginal delivery not achieved within 24 hours.

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Analysis 1.2

Comparison 1 (1.1) PGE2 (all regimens) vs placebo/no treatment (all women), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 1.3

Comparison 1 (1.1) PGE2 (all regimens) vs placebo/no treatment (all women), Outcome 3 Caesarean section.

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Analysis 1.4

Comparison 1 (1.1) PGE2 (all regimens) vs placebo/no treatment (all women), Outcome 4 Serious neonatal morbidity or perinatal death.

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Analysis 1.5

Comparison 1 (1.1) PGE2 (all regimens) vs placebo/no treatment (all women), Outcome 5 Serious maternal morbidity or death.

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Analysis 1.6

Comparison 1 (1.1) PGE2 (all regimens) vs placebo/no treatment (all women), Outcome 6 Cervix unfavourable/unchanged after 12 to 24 hours.

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Analysis 1.7

Comparison 1 (1.1) PGE2 (all regimens) vs placebo/no treatment (all women), Outcome 7 Oxytocin augmentation.

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Analysis 1.8

Comparison 1 (1.1) PGE2 (all regimens) vs placebo/no treatment (all women), Outcome 8 Uterine hyperstimulation without FHR changes.

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Analysis 1.9

Comparison 1 (1.1) PGE2 (all regimens) vs placebo/no treatment (all women), Outcome 9 Uterine rupture.

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Analysis 1.10

Comparison 1 (1.1) PGE2 (all regimens) vs placebo/no treatment (all women), Outcome 10 Epidural analgesia.

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Analysis 1.11

Comparison 1 (1.1) PGE2 (all regimens) vs placebo/no treatment (all women), Outcome 11 Instrumental vaginal delivery.

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Analysis 1.12

Comparison 1 (1.1) PGE2 (all regimens) vs placebo/no treatment (all women), Outcome 12 Meconium‐stained liquor.

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Analysis 1.13

Comparison 1 (1.1) PGE2 (all regimens) vs placebo/no treatment (all women), Outcome 13 Apgar score < 7 at 5 minutes.

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Analysis 1.14

Comparison 1 (1.1) PGE2 (all regimens) vs placebo/no treatment (all women), Outcome 14 Neonatal intensive care unit admission.

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Analysis 1.16

Comparison 1 (1.1) PGE2 (all regimens) vs placebo/no treatment (all women), Outcome 16 Perinatal death.

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Analysis 1.18

Comparison 1 (1.1) PGE2 (all regimens) vs placebo/no treatment (all women), Outcome 18 Maternal side‐effects (all).

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Analysis 1.19

Comparison 1 (1.1) PGE2 (all regimens) vs placebo/no treatment (all women), Outcome 19 Nausea (maternal).

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Analysis 1.20

Comparison 1 (1.1) PGE2 (all regimens) vs placebo/no treatment (all women), Outcome 20 Vomitting (maternal).

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Analysis 1.21

Comparison 1 (1.1) PGE2 (all regimens) vs placebo/no treatment (all women), Outcome 21 Diarrhoea (maternal).

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Analysis 1.22

Comparison 1 (1.1) PGE2 (all regimens) vs placebo/no treatment (all women), Outcome 22 Other maternal side‐effects.

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Analysis 1.23

Comparison 1 (1.1) PGE2 (all regimens) vs placebo/no treatment (all women), Outcome 23 Postpartum haemorrhage.

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Analysis 1.24

Comparison 1 (1.1) PGE2 (all regimens) vs placebo/no treatment (all women), Outcome 24 Serious maternal complication.

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Analysis 1.26

Comparison 1 (1.1) PGE2 (all regimens) vs placebo/no treatment (all women), Outcome 26 Woman not satisfied.

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Analysis 2.1

Comparison 2 (1.2) PGE2 (all regimens) vs placebo/no treatment (all women, unfavourable cervix), Outcome 1 Vaginal delivery not achieved within 24 hours.

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Analysis 2.2

Comparison 2 (1.2) PGE2 (all regimens) vs placebo/no treatment (all women, unfavourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 2.3

Comparison 2 (1.2) PGE2 (all regimens) vs placebo/no treatment (all women, unfavourable cervix), Outcome 3 Caesarean section.

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Analysis 2.4

Comparison 2 (1.2) PGE2 (all regimens) vs placebo/no treatment (all women, unfavourable cervix), Outcome 4 Serious neonatal morbidity or perinatal death.

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Analysis 2.5

Comparison 2 (1.2) PGE2 (all regimens) vs placebo/no treatment (all women, unfavourable cervix), Outcome 5 Serious maternal morbidity or death.

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Analysis 2.6

Comparison 2 (1.2) PGE2 (all regimens) vs placebo/no treatment (all women, unfavourable cervix), Outcome 6 Cervix unfavourable/unchanged after 12 to 24 hours.

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Analysis 2.7

Comparison 2 (1.2) PGE2 (all regimens) vs placebo/no treatment (all women, unfavourable cervix), Outcome 7 Oxytocin augmentation.

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Analysis 2.8

Comparison 2 (1.2) PGE2 (all regimens) vs placebo/no treatment (all women, unfavourable cervix), Outcome 8 Uterine hyperstimulation without FHR changes.

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Analysis 2.9

Comparison 2 (1.2) PGE2 (all regimens) vs placebo/no treatment (all women, unfavourable cervix), Outcome 9 Uterine rupture.

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Analysis 2.10

Comparison 2 (1.2) PGE2 (all regimens) vs placebo/no treatment (all women, unfavourable cervix), Outcome 10 Epidural analgesia.

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Analysis 2.11

Comparison 2 (1.2) PGE2 (all regimens) vs placebo/no treatment (all women, unfavourable cervix), Outcome 11 Instrumental vaginal delivery.

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Analysis 2.12

Comparison 2 (1.2) PGE2 (all regimens) vs placebo/no treatment (all women, unfavourable cervix), Outcome 12 Meconium‐stained liquor.

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Analysis 2.13

Comparison 2 (1.2) PGE2 (all regimens) vs placebo/no treatment (all women, unfavourable cervix), Outcome 13 Apgar score < 7 at 5 minutes.

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Analysis 2.14

Comparison 2 (1.2) PGE2 (all regimens) vs placebo/no treatment (all women, unfavourable cervix), Outcome 14 Neonatal intensive care unit admission.

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Analysis 2.16

Comparison 2 (1.2) PGE2 (all regimens) vs placebo/no treatment (all women, unfavourable cervix), Outcome 16 Perinatal death.

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Analysis 2.18

Comparison 2 (1.2) PGE2 (all regimens) vs placebo/no treatment (all women, unfavourable cervix), Outcome 18 Maternal side‐effects (all).

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Analysis 2.19

Comparison 2 (1.2) PGE2 (all regimens) vs placebo/no treatment (all women, unfavourable cervix), Outcome 19 Nausea (maternal).

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Analysis 2.20

Comparison 2 (1.2) PGE2 (all regimens) vs placebo/no treatment (all women, unfavourable cervix), Outcome 20 Vomitting (maternal).

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Analysis 2.21

Comparison 2 (1.2) PGE2 (all regimens) vs placebo/no treatment (all women, unfavourable cervix), Outcome 21 Diarrhoea (maternal).

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Analysis 2.22

Comparison 2 (1.2) PGE2 (all regimens) vs placebo/no treatment (all women, unfavourable cervix), Outcome 22 Other maternal side‐effects.

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Analysis 2.23

Comparison 2 (1.2) PGE2 (all regimens) vs placebo/no treatment (all women, unfavourable cervix), Outcome 23 Postpartum haemorrhage.

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Analysis 2.24

Comparison 2 (1.2) PGE2 (all regimens) vs placebo/no treatment (all women, unfavourable cervix), Outcome 24 Serious maternal complication.

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Analysis 3.1

Comparison 3 (1.3) PGE2 (all regimens) vs placebo/no treatment (all women, favourable cervix), Outcome 1 Vaginal delivery not achieved within 24 hours.

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Analysis 3.2

Comparison 3 (1.3) PGE2 (all regimens) vs placebo/no treatment (all women, favourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 3.3

Comparison 3 (1.3) PGE2 (all regimens) vs placebo/no treatment (all women, favourable cervix), Outcome 3 Caesarean section.

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Analysis 3.4

Comparison 3 (1.3) PGE2 (all regimens) vs placebo/no treatment (all women, favourable cervix), Outcome 4 Serious neonatal morbidity or perinatal death.

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Analysis 3.5

Comparison 3 (1.3) PGE2 (all regimens) vs placebo/no treatment (all women, favourable cervix), Outcome 5 Oxytocin augmentation.

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Analysis 3.7

Comparison 3 (1.3) PGE2 (all regimens) vs placebo/no treatment (all women, favourable cervix), Outcome 7 Uterine hyperstimulation without FHR changes.

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Analysis 3.11

Comparison 3 (1.3) PGE2 (all regimens) vs placebo/no treatment (all women, favourable cervix), Outcome 11 Instrumental vaginal delivery.

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Analysis 3.16

Comparison 3 (1.3) PGE2 (all regimens) vs placebo/no treatment (all women, favourable cervix), Outcome 16 Perinatal death.

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Analysis 4.2

Comparison 4 (1.5) PGE2 (all regimens) vs placebo/no treatment (all women, intact membranes, unfavourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 4.3

Comparison 4 (1.5) PGE2 (all regimens) vs placebo/no treatment (all women, intact membranes, unfavourable cervix), Outcome 3 Caesarean section.

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Analysis 4.6

Comparison 4 (1.5) PGE2 (all regimens) vs placebo/no treatment (all women, intact membranes, unfavourable cervix), Outcome 6 Cervix unfavourable/unchanged after 12 to 24 hours.

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Analysis 4.7

Comparison 4 (1.5) PGE2 (all regimens) vs placebo/no treatment (all women, intact membranes, unfavourable cervix), Outcome 7 Oxytocin augmentation.

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Analysis 4.8

Comparison 4 (1.5) PGE2 (all regimens) vs placebo/no treatment (all women, intact membranes, unfavourable cervix), Outcome 8 Uterine hyperstimulation without FHR changes.

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Analysis 4.13

Comparison 4 (1.5) PGE2 (all regimens) vs placebo/no treatment (all women, intact membranes, unfavourable cervix), Outcome 13 Apgar score < 7 at 5 minutes.

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Analysis 4.14

Comparison 4 (1.5) PGE2 (all regimens) vs placebo/no treatment (all women, intact membranes, unfavourable cervix), Outcome 14 Neonatal intensive care unit admission.

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Analysis 4.18

Comparison 4 (1.5) PGE2 (all regimens) vs placebo/no treatment (all women, intact membranes, unfavourable cervix), Outcome 18 Maternal side‐effects (all).

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Analysis 4.23

Comparison 4 (1.5) PGE2 (all regimens) vs placebo/no treatment (all women, intact membranes, unfavourable cervix), Outcome 23 Postpartum haemorrhage.

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Analysis 5.1

Comparison 5 (1.6) PGE2 (all regimens) vs placebo/no treatment (all women, intact membranes, favourable cervix), Outcome 1 Vaginal delivery not achieved within 24 hours.

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Analysis 5.3

Comparison 5 (1.6) PGE2 (all regimens) vs placebo/no treatment (all women, intact membranes, favourable cervix), Outcome 3 Caesarean section.

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Analysis 5.4

Comparison 5 (1.6) PGE2 (all regimens) vs placebo/no treatment (all women, intact membranes, favourable cervix), Outcome 4 Serious neonatal morbidity or perinatal death.

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Analysis 5.7

Comparison 5 (1.6) PGE2 (all regimens) vs placebo/no treatment (all women, intact membranes, favourable cervix), Outcome 7 Oxytocin augmentation.

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Analysis 5.11

Comparison 5 (1.6) PGE2 (all regimens) vs placebo/no treatment (all women, intact membranes, favourable cervix), Outcome 11 Instrumental vaginal delivery.

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Analysis 5.16

Comparison 5 (1.6) PGE2 (all regimens) vs placebo/no treatment (all women, intact membranes, favourable cervix), Outcome 16 Perinatal death.

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Analysis 6.3

Comparison 6 (1.7) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, variable/undefined cervix), Outcome 3 Caesarean section.

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Analysis 6.4

Comparison 6 (1.7) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, variable/undefined cervix), Outcome 4 Serious neonatal morbidity or perinatal death.

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Analysis 6.8

Comparison 6 (1.7) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, variable/undefined cervix), Outcome 8 Uterine hyperstimulation without FHR changes.

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Analysis 6.9

Comparison 6 (1.7) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, variable/undefined cervix), Outcome 9 Uterine rupture.

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Analysis 6.10

Comparison 6 (1.7) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, variable/undefined cervix), Outcome 10 Epidural analgesia.

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Analysis 6.11

Comparison 6 (1.7) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, variable/undefined cervix), Outcome 11 Instrumental vaginal delivery.

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Analysis 6.12

Comparison 6 (1.7) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, variable/undefined cervix), Outcome 12 Meconium‐stained liquor.

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Analysis 6.13

Comparison 6 (1.7) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, variable/undefined cervix), Outcome 13 Apgar score < 7 at 5 minutes.

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Analysis 6.14

Comparison 6 (1.7) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, variable/undefined cervix), Outcome 14 Neonatal intensive care unit admission.

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Analysis 6.16

Comparison 6 (1.7) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, variable/undefined cervix), Outcome 16 Perinatal death.

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Analysis 6.18

Comparison 6 (1.7) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, variable/undefined cervix), Outcome 18 Maternal side‐effects (all).

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Analysis 6.20

Comparison 6 (1.7) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, variable/undefined cervix), Outcome 20 Vomitting (maternal).

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Analysis 6.21

Comparison 6 (1.7) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, variable/undefined cervix), Outcome 21 Diarrhoea (maternal).

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Analysis 6.23

Comparison 6 (1.7) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, variable/undefined cervix), Outcome 23 Postpartum haemorrhage.

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Analysis 6.26

Comparison 6 (1.7) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, variable/undefined cervix), Outcome 26 Woman not satisfied.

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Analysis 7.2

Comparison 7 (1.8) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, unfavourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 7.3

Comparison 7 (1.8) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, unfavourable cervix), Outcome 3 Caesarean section.

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Analysis 7.4

Comparison 7 (1.8) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, unfavourable cervix), Outcome 4 Serious neonatal morbidity or perinatal death.

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Analysis 7.5

Comparison 7 (1.8) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, unfavourable cervix), Outcome 5 Serious maternal morbidity or death.

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Analysis 7.7

Comparison 7 (1.8) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, unfavourable cervix), Outcome 7 Oxytocin augmentation.

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Analysis 7.8

Comparison 7 (1.8) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, unfavourable cervix), Outcome 8 Uterine hyperstimulation without FHR changes.

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Analysis 7.9

Comparison 7 (1.8) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, unfavourable cervix), Outcome 9 Uterine rupture.

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Analysis 7.10

Comparison 7 (1.8) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, unfavourable cervix), Outcome 10 Epidural analgesia.

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Analysis 7.11

Comparison 7 (1.8) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, unfavourable cervix), Outcome 11 Instrumental vaginal delivery.

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Analysis 7.12

Comparison 7 (1.8) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, unfavourable cervix), Outcome 12 Meconium‐stained liquor.

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Analysis 7.13

Comparison 7 (1.8) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, unfavourable cervix), Outcome 13 Apgar score < 7 at 5 minutes.

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Analysis 7.14

Comparison 7 (1.8) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, unfavourable cervix), Outcome 14 Neonatal intensive care unit admission.

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Analysis 7.16

Comparison 7 (1.8) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, unfavourable cervix), Outcome 16 Perinatal death.

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Analysis 7.18

Comparison 7 (1.8) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, unfavourable cervix), Outcome 18 Maternal side‐effects (all).

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Analysis 7.20

Comparison 7 (1.8) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, unfavourable cervix), Outcome 20 Vomitting (maternal).

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Analysis 7.22

Comparison 7 (1.8) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, unfavourable cervix), Outcome 22 Other maternal side‐effects.

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Analysis 7.23

Comparison 7 (1.8) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, unfavourable cervix), Outcome 23 Postpartum haemorrhage.

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Analysis 7.24

Comparison 7 (1.8) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, unfavourable cervix), Outcome 24 Serious maternal complication.

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Analysis 8.1

Comparison 8 (1.10) PGE2 (all regimens) vs placebo/no treatment (all primiparae), Outcome 1 Vaginal delivery not achieved within 24 hours.

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Analysis 8.2

Comparison 8 (1.10) PGE2 (all regimens) vs placebo/no treatment (all primiparae), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 8.3

Comparison 8 (1.10) PGE2 (all regimens) vs placebo/no treatment (all primiparae), Outcome 3 Caesarean section.

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Analysis 8.4

Comparison 8 (1.10) PGE2 (all regimens) vs placebo/no treatment (all primiparae), Outcome 4 Serious neonatal morbidity or perinatal death.

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Analysis 8.5

Comparison 8 (1.10) PGE2 (all regimens) vs placebo/no treatment (all primiparae), Outcome 5 Serious maternal morbidity or death.

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Analysis 8.6

Comparison 8 (1.10) PGE2 (all regimens) vs placebo/no treatment (all primiparae), Outcome 6 Cervix unfavourable/unchanged after 12 to 24 hours.

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Analysis 8.7

Comparison 8 (1.10) PGE2 (all regimens) vs placebo/no treatment (all primiparae), Outcome 7 Oxytocin augmentation.

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Analysis 8.8

Comparison 8 (1.10) PGE2 (all regimens) vs placebo/no treatment (all primiparae), Outcome 8 Uterine hyperstimulation without FHR changes.

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Analysis 8.9

Comparison 8 (1.10) PGE2 (all regimens) vs placebo/no treatment (all primiparae), Outcome 9 Uterine rupture.

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Analysis 8.10

Comparison 8 (1.10) PGE2 (all regimens) vs placebo/no treatment (all primiparae), Outcome 10 Epidural analgesia.

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Analysis 8.11

Comparison 8 (1.10) PGE2 (all regimens) vs placebo/no treatment (all primiparae), Outcome 11 Instrumental vaginal delivery.

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Analysis 8.12

Comparison 8 (1.10) PGE2 (all regimens) vs placebo/no treatment (all primiparae), Outcome 12 Meconium‐stained liquor.

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Analysis 8.13

Comparison 8 (1.10) PGE2 (all regimens) vs placebo/no treatment (all primiparae), Outcome 13 Apgar score < 7 at 5 minutes.

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Analysis 8.14

Comparison 8 (1.10) PGE2 (all regimens) vs placebo/no treatment (all primiparae), Outcome 14 Neonatal intensive care unit admission.

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Analysis 8.16

Comparison 8 (1.10) PGE2 (all regimens) vs placebo/no treatment (all primiparae), Outcome 16 Perinatal death.

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Analysis 8.18

Comparison 8 (1.10) PGE2 (all regimens) vs placebo/no treatment (all primiparae), Outcome 18 Maternal side‐effects (all).

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Analysis 8.20

Comparison 8 (1.10) PGE2 (all regimens) vs placebo/no treatment (all primiparae), Outcome 20 Vomitting (maternal).

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Analysis 8.21

Comparison 8 (1.10) PGE2 (all regimens) vs placebo/no treatment (all primiparae), Outcome 21 Diarrhoea (maternal).

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Analysis 8.22

Comparison 8 (1.10) PGE2 (all regimens) vs placebo/no treatment (all primiparae), Outcome 22 Other maternal side‐effects.

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Analysis 8.23

Comparison 8 (1.10) PGE2 (all regimens) vs placebo/no treatment (all primiparae), Outcome 23 Postpartum haemorrhage.

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Analysis 9.1

Comparison 9 (1.11) PGE2 (all regimens) vs placebo/no treatment (all primiparae, unfavourable cervix), Outcome 1 Vaginal delivery not achieved within 24 hours.

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Analysis 9.2

Comparison 9 (1.11) PGE2 (all regimens) vs placebo/no treatment (all primiparae, unfavourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 9.3

Comparison 9 (1.11) PGE2 (all regimens) vs placebo/no treatment (all primiparae, unfavourable cervix), Outcome 3 Caesarean section.

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Analysis 9.4

Comparison 9 (1.11) PGE2 (all regimens) vs placebo/no treatment (all primiparae, unfavourable cervix), Outcome 4 Serious neonatal morbidity or perinatal death.

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Analysis 9.5

Comparison 9 (1.11) PGE2 (all regimens) vs placebo/no treatment (all primiparae, unfavourable cervix), Outcome 5 Serious maternal morbidity or death.

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Analysis 9.7

Comparison 9 (1.11) PGE2 (all regimens) vs placebo/no treatment (all primiparae, unfavourable cervix), Outcome 7 Oxytocin augmentation.

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Analysis 9.8

Comparison 9 (1.11) PGE2 (all regimens) vs placebo/no treatment (all primiparae, unfavourable cervix), Outcome 8 Uterine hyperstimulation without FHR changes.

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Analysis 9.10

Comparison 9 (1.11) PGE2 (all regimens) vs placebo/no treatment (all primiparae, unfavourable cervix), Outcome 10 Epidural analgesia.

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Analysis 9.11

Comparison 9 (1.11) PGE2 (all regimens) vs placebo/no treatment (all primiparae, unfavourable cervix), Outcome 11 Instrumental vaginal delivery.

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Analysis 9.12

Comparison 9 (1.11) PGE2 (all regimens) vs placebo/no treatment (all primiparae, unfavourable cervix), Outcome 12 Meconium‐stained liquor.

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Analysis 9.13

Comparison 9 (1.11) PGE2 (all regimens) vs placebo/no treatment (all primiparae, unfavourable cervix), Outcome 13 Apgar score < 7 at 5 minutes.

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Analysis 9.14

Comparison 9 (1.11) PGE2 (all regimens) vs placebo/no treatment (all primiparae, unfavourable cervix), Outcome 14 Neonatal intensive care unit admission.

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Analysis 9.16

Comparison 9 (1.11) PGE2 (all regimens) vs placebo/no treatment (all primiparae, unfavourable cervix), Outcome 16 Perinatal death.

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Analysis 9.18

Comparison 9 (1.11) PGE2 (all regimens) vs placebo/no treatment (all primiparae, unfavourable cervix), Outcome 18 Maternal side‐effects (all).

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Analysis 9.22

Comparison 9 (1.11) PGE2 (all regimens) vs placebo/no treatment (all primiparae, unfavourable cervix), Outcome 22 Other maternal side‐effects.

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Analysis 9.23

Comparison 9 (1.11) PGE2 (all regimens) vs placebo/no treatment (all primiparae, unfavourable cervix), Outcome 23 Postpartum haemorrhage.

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Analysis 10.1

Comparison 10 (1.12) PGE2 (all regimens) vs placebo/no treatment (all primiparae, favourable cervix), Outcome 1 Vaginal delivery not achieved within 24 hours.

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Analysis 10.3

Comparison 10 (1.12) PGE2 (all regimens) vs placebo/no treatment (all primiparae, favourable cervix), Outcome 3 Caesarean section.

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Analysis 11.2

Comparison 11 (1.14) PGE2 (all regimens) vs placebo/no treatment (all primiparae, intact membranes, unfavourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 11.3

Comparison 11 (1.14) PGE2 (all regimens) vs placebo/no treatment (all primiparae, intact membranes, unfavourable cervix), Outcome 3 Caesarean section.

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Analysis 12.1

Comparison 12 (1.15) PGE2 (all regimens) vs placebo/no treatment (all primiparae, intact membranes, favourable cervix), Outcome 1 Vaginal delivery not achieved within 24 hours.

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Analysis 12.3

Comparison 12 (1.15) PGE2 (all regimens) vs placebo/no treatment (all primiparae, intact membranes, favourable cervix), Outcome 3 Caesarean section.

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Analysis 13.3

Comparison 13 (1.16) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured memb., variable/undefined cervix), Outcome 3 Caesarean section.

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Analysis 13.4

Comparison 13 (1.16) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured memb., variable/undefined cervix), Outcome 4 Serious neonatal morbidity or perinatal death.

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Analysis 13.8

Comparison 13 (1.16) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured memb., variable/undefined cervix), Outcome 8 Uterine hyperstimulation without FHR changes.

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Analysis 13.9

Comparison 13 (1.16) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured memb., variable/undefined cervix), Outcome 9 Uterine rupture.

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Analysis 13.10

Comparison 13 (1.16) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured memb., variable/undefined cervix), Outcome 10 Epidural analgesia.

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Analysis 13.11

Comparison 13 (1.16) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured memb., variable/undefined cervix), Outcome 11 Instrumental vaginal delivery.

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Analysis 13.16

Comparison 13 (1.16) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured memb., variable/undefined cervix), Outcome 16 Perinatal death.

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Analysis 13.18

Comparison 13 (1.16) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured memb., variable/undefined cervix), Outcome 18 Maternal side‐effects (all).

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Analysis 13.20

Comparison 13 (1.16) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured memb., variable/undefined cervix), Outcome 20 Vomitting (maternal).

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Analysis 13.21

Comparison 13 (1.16) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured memb., variable/undefined cervix), Outcome 21 Diarrhoea (maternal).

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Analysis 13.23

Comparison 13 (1.16) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured memb., variable/undefined cervix), Outcome 23 Postpartum haemorrhage.

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Analysis 14.2

Comparison 14 (1.17) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured membranes, unfavourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 14.3

Comparison 14 (1.17) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured membranes, unfavourable cervix), Outcome 3 Caesarean section.

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Analysis 14.4

Comparison 14 (1.17) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured membranes, unfavourable cervix), Outcome 4 Serious neonatal morbidity or perinatal death.

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Analysis 14.7

Comparison 14 (1.17) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured membranes, unfavourable cervix), Outcome 7 Oxytocin augmentation.

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Analysis 14.8

Comparison 14 (1.17) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured membranes, unfavourable cervix), Outcome 8 Uterine hyperstimulation without FHR changes.

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Analysis 14.10

Comparison 14 (1.17) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured membranes, unfavourable cervix), Outcome 10 Epidural analgesia.

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Analysis 14.11

Comparison 14 (1.17) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured membranes, unfavourable cervix), Outcome 11 Instrumental vaginal delivery.

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Analysis 14.12

Comparison 14 (1.17) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured membranes, unfavourable cervix), Outcome 12 Meconium‐stained liquor.

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Analysis 14.13

Comparison 14 (1.17) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured membranes, unfavourable cervix), Outcome 13 Apgar score < 7 at 5 minutes.

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Analysis 14.14

Comparison 14 (1.17) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured membranes, unfavourable cervix), Outcome 14 Neonatal intensive care unit admission.

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Analysis 14.16

Comparison 14 (1.17) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured membranes, unfavourable cervix), Outcome 16 Perinatal death.

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Analysis 14.18

Comparison 14 (1.17) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured membranes, unfavourable cervix), Outcome 18 Maternal side‐effects (all).

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Analysis 14.22

Comparison 14 (1.17) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured membranes, unfavourable cervix), Outcome 22 Other maternal side‐effects.

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Analysis 14.23

Comparison 14 (1.17) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured membranes, unfavourable cervix), Outcome 23 Postpartum haemorrhage.

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Analysis 15.1

Comparison 15 (1.19) PGE2 (all regimens) vs placebo/no treatment (all multiparae, without previous caesarean section), Outcome 1 Vaginal delivery not achieved within 24 hours.

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Analysis 15.2

Comparison 15 (1.19) PGE2 (all regimens) vs placebo/no treatment (all multiparae, without previous caesarean section), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 15.3

Comparison 15 (1.19) PGE2 (all regimens) vs placebo/no treatment (all multiparae, without previous caesarean section), Outcome 3 Caesarean section.

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Analysis 15.4

Comparison 15 (1.19) PGE2 (all regimens) vs placebo/no treatment (all multiparae, without previous caesarean section), Outcome 4 Serious neonatal morbidity or perinatal death.

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Analysis 15.5

Comparison 15 (1.19) PGE2 (all regimens) vs placebo/no treatment (all multiparae, without previous caesarean section), Outcome 5 Uterine rupture.

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Analysis 15.6

Comparison 15 (1.19) PGE2 (all regimens) vs placebo/no treatment (all multiparae, without previous caesarean section), Outcome 6 Epidural analgesia.

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Analysis 15.7

Comparison 15 (1.19) PGE2 (all regimens) vs placebo/no treatment (all multiparae, without previous caesarean section), Outcome 7 Oxytocin augmentation.

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Analysis 15.8

Comparison 15 (1.19) PGE2 (all regimens) vs placebo/no treatment (all multiparae, without previous caesarean section), Outcome 8 Uterine hyperstimulation without FHR changes.

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Analysis 15.11

Comparison 15 (1.19) PGE2 (all regimens) vs placebo/no treatment (all multiparae, without previous caesarean section), Outcome 11 Instrumental vaginal delivery.

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Analysis 15.12

Comparison 15 (1.19) PGE2 (all regimens) vs placebo/no treatment (all multiparae, without previous caesarean section), Outcome 12 Meconium‐stained liquor.

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Analysis 15.16

Comparison 15 (1.19) PGE2 (all regimens) vs placebo/no treatment (all multiparae, without previous caesarean section), Outcome 16 Perinatal death.

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Analysis 15.18

Comparison 15 (1.19) PGE2 (all regimens) vs placebo/no treatment (all multiparae, without previous caesarean section), Outcome 18 Maternal side‐effects (all).

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Analysis 15.20

Comparison 15 (1.19) PGE2 (all regimens) vs placebo/no treatment (all multiparae, without previous caesarean section), Outcome 20 Vomitting (maternal).

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Analysis 15.21

Comparison 15 (1.19) PGE2 (all regimens) vs placebo/no treatment (all multiparae, without previous caesarean section), Outcome 21 Diarrhoea (maternal).

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Analysis 15.23

Comparison 15 (1.19) PGE2 (all regimens) vs placebo/no treatment (all multiparae, without previous caesarean section), Outcome 23 Postpartum haemorrhage.

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Analysis 16.2

Comparison 16 (1.20) PGE2 (all regimens) vs placebo/no treatment (all multiparae, unfavourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 16.3

Comparison 16 (1.20) PGE2 (all regimens) vs placebo/no treatment (all multiparae, unfavourable cervix), Outcome 3 Caesarean section.

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Analysis 17.1

Comparison 17 (1.21) PGE2 (all regimens) vs placebo/no treatment (all multiparae, favourable cervix), Outcome 1 Vaginal delivery not achieved within 24 hours.

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Analysis 17.3

Comparison 17 (1.21) PGE2 (all regimens) vs placebo/no treatment (all multiparae, favourable cervix), Outcome 3 Caesarean section.

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Analysis 17.7

Comparison 17 (1.21) PGE2 (all regimens) vs placebo/no treatment (all multiparae, favourable cervix), Outcome 7 Oxytocin augmentation.

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Analysis 18.2

Comparison 18 (1.23) PGE2 (all regimens) vs placebo/no treatment (all multiparae, intact membranes, unfavourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 18.3

Comparison 18 (1.23) PGE2 (all regimens) vs placebo/no treatment (all multiparae, intact membranes, unfavourable cervix), Outcome 3 Caesarean section.

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Analysis 19.1

Comparison 19 (1.24) PGE2 (all regimens) vs placebo/no treatment (all multiparae, intact membranes, favourable cervix), Outcome 1 Vaginal delivery not achieved within 24 hours.

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Analysis 19.3

Comparison 19 (1.24) PGE2 (all regimens) vs placebo/no treatment (all multiparae, intact membranes, favourable cervix), Outcome 3 Caesarean section.

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Analysis 20.3

Comparison 20 (1.25) PGE2 (all regimens) vs placebo/no treatment (all multi., ruptured membranes, variable/undefined cervix), Outcome 3 Caesarean section.

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Analysis 20.4

Comparison 20 (1.25) PGE2 (all regimens) vs placebo/no treatment (all multi., ruptured membranes, variable/undefined cervix), Outcome 4 Serious neonatal morbidity or perinatal death.

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Analysis 20.8

Comparison 20 (1.25) PGE2 (all regimens) vs placebo/no treatment (all multi., ruptured membranes, variable/undefined cervix), Outcome 8 Uterine hyperstimulation without FHR changes.

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Analysis 20.9

Comparison 20 (1.25) PGE2 (all regimens) vs placebo/no treatment (all multi., ruptured membranes, variable/undefined cervix), Outcome 9 Uterine rupture.

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Analysis 20.10

Comparison 20 (1.25) PGE2 (all regimens) vs placebo/no treatment (all multi., ruptured membranes, variable/undefined cervix), Outcome 10 Epidural analgesia.

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Analysis 20.11

Comparison 20 (1.25) PGE2 (all regimens) vs placebo/no treatment (all multi., ruptured membranes, variable/undefined cervix), Outcome 11 Instrumental vaginal delivery.

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Analysis 20.12

Comparison 20 (1.25) PGE2 (all regimens) vs placebo/no treatment (all multi., ruptured membranes, variable/undefined cervix), Outcome 12 Meconium‐stained liquor.

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Analysis 20.16

Comparison 20 (1.25) PGE2 (all regimens) vs placebo/no treatment (all multi., ruptured membranes, variable/undefined cervix), Outcome 16 Perinatal death.

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Analysis 20.18

Comparison 20 (1.25) PGE2 (all regimens) vs placebo/no treatment (all multi., ruptured membranes, variable/undefined cervix), Outcome 18 Maternal side‐effects (all).

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Analysis 20.20

Comparison 20 (1.25) PGE2 (all regimens) vs placebo/no treatment (all multi., ruptured membranes, variable/undefined cervix), Outcome 20 Vomitting (maternal).

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Analysis 20.21

Comparison 20 (1.25) PGE2 (all regimens) vs placebo/no treatment (all multi., ruptured membranes, variable/undefined cervix), Outcome 21 Diarrhoea (maternal).

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Analysis 20.23

Comparison 20 (1.25) PGE2 (all regimens) vs placebo/no treatment (all multi., ruptured membranes, variable/undefined cervix), Outcome 23 Postpartum haemorrhage.

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Analysis 22.2

Comparison 22 (2.1) PGF2a vs placebo (all women), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 22.3

Comparison 22 (2.1) PGF2a vs placebo (all women), Outcome 3 Caesarean section.

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Analysis 22.6

Comparison 22 (2.1) PGF2a vs placebo (all women), Outcome 6 Cervix unfavourable/unchanged after 12 to 24 hours.

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Analysis 22.7

Comparison 22 (2.1) PGF2a vs placebo (all women), Outcome 7 Oxytocin augmentation.

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Analysis 22.10

Comparison 22 (2.1) PGF2a vs placebo (all women), Outcome 10 Epidural analgesia.

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Analysis 22.11

Comparison 22 (2.1) PGF2a vs placebo (all women), Outcome 11 Instrumental vaginal delivery.

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Analysis 23.2

Comparison 23 (2.2) PGF2a vs placebo (all women, unfavourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 23.3

Comparison 23 (2.2) PGF2a vs placebo (all women, unfavourable cervix), Outcome 3 Caesarean section.

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Analysis 23.7

Comparison 23 (2.2) PGF2a vs placebo (all women, unfavourable cervix), Outcome 7 Oxytocin augmentation.

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Analysis 23.10

Comparison 23 (2.2) PGF2a vs placebo (all women, unfavourable cervix), Outcome 10 Epidural analgesia.

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Analysis 24.2

Comparison 24 (2.10) PGF2a vs placebo (all primiparae), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 24.3

Comparison 24 (2.10) PGF2a vs placebo (all primiparae), Outcome 3 Caesarean section.

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Analysis 24.7

Comparison 24 (2.10) PGF2a vs placebo (all primiparae), Outcome 7 Oxytocin augmentation.

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Analysis 24.10

Comparison 24 (2.10) PGF2a vs placebo (all primiparae), Outcome 10 Epidural analgesia.

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Analysis 25.2

Comparison 25 (2.11) PGF2a vs placebo (all primiparae, unfavourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 25.3

Comparison 25 (2.11) PGF2a vs placebo (all primiparae, unfavourable cervix), Outcome 3 Caesarean section.

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Analysis 25.7

Comparison 25 (2.11) PGF2a vs placebo (all primiparae, unfavourable cervix), Outcome 7 Oxytocin augmentation.

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Analysis 25.10

Comparison 25 (2.11) PGF2a vs placebo (all primiparae, unfavourable cervix), Outcome 10 Epidural analgesia.

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Analysis 26.1

Comparison 26 (3.1) PGF2a vs PGE2 (all women), Outcome 1 Vaginal delivery not achieved within 24 hours.

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Analysis 26.2

Comparison 26 (3.1) PGF2a vs PGE2 (all women), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 26.3

Comparison 26 (3.1) PGF2a vs PGE2 (all women), Outcome 3 Caesarean section.

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Analysis 26.7

Comparison 26 (3.1) PGF2a vs PGE2 (all women), Outcome 7 Oxytocin augmentation.

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Analysis 26.10

Comparison 26 (3.1) PGF2a vs PGE2 (all women), Outcome 10 Epidural analgesia.

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Analysis 26.13

Comparison 26 (3.1) PGF2a vs PGE2 (all women), Outcome 13 Apgar score < 7 at 5 minutes.

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Analysis 27.1

Comparison 27 (3.2) PGF2a vs PGE2 (all women, unfavourable cervix), Outcome 1 Vaginal delivery not achieved within 24 hours.

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Analysis 27.2

Comparison 27 (3.2) PGF2a vs PGE2 (all women, unfavourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 27.3

Comparison 27 (3.2) PGF2a vs PGE2 (all women, unfavourable cervix), Outcome 3 Caesarean section.

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Analysis 27.7

Comparison 27 (3.2) PGF2a vs PGE2 (all women, unfavourable cervix), Outcome 7 Oxytocin augmentation.

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Analysis 27.10

Comparison 27 (3.2) PGF2a vs PGE2 (all women, unfavourable cervix), Outcome 10 Epidural analgesia.

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Analysis 27.13

Comparison 27 (3.2) PGF2a vs PGE2 (all women, unfavourable cervix), Outcome 13 Apgar score < 7 at 5 minutes.

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Analysis 28.2

Comparison 28 (3.10) PGF2a vs PGE2 (all primiparae), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 28.3

Comparison 28 (3.10) PGF2a vs PGE2 (all primiparae), Outcome 3 Caesarean section.

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Analysis 28.7

Comparison 28 (3.10) PGF2a vs PGE2 (all primiparae), Outcome 7 Oxytocin augmentation.

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Analysis 28.10

Comparison 28 (3.10) PGF2a vs PGE2 (all primiparae), Outcome 10 Epidural analgesia.

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Analysis 29.2

Comparison 29 (3.11) PGF2a vs PGE2 (all primiparae, unfavourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 29.3

Comparison 29 (3.11) PGF2a vs PGE2 (all primiparae, unfavourable cervix), Outcome 3 Caesarean section.

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Analysis 29.7

Comparison 29 (3.11) PGF2a vs PGE2 (all primiparae, unfavourable cervix), Outcome 7 Oxytocin augmentation.

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Analysis 29.10

Comparison 29 (3.11) PGF2a vs PGE2 (all primiparae, unfavourable cervix), Outcome 10 Epidural analgesia.

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Analysis 31.1

Comparison 31 (4.1) PGE2 gel vs PGE2 tablet (all women), Outcome 1 Vaginal delivery not achieved within 24 hours.

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Analysis 31.2

Comparison 31 (4.1) PGE2 gel vs PGE2 tablet (all women), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 31.3

Comparison 31 (4.1) PGE2 gel vs PGE2 tablet (all women), Outcome 3 Caesarean section.

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Analysis 31.5

Comparison 31 (4.1) PGE2 gel vs PGE2 tablet (all women), Outcome 5 Serious maternal morbidity or death.

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Analysis 31.6

Comparison 31 (4.1) PGE2 gel vs PGE2 tablet (all women), Outcome 6 Cervix unfavourable/unchanged after 12 to 24 hours.

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Analysis 31.7

Comparison 31 (4.1) PGE2 gel vs PGE2 tablet (all women), Outcome 7 Oxytocin augmentation.

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Analysis 31.10

Comparison 31 (4.1) PGE2 gel vs PGE2 tablet (all women), Outcome 10 Epidural analgesia.

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Analysis 31.11

Comparison 31 (4.1) PGE2 gel vs PGE2 tablet (all women), Outcome 11 Instrumental vaginal delivery.

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Analysis 31.13

Comparison 31 (4.1) PGE2 gel vs PGE2 tablet (all women), Outcome 13 Apgar score < 7 at 5 minutes.

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Analysis 31.23

Comparison 31 (4.1) PGE2 gel vs PGE2 tablet (all women), Outcome 23 Postpartum haemorrhage.

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Analysis 33.1

Comparison 33 (4.2) PGE2 gel vs PGE2 tablet (all women, unfavourable cervix), Outcome 1 Vaginal delivery not achieved within 24 hours.

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Analysis 33.2

Comparison 33 (4.2) PGE2 gel vs PGE2 tablet (all women, unfavourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 33.3

Comparison 33 (4.2) PGE2 gel vs PGE2 tablet (all women, unfavourable cervix), Outcome 3 Caesarean section.

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Analysis 33.5

Comparison 33 (4.2) PGE2 gel vs PGE2 tablet (all women, unfavourable cervix), Outcome 5 Serious maternal morbidity or death.

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Analysis 33.6

Comparison 33 (4.2) PGE2 gel vs PGE2 tablet (all women, unfavourable cervix), Outcome 6 Cervix unfavourable/unchanged after 12 to 24 hours.

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Analysis 33.7

Comparison 33 (4.2) PGE2 gel vs PGE2 tablet (all women, unfavourable cervix), Outcome 7 Oxytocin augmentation.

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Analysis 33.10

Comparison 33 (4.2) PGE2 gel vs PGE2 tablet (all women, unfavourable cervix), Outcome 10 Epidural analgesia.

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Analysis 33.11

Comparison 33 (4.2) PGE2 gel vs PGE2 tablet (all women, unfavourable cervix), Outcome 11 Instrumental vaginal delivery.

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Analysis 33.13

Comparison 33 (4.2) PGE2 gel vs PGE2 tablet (all women, unfavourable cervix), Outcome 13 Apgar score < 7 at 5 minutes.

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Analysis 33.23

Comparison 33 (4.2) PGE2 gel vs PGE2 tablet (all women, unfavourable cervix), Outcome 23 Postpartum haemorrhage.

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Analysis 34.1

Comparison 34 (4.3) PGE2 gel vs PGE2 tablet (all women, favourable cervix), Outcome 1 Vaginal delivery not achieved within 24 hours.

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Analysis 34.2

Comparison 34 (4.3) PGE2 gel vs PGE2 tablet (all women, favourable cervix), Outcome 2 Caesarean section.

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Analysis 34.7

Comparison 34 (4.3) PGE2 gel vs PGE2 tablet (all women, favourable cervix), Outcome 7 Oxytocin augmentation.

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Analysis 34.13

Comparison 34 (4.3) PGE2 gel vs PGE2 tablet (all women, favourable cervix), Outcome 13 Apgar score < 7 at 5 minutes.

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Analysis 35.3

Comparison 35 (4.4) PGE2 gel vs PGE2 tablet (all women, intact membranes, variable or undefined cervix), Outcome 3 Caesarean section.

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Analysis 35.7

Comparison 35 (4.4) PGE2 gel vs PGE2 tablet (all women, intact membranes, variable or undefined cervix), Outcome 7 Oxytocin augmentation.

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Analysis 35.10

Comparison 35 (4.4) PGE2 gel vs PGE2 tablet (all women, intact membranes, variable or undefined cervix), Outcome 10 Epidural analgesia.

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Analysis 35.11

Comparison 35 (4.4) PGE2 gel vs PGE2 tablet (all women, intact membranes, variable or undefined cervix), Outcome 11 Instrumental vaginal delivery.

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Analysis 35.23

Comparison 35 (4.4) PGE2 gel vs PGE2 tablet (all women, intact membranes, variable or undefined cervix), Outcome 23 Postpartum haemorrhage.

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Analysis 36.1

Comparison 36 (4.5) PGE2 gel vs PGE2 tablet (all women, intact membranes, unfavourable cervix), Outcome 1 Vaginal delivery not achieved within 24 hours.

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Analysis 36.2

Comparison 36 (4.5) PGE2 gel vs PGE2 tablet (all women, intact membranes, unfavourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 36.3

Comparison 36 (4.5) PGE2 gel vs PGE2 tablet (all women, intact membranes, unfavourable cervix), Outcome 3 Caesarean section.

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Analysis 36.5

Comparison 36 (4.5) PGE2 gel vs PGE2 tablet (all women, intact membranes, unfavourable cervix), Outcome 5 Serious maternal morbidity or death.

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Analysis 36.6

Comparison 36 (4.5) PGE2 gel vs PGE2 tablet (all women, intact membranes, unfavourable cervix), Outcome 6 Cervix unfavourable/unchanged after 12 to 24 hours.

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Analysis 36.7

Comparison 36 (4.5) PGE2 gel vs PGE2 tablet (all women, intact membranes, unfavourable cervix), Outcome 7 Oxytocin augmentation.

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Analysis 36.10

Comparison 36 (4.5) PGE2 gel vs PGE2 tablet (all women, intact membranes, unfavourable cervix), Outcome 10 Epidural analgesia.

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Analysis 36.11

Comparison 36 (4.5) PGE2 gel vs PGE2 tablet (all women, intact membranes, unfavourable cervix), Outcome 11 Instrumental vaginal delivery.

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Analysis 37.1

Comparison 37 (4.10) PGE2 gel vs PGE2 tablet (all primiparae), Outcome 1 Vaginal delivery not achieved within 24 hours.

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Analysis 37.2

Comparison 37 (4.10) PGE2 gel vs PGE2 tablet (all primiparae), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 37.3

Comparison 37 (4.10) PGE2 gel vs PGE2 tablet (all primiparae), Outcome 3 Caesarean section.

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Analysis 37.5

Comparison 37 (4.10) PGE2 gel vs PGE2 tablet (all primiparae), Outcome 5 Serious maternal morbidity or death.

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Analysis 37.6

Comparison 37 (4.10) PGE2 gel vs PGE2 tablet (all primiparae), Outcome 6 Cervix unfavourable/unchanged after 12 to 24 hours.

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Analysis 37.7

Comparison 37 (4.10) PGE2 gel vs PGE2 tablet (all primiparae), Outcome 7 Oxytocin augmentation.

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Analysis 37.10

Comparison 37 (4.10) PGE2 gel vs PGE2 tablet (all primiparae), Outcome 10 Epidural analgesia.

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Analysis 37.11

Comparison 37 (4.10) PGE2 gel vs PGE2 tablet (all primiparae), Outcome 11 Instrumental vaginal delivery.

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Analysis 37.13

Comparison 37 (4.10) PGE2 gel vs PGE2 tablet (all primiparae), Outcome 13 Apgar score < 7 at 5 minutes.

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Analysis 37.23

Comparison 37 (4.10) PGE2 gel vs PGE2 tablet (all primiparae), Outcome 23 Postpartum haemorrhage.

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Analysis 38.1

Comparison 38 (4.11) PGE2 gel vs PGE2 tablet (all primiparae, unfavourable cervix), Outcome 1 Vaginal delivery not achieved within 24 hours.

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Analysis 38.2

Comparison 38 (4.11) PGE2 gel vs PGE2 tablet (all primiparae, unfavourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 38.3

Comparison 38 (4.11) PGE2 gel vs PGE2 tablet (all primiparae, unfavourable cervix), Outcome 3 Caesarean section.

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Analysis 38.5

Comparison 38 (4.11) PGE2 gel vs PGE2 tablet (all primiparae, unfavourable cervix), Outcome 5 Serious maternal morbidity or death.

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Analysis 38.6

Comparison 38 (4.11) PGE2 gel vs PGE2 tablet (all primiparae, unfavourable cervix), Outcome 6 Cervix unfavourable/unchanged after 12 to 24 hours.

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Analysis 38.7

Comparison 38 (4.11) PGE2 gel vs PGE2 tablet (all primiparae, unfavourable cervix), Outcome 7 Oxytocin augmentation.

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Analysis 38.10

Comparison 38 (4.11) PGE2 gel vs PGE2 tablet (all primiparae, unfavourable cervix), Outcome 10 Epidural analgesia.

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Analysis 38.11

Comparison 38 (4.11) PGE2 gel vs PGE2 tablet (all primiparae, unfavourable cervix), Outcome 11 Instrumental vaginal delivery.

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Analysis 38.13

Comparison 38 (4.11) PGE2 gel vs PGE2 tablet (all primiparae, unfavourable cervix), Outcome 13 Apgar score < 7 at 5 minutes.

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Analysis 38.23

Comparison 38 (4.11) PGE2 gel vs PGE2 tablet (all primiparae, unfavourable cervix), Outcome 23 Postpartum haemorrhage.

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Analysis 39.1

Comparison 39 (4.14) PGE2 gel vs PGE2 tablet (all primiparae, intact membranes, unfavourable cervix), Outcome 1 Vaginal delivery not achieved within 24 hours.

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Analysis 39.2

Comparison 39 (4.14) PGE2 gel vs PGE2 tablet (all primiparae, intact membranes, unfavourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 39.3

Comparison 39 (4.14) PGE2 gel vs PGE2 tablet (all primiparae, intact membranes, unfavourable cervix), Outcome 3 Caesarean section.

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Analysis 39.5

Comparison 39 (4.14) PGE2 gel vs PGE2 tablet (all primiparae, intact membranes, unfavourable cervix), Outcome 5 Serious maternal morbidity or death.

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Analysis 39.6

Comparison 39 (4.14) PGE2 gel vs PGE2 tablet (all primiparae, intact membranes, unfavourable cervix), Outcome 6 Cervix unfavourable/unchanged after 12 to 24 hours.

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Analysis 39.7

Comparison 39 (4.14) PGE2 gel vs PGE2 tablet (all primiparae, intact membranes, unfavourable cervix), Outcome 7 Oxytocin augmentation.

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Analysis 39.10

Comparison 39 (4.14) PGE2 gel vs PGE2 tablet (all primiparae, intact membranes, unfavourable cervix), Outcome 10 Epidural analgesia.

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Analysis 39.11

Comparison 39 (4.14) PGE2 gel vs PGE2 tablet (all primiparae, intact membranes, unfavourable cervix), Outcome 11 Instrumental vaginal delivery.

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Analysis 40.2

Comparison 40 (5.1) PGE2 gel vs PGE2 suppository/pessary (all women), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 40.3

Comparison 40 (5.1) PGE2 gel vs PGE2 suppository/pessary (all women), Outcome 3 Caesarean section.

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Analysis 40.8

Comparison 40 (5.1) PGE2 gel vs PGE2 suppository/pessary (all women), Outcome 8 Uterine hyperstimulation without FHR changes.

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Analysis 40.13

Comparison 40 (5.1) PGE2 gel vs PGE2 suppository/pessary (all women), Outcome 13 Apgar score < 7 at 5 minutes.

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Analysis 40.18

Comparison 40 (5.1) PGE2 gel vs PGE2 suppository/pessary (all women), Outcome 18 Maternal side‐effects (all).

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Analysis 40.19

Comparison 40 (5.1) PGE2 gel vs PGE2 suppository/pessary (all women), Outcome 19 Nausea (maternal).

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Analysis 40.20

Comparison 40 (5.1) PGE2 gel vs PGE2 suppository/pessary (all women), Outcome 20 Vomitting (maternal).

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Analysis 40.21

Comparison 40 (5.1) PGE2 gel vs PGE2 suppository/pessary (all women), Outcome 21 Diarrhoea (maternal).

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Analysis 40.22

Comparison 40 (5.1) PGE2 gel vs PGE2 suppository/pessary (all women), Outcome 22 Other maternal side‐effects.

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Analysis 41.2

Comparison 41 (5.2) PGE2 gel vs PGE2 suppository/pessary (all women, unfavourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 41.3

Comparison 41 (5.2) PGE2 gel vs PGE2 suppository/pessary (all women, unfavourable cervix), Outcome 3 Caesarean section.

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Analysis 41.8

Comparison 41 (5.2) PGE2 gel vs PGE2 suppository/pessary (all women, unfavourable cervix), Outcome 8 Uterine hyperstimulation without FHR changes.

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Analysis 41.13

Comparison 41 (5.2) PGE2 gel vs PGE2 suppository/pessary (all women, unfavourable cervix), Outcome 13 Apgar score < 7 at 5 minutes.

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Analysis 41.18

Comparison 41 (5.2) PGE2 gel vs PGE2 suppository/pessary (all women, unfavourable cervix), Outcome 18 Maternal side‐effects (all).

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Analysis 41.19

Comparison 41 (5.2) PGE2 gel vs PGE2 suppository/pessary (all women, unfavourable cervix), Outcome 19 Nausea (maternal).

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Analysis 41.20

Comparison 41 (5.2) PGE2 gel vs PGE2 suppository/pessary (all women, unfavourable cervix), Outcome 20 Vomitting (maternal).

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Analysis 41.21

Comparison 41 (5.2) PGE2 gel vs PGE2 suppository/pessary (all women, unfavourable cervix), Outcome 21 Diarrhoea (maternal).

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Analysis 41.22

Comparison 41 (5.2) PGE2 gel vs PGE2 suppository/pessary (all women, unfavourable cervix), Outcome 22 Other maternal side‐effects.

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Analysis 42.2

Comparison 42 (5.5) PGE2 gel vs PGE2 suppository/pessary (all women, intact membranes, unfavourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 42.3

Comparison 42 (5.5) PGE2 gel vs PGE2 suppository/pessary (all women, intact membranes, unfavourable cervix), Outcome 3 Caesarean section.

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Analysis 42.8

Comparison 42 (5.5) PGE2 gel vs PGE2 suppository/pessary (all women, intact membranes, unfavourable cervix), Outcome 8 Uterine hyperstimulation without FHR changes.

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Analysis 42.13

Comparison 42 (5.5) PGE2 gel vs PGE2 suppository/pessary (all women, intact membranes, unfavourable cervix), Outcome 13 Apgar score < 7 at 5 minutes.

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Analysis 42.18

Comparison 42 (5.5) PGE2 gel vs PGE2 suppository/pessary (all women, intact membranes, unfavourable cervix), Outcome 18 Maternal side‐effects (all).

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Analysis 42.19

Comparison 42 (5.5) PGE2 gel vs PGE2 suppository/pessary (all women, intact membranes, unfavourable cervix), Outcome 19 Nausea (maternal).

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Analysis 42.20

Comparison 42 (5.5) PGE2 gel vs PGE2 suppository/pessary (all women, intact membranes, unfavourable cervix), Outcome 20 Vomitting (maternal).

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Analysis 42.21

Comparison 42 (5.5) PGE2 gel vs PGE2 suppository/pessary (all women, intact membranes, unfavourable cervix), Outcome 21 Diarrhoea (maternal).

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Analysis 42.22

Comparison 42 (5.5) PGE2 gel vs PGE2 suppository/pessary (all women, intact membranes, unfavourable cervix), Outcome 22 Other maternal side‐effects.

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Analysis 43.3

Comparison 43 (6.1) PGE2 tablet vs PGE2 pessary/suppository (all women), Outcome 3 Caesarean section.

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Analysis 43.7

Comparison 43 (6.1) PGE2 tablet vs PGE2 pessary/suppository (all women), Outcome 7 Oxytocin augmentation.

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Analysis 43.8

Comparison 43 (6.1) PGE2 tablet vs PGE2 pessary/suppository (all women), Outcome 8 Uterine hyperstimulation without FHR changes.

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Analysis 43.10

Comparison 43 (6.1) PGE2 tablet vs PGE2 pessary/suppository (all women), Outcome 10 Epidural analgesia.

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Analysis 43.11

Comparison 43 (6.1) PGE2 tablet vs PGE2 pessary/suppository (all women), Outcome 11 Instrumental vaginal delivery.

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Analysis 43.13

Comparison 43 (6.1) PGE2 tablet vs PGE2 pessary/suppository (all women), Outcome 13 Apgar score < 7 at 5 minutes.

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Analysis 43.18

Comparison 43 (6.1) PGE2 tablet vs PGE2 pessary/suppository (all women), Outcome 18 Maternal side‐effects (all).

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Analysis 43.20

Comparison 43 (6.1) PGE2 tablet vs PGE2 pessary/suppository (all women), Outcome 20 Vomitting (maternal).

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Analysis 43.21

Comparison 43 (6.1) PGE2 tablet vs PGE2 pessary/suppository (all women), Outcome 21 Diarrhoea (maternal).

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Analysis 43.23

Comparison 43 (6.1) PGE2 tablet vs PGE2 pessary/suppository (all women), Outcome 23 Postpartum haemorrhage.

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Analysis 44.3

Comparison 44 (6.2) PGE2 tablet vs PGE2 pessary/suppository (all women, unfavourable cervix), Outcome 3 Caesarean section.

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Analysis 44.7

Comparison 44 (6.2) PGE2 tablet vs PGE2 pessary/suppository (all women, unfavourable cervix), Outcome 7 Oxytocin augmentation.

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Analysis 44.8

Comparison 44 (6.2) PGE2 tablet vs PGE2 pessary/suppository (all women, unfavourable cervix), Outcome 8 Uterine hyperstimulation without FHR changes.

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Analysis 44.11

Comparison 44 (6.2) PGE2 tablet vs PGE2 pessary/suppository (all women, unfavourable cervix), Outcome 11 Instrumental vaginal delivery.

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Analysis 44.13

Comparison 44 (6.2) PGE2 tablet vs PGE2 pessary/suppository (all women, unfavourable cervix), Outcome 13 Apgar score < 7 at 5 minutes.

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Analysis 44.18

Comparison 44 (6.2) PGE2 tablet vs PGE2 pessary/suppository (all women, unfavourable cervix), Outcome 18 Maternal side‐effects (all).

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Analysis 44.20

Comparison 44 (6.2) PGE2 tablet vs PGE2 pessary/suppository (all women, unfavourable cervix), Outcome 20 Vomitting (maternal).

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Analysis 44.21

Comparison 44 (6.2) PGE2 tablet vs PGE2 pessary/suppository (all women, unfavourable cervix), Outcome 21 Diarrhoea (maternal).

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Analysis 45.3

Comparison 45 (6.10) PGE2 tablet vs PGE2 pessary/suppository (all primiparae), Outcome 3 Caesarean section.

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Analysis 45.7

Comparison 45 (6.10) PGE2 tablet vs PGE2 pessary/suppository (all primiparae), Outcome 7 Oxytocin augmentation.

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Analysis 46.3

Comparison 46 (6.19) PGE2 tablet vs PGE2 pessary/suppository (all multiparae), Outcome 3 Caesarean section.

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Analysis 46.7

Comparison 46 (6.19) PGE2 tablet vs PGE2 pessary/suppository (all multiparae), Outcome 7 Oxytocin augmentation.

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Analysis 47.1

Comparison 47 (7.1) PGE2 (controlled release) vs all PGE2 delivery systems (all women), Outcome 1 Vaginal delivery not achieved within 24 hours.

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Analysis 47.2

Comparison 47 (7.1) PGE2 (controlled release) vs all PGE2 delivery systems (all women), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 47.3

Comparison 47 (7.1) PGE2 (controlled release) vs all PGE2 delivery systems (all women), Outcome 3 Caesarean section.

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Analysis 47.4

Comparison 47 (7.1) PGE2 (controlled release) vs all PGE2 delivery systems (all women), Outcome 4 Serious neonatal morbidity or perinatal death.

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Analysis 47.5

Comparison 47 (7.1) PGE2 (controlled release) vs all PGE2 delivery systems (all women), Outcome 5 Serious maternal morbidity or death.

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Analysis 47.7

Comparison 47 (7.1) PGE2 (controlled release) vs all PGE2 delivery systems (all women), Outcome 7 Oxytocin augmentation.

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Analysis 47.8

Comparison 47 (7.1) PGE2 (controlled release) vs all PGE2 delivery systems (all women), Outcome 8 Uterine hyperstimulation without FHR changes.

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Analysis 47.9

Comparison 47 (7.1) PGE2 (controlled release) vs all PGE2 delivery systems (all women), Outcome 9 Uterine rupture.

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Analysis 47.10

Comparison 47 (7.1) PGE2 (controlled release) vs all PGE2 delivery systems (all women), Outcome 10 Epidural analgesia.

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Analysis 47.11

Comparison 47 (7.1) PGE2 (controlled release) vs all PGE2 delivery systems (all women), Outcome 11 Instrumental vaginal delivery.

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Analysis 47.13

Comparison 47 (7.1) PGE2 (controlled release) vs all PGE2 delivery systems (all women), Outcome 13 Apgar score < 7 at 5 minutes.

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Analysis 47.20

Comparison 47 (7.1) PGE2 (controlled release) vs all PGE2 delivery systems (all women), Outcome 20 Vomitting (maternal).

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Analysis 47.21

Comparison 47 (7.1) PGE2 (controlled release) vs all PGE2 delivery systems (all women), Outcome 21 Diarrhoea (maternal).

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Analysis 48.2

Comparison 48 (7.2) PGE2 (controlled release) vs all PGE2 delivery systems (all women, unfavourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 48.3

Comparison 48 (7.2) PGE2 (controlled release) vs all PGE2 delivery systems (all women, unfavourable cervix), Outcome 3 Caesarean section.

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Analysis 48.4

Comparison 48 (7.2) PGE2 (controlled release) vs all PGE2 delivery systems (all women, unfavourable cervix), Outcome 4 Serious neonatal morbidity or perinatal death.

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Analysis 48.5

Comparison 48 (7.2) PGE2 (controlled release) vs all PGE2 delivery systems (all women, unfavourable cervix), Outcome 5 Serious maternal morbidity or death.

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Analysis 48.7

Comparison 48 (7.2) PGE2 (controlled release) vs all PGE2 delivery systems (all women, unfavourable cervix), Outcome 7 Oxytocin augmentation.

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Analysis 48.8

Comparison 48 (7.2) PGE2 (controlled release) vs all PGE2 delivery systems (all women, unfavourable cervix), Outcome 8 Uterine hyperstimulation without FHR changes.

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Analysis 48.10

Comparison 48 (7.2) PGE2 (controlled release) vs all PGE2 delivery systems (all women, unfavourable cervix), Outcome 10 Epidural analgesia.

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Analysis 48.11

Comparison 48 (7.2) PGE2 (controlled release) vs all PGE2 delivery systems (all women, unfavourable cervix), Outcome 11 Instrumental vaginal delivery.

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Analysis 48.13

Comparison 48 (7.2) PGE2 (controlled release) vs all PGE2 delivery systems (all women, unfavourable cervix), Outcome 13 Apgar score < 7 at 5 minutes.

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Analysis 49.3

Comparison 49 (7.1) PGE2 (controlled release) vs all PGE2 delivery systems (all women, intact, variable cervix), Outcome 3 Caesarean section.

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Analysis 49.10

Comparison 49 (7.1) PGE2 (controlled release) vs all PGE2 delivery systems (all women, intact, variable cervix), Outcome 10 Epidural analgesia.

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Analysis 49.11

Comparison 49 (7.1) PGE2 (controlled release) vs all PGE2 delivery systems (all women, intact, variable cervix), Outcome 11 Instrumental vaginal delivery.

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Analysis 50.2

Comparison 50 (7.5) PGE2 (controlled release) vs all PGE2 delivery systems (all women, intact membranes, unfav. cervix), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 50.3

Comparison 50 (7.5) PGE2 (controlled release) vs all PGE2 delivery systems (all women, intact membranes, unfav. cervix), Outcome 3 Caesarean section.

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Analysis 50.4

Comparison 50 (7.5) PGE2 (controlled release) vs all PGE2 delivery systems (all women, intact membranes, unfav. cervix), Outcome 4 Serious neonatal morbidity or perinatal death.

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Analysis 50.5

Comparison 50 (7.5) PGE2 (controlled release) vs all PGE2 delivery systems (all women, intact membranes, unfav. cervix), Outcome 5 Serious maternal morbidity or death.

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Analysis 50.7

Comparison 50 (7.5) PGE2 (controlled release) vs all PGE2 delivery systems (all women, intact membranes, unfav. cervix), Outcome 7 Oxytocin augmentation.

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Analysis 50.8

Comparison 50 (7.5) PGE2 (controlled release) vs all PGE2 delivery systems (all women, intact membranes, unfav. cervix), Outcome 8 Uterine hyperstimulation without FHR changes.

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Analysis 50.11

Comparison 50 (7.5) PGE2 (controlled release) vs all PGE2 delivery systems (all women, intact membranes, unfav. cervix), Outcome 11 Instrumental vaginal delivery.

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Analysis 51.2

Comparison 51 (7.10) PGE2 (controlled release) vs all PGE2 delivery systems (all primiparae), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 51.3

Comparison 51 (7.10) PGE2 (controlled release) vs all PGE2 delivery systems (all primiparae), Outcome 3 Caesarean section.

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Analysis 51.7

Comparison 51 (7.10) PGE2 (controlled release) vs all PGE2 delivery systems (all primiparae), Outcome 7 Oxytocin augmentation.

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Analysis 51.8

Comparison 51 (7.10) PGE2 (controlled release) vs all PGE2 delivery systems (all primiparae), Outcome 8 Uterine hyperstimulation without FHR changes.

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Analysis 51.10

Comparison 51 (7.10) PGE2 (controlled release) vs all PGE2 delivery systems (all primiparae), Outcome 10 Epidural analgesia.

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Analysis 51.11

Comparison 51 (7.10) PGE2 (controlled release) vs all PGE2 delivery systems (all primiparae), Outcome 11 Instrumental vaginal delivery.

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Analysis 52.2

Comparison 52 (7.11) PGE2 (controlled release) vs all PGE2 delivery systems (all primiparae, unfavourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 52.3

Comparison 52 (7.11) PGE2 (controlled release) vs all PGE2 delivery systems (all primiparae, unfavourable cervix), Outcome 3 Caesarean section.

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Analysis 52.7

Comparison 52 (7.11) PGE2 (controlled release) vs all PGE2 delivery systems (all primiparae, unfavourable cervix), Outcome 7 Oxytocin augmentation.

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Analysis 52.8

Comparison 52 (7.11) PGE2 (controlled release) vs all PGE2 delivery systems (all primiparae, unfavourable cervix), Outcome 8 Uterine hyperstimulation without FHR changes.

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Analysis 52.10

Comparison 52 (7.11) PGE2 (controlled release) vs all PGE2 delivery systems (all primiparae, unfavourable cervix), Outcome 10 Epidural analgesia.

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Analysis 52.11

Comparison 52 (7.11) PGE2 (controlled release) vs all PGE2 delivery systems (all primiparae, unfavourable cervix), Outcome 11 Instrumental vaginal delivery.

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Analysis 53.2

Comparison 53 (7.14) PGE2 (controlled release) vs all PGE2 delivery systems (all prim., intact membranes, unfav. cervix), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 53.3

Comparison 53 (7.14) PGE2 (controlled release) vs all PGE2 delivery systems (all prim., intact membranes, unfav. cervix), Outcome 3 Caesarean section.

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Analysis 53.7

Comparison 53 (7.14) PGE2 (controlled release) vs all PGE2 delivery systems (all prim., intact membranes, unfav. cervix), Outcome 7 Oxytocin augmentation.

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Analysis 54.2

Comparison 54 (7.19) PGE2 (controlled release) vs all PGE2 delivery systems (all multiparae), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 54.3

Comparison 54 (7.19) PGE2 (controlled release) vs all PGE2 delivery systems (all multiparae), Outcome 3 Caesarean section.

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Analysis 54.7

Comparison 54 (7.19) PGE2 (controlled release) vs all PGE2 delivery systems (all multiparae), Outcome 7 Oxytocin augmentation.

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Analysis 54.11

Comparison 54 (7.19) PGE2 (controlled release) vs all PGE2 delivery systems (all multiparae), Outcome 11 Instrumental vaginal delivery.

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Analysis 55.2

Comparison 55 (7.20) PGE2 (controlled release) vs all PGE2 delivery systems (all multiparae, unfavourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 55.3

Comparison 55 (7.20) PGE2 (controlled release) vs all PGE2 delivery systems (all multiparae, unfavourable cervix), Outcome 3 Caesarean section.

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Analysis 55.7

Comparison 55 (7.20) PGE2 (controlled release) vs all PGE2 delivery systems (all multiparae, unfavourable cervix), Outcome 7 Oxytocin augmentation.

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Analysis 55.11

Comparison 55 (7.20) PGE2 (controlled release) vs all PGE2 delivery systems (all multiparae, unfavourable cervix), Outcome 11 Instrumental vaginal delivery.

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Analysis 56.2

Comparison 56 (7.23) PGE2 (controlled release) vs all PGE2 delivery systems (all multi., intact membranes, unfav. cervix), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 56.3

Comparison 56 (7.23) PGE2 (controlled release) vs all PGE2 delivery systems (all multi., intact membranes, unfav. cervix), Outcome 3 Caesarean section.

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Analysis 56.7

Comparison 56 (7.23) PGE2 (controlled release) vs all PGE2 delivery systems (all multi., intact membranes, unfav. cervix), Outcome 7 Oxytocin augmentation.

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Analysis 57.2

Comparison 57 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 57.3

Comparison 57 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 3 Caesarean section.

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Analysis 57.4

Comparison 57 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 4 Serious neonatal morbidity or perinatal death.

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Analysis 57.7

Comparison 57 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 7 Oxytocin augmentation.

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Analysis 57.8

Comparison 57 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 8 Uterine hyperstimulation without FHR changes.

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Analysis 57.10

Comparison 57 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 10 Epidural analgesia.

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Analysis 57.11

Comparison 57 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 11 Instrumental vaginal delivery.

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Analysis 57.12

Comparison 57 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 12 Meconium‐stained liquor.

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Analysis 57.13

Comparison 57 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 13 Apgar score < 7 at 5 minutes.

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Analysis 57.14

Comparison 57 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 14 Neonatal intensive care unit admission.

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Analysis 57.16

Comparison 57 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 16 Perinatal death.

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Analysis 57.18

Comparison 57 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 18 Maternal side‐effects (all).

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Analysis 57.19

Comparison 57 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 19 Nausea (maternal).

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Analysis 57.20

Comparison 57 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 20 Vomitting (maternal).

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Analysis 57.21

Comparison 57 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 21 Diarrhoea (maternal).

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Analysis 57.22

Comparison 57 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 22 Other maternal side‐effects.

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Analysis 57.23

Comparison 57 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 23 Postpartum haemorrhage.

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Analysis 58.2

Comparison 58 (8.2) PGE2 low dose vs PGE2 high dose (all women, unfavourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 58.3

Comparison 58 (8.2) PGE2 low dose vs PGE2 high dose (all women, unfavourable cervix), Outcome 3 Caesarean section.

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Analysis 58.7

Comparison 58 (8.2) PGE2 low dose vs PGE2 high dose (all women, unfavourable cervix), Outcome 7 Oxytocin augmentation.

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Analysis 58.8

Comparison 58 (8.2) PGE2 low dose vs PGE2 high dose (all women, unfavourable cervix), Outcome 8 Uterine hyperstimulation without FHR changes.

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Analysis 58.13

Comparison 58 (8.2) PGE2 low dose vs PGE2 high dose (all women, unfavourable cervix), Outcome 13 Apgar score < 7 at 5 minutes.

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Analysis 58.18

Comparison 58 (8.2) PGE2 low dose vs PGE2 high dose (all women, unfavourable cervix), Outcome 18 Maternal side‐effects (all).

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Analysis 58.19

Comparison 58 (8.2) PGE2 low dose vs PGE2 high dose (all women, unfavourable cervix), Outcome 19 Nausea (maternal).

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Analysis 58.20

Comparison 58 (8.2) PGE2 low dose vs PGE2 high dose (all women, unfavourable cervix), Outcome 20 Vomitting (maternal).

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Analysis 58.21

Comparison 58 (8.2) PGE2 low dose vs PGE2 high dose (all women, unfavourable cervix), Outcome 21 Diarrhoea (maternal).

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Analysis 58.22

Comparison 58 (8.2) PGE2 low dose vs PGE2 high dose (all women, unfavourable cervix), Outcome 22 Other maternal side‐effects.

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Analysis 59.3

Comparison 59 (8.4) PGE2 low dose vs PGE2 high dose (all women, intact membranes, variable or undefined cervix), Outcome 3 Caesarean section.

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Analysis 59.7

Comparison 59 (8.4) PGE2 low dose vs PGE2 high dose (all women, intact membranes, variable or undefined cervix), Outcome 7 Oxytocin augmentation.

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Analysis 59.10

Comparison 59 (8.4) PGE2 low dose vs PGE2 high dose (all women, intact membranes, variable or undefined cervix), Outcome 10 Epidural analgesia.

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Analysis 59.11

Comparison 59 (8.4) PGE2 low dose vs PGE2 high dose (all women, intact membranes, variable or undefined cervix), Outcome 11 Instrumental vaginal delivery.

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Analysis 59.23

Comparison 59 (8.4) PGE2 low dose vs PGE2 high dose (all women, intact membranes, variable or undefined cervix), Outcome 23 Postpartum haemorrhage.

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Analysis 60.2

Comparison 60 (8.5) PGE2 low dose vs PGE2 high dose (all women, intact membranes, unfavourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 60.3

Comparison 60 (8.5) PGE2 low dose vs PGE2 high dose (all women, intact membranes, unfavourable cervix), Outcome 3 Caesarean section.

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Analysis 60.13

Comparison 60 (8.5) PGE2 low dose vs PGE2 high dose (all women, intact membranes, unfavourable cervix), Outcome 13 Apgar score < 7 at 5 minutes.

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Analysis 60.18

Comparison 60 (8.5) PGE2 low dose vs PGE2 high dose (all women, intact membranes, unfavourable cervix), Outcome 18 Maternal side‐effects (all).

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Analysis 60.19

Comparison 60 (8.5) PGE2 low dose vs PGE2 high dose (all women, intact membranes, unfavourable cervix), Outcome 19 Nausea (maternal).

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Analysis 60.20

Comparison 60 (8.5) PGE2 low dose vs PGE2 high dose (all women, intact membranes, unfavourable cervix), Outcome 20 Vomitting (maternal).

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Analysis 60.21

Comparison 60 (8.5) PGE2 low dose vs PGE2 high dose (all women, intact membranes, unfavourable cervix), Outcome 21 Diarrhoea (maternal).

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Analysis 60.22

Comparison 60 (8.5) PGE2 low dose vs PGE2 high dose (all women, intact membranes, unfavourable cervix), Outcome 22 Other maternal side‐effects.

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Analysis 61.3

Comparison 61 (8.10) PGE2 low dose vs PGE2 high dose (all primiparae), Outcome 3 Caesarean section.

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Analysis 61.4

Comparison 61 (8.10) PGE2 low dose vs PGE2 high dose (all primiparae), Outcome 4 Serious neonatal morbidity or perinatal death.

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Analysis 61.7

Comparison 61 (8.10) PGE2 low dose vs PGE2 high dose (all primiparae), Outcome 7 Oxytocin augmentation.

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Analysis 61.10

Comparison 61 (8.10) PGE2 low dose vs PGE2 high dose (all primiparae), Outcome 10 Epidural analgesia.

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Analysis 61.11

Comparison 61 (8.10) PGE2 low dose vs PGE2 high dose (all primiparae), Outcome 11 Instrumental vaginal delivery.

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Analysis 61.12

Comparison 61 (8.10) PGE2 low dose vs PGE2 high dose (all primiparae), Outcome 12 Meconium‐stained liquor.

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Analysis 61.13

Comparison 61 (8.10) PGE2 low dose vs PGE2 high dose (all primiparae), Outcome 13 Apgar score < 7 at 5 minutes.

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Analysis 61.14

Comparison 61 (8.10) PGE2 low dose vs PGE2 high dose (all primiparae), Outcome 14 Neonatal intensive care unit admission.

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Analysis 61.16

Comparison 61 (8.10) PGE2 low dose vs PGE2 high dose (all primiparae), Outcome 16 Perinatal death.

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Analysis 61.23

Comparison 61 (8.10) PGE2 low dose vs PGE2 high dose (all primiparae), Outcome 23 Postpartum haemorrhage.

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Analysis 62.3

Comparison 62 (8.19) PGE2 low dose vs PGE2 high dose (all multiparae), Outcome 3 Caesarean section.

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Analysis 62.4

Comparison 62 (8.19) PGE2 low dose vs PGE2 high dose (all multiparae), Outcome 4 Serious neonatal morbidity or perinatal death.

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Analysis 62.7

Comparison 62 (8.19) PGE2 low dose vs PGE2 high dose (all multiparae), Outcome 7 Oxytocin augmentation.

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Analysis 62.10

Comparison 62 (8.19) PGE2 low dose vs PGE2 high dose (all multiparae), Outcome 10 Epidural analgesia.

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Analysis 62.11

Comparison 62 (8.19) PGE2 low dose vs PGE2 high dose (all multiparae), Outcome 11 Instrumental vaginal delivery.

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Analysis 62.12

Comparison 62 (8.19) PGE2 low dose vs PGE2 high dose (all multiparae), Outcome 12 Meconium‐stained liquor.

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Analysis 62.13

Comparison 62 (8.19) PGE2 low dose vs PGE2 high dose (all multiparae), Outcome 13 Apgar score < 7 at 5 minutes.

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Analysis 62.14

Comparison 62 (8.19) PGE2 low dose vs PGE2 high dose (all multiparae), Outcome 14 Neonatal intensive care unit admission.

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Analysis 62.16

Comparison 62 (8.19) PGE2 low dose vs PGE2 high dose (all multiparae), Outcome 16 Perinatal death.

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Analysis 62.23

Comparison 62 (8.19) PGE2 low dose vs PGE2 high dose (all multiparae), Outcome 23 Postpartum haemorrhage.

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Analysis 63.2

Comparison 63 PGE2 (all regimens) vs placebo/no treatment (all women, outpatient ripening), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 63.3

Comparison 63 PGE2 (all regimens) vs placebo/no treatment (all women, outpatient ripening), Outcome 3 Caesarean section.

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Analysis 63.6

Comparison 63 PGE2 (all regimens) vs placebo/no treatment (all women, outpatient ripening), Outcome 6 Cervix unfavourable/unchanged after 12 to 24 hours.

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Analysis 63.8

Comparison 63 PGE2 (all regimens) vs placebo/no treatment (all women, outpatient ripening), Outcome 8 Uterine hyperstimulation without FHR changes.

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Analysis 63.10

Comparison 63 PGE2 (all regimens) vs placebo/no treatment (all women, outpatient ripening), Outcome 10 Epidural analgesia.

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Analysis 63.12

Comparison 63 PGE2 (all regimens) vs placebo/no treatment (all women, outpatient ripening), Outcome 12 Meconium‐stained liquor.

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Analysis 63.13

Comparison 63 PGE2 (all regimens) vs placebo/no treatment (all women, outpatient ripening), Outcome 13 Apgar score < 7 at 5 minutes.

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Analysis 63.14

Comparison 63 PGE2 (all regimens) vs placebo/no treatment (all women, outpatient ripening), Outcome 14 Neonatal intensive care unit admission.

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Table 1. Tests for subgroup differences (within comparison of vaginal PGE2 versus placeb0)

Outcome/intervention	Summary statistic (Mantel‐Haenszel method) (RR, (95% CI))	Summary statistic (inverse variance method) (RR, (95% CI))
Uterine hyperstimulation with fetal heart rate changes
Once only PGE2	1.38 (0.46 to 4.15) I² = 0%	1.41 (0.44 to 4.52) I² = 0%
Repeated PGE2	5.34 (0.27 to 106.7) I² = n/a	5.34 (0.27 to 106.7) I² = n/a
Sustained release PGE2	10.87 (2.69 to 43.92) I² = 0%	2.90 (1.21 to 6.96) I² = 0%
		Test for subgroup difference Chi² = 3.44 df = 2 (P = 0.18), I² = 41.8%
Caesarean section
Once only PGE2	1.03 (0.84 to 1.26) I² = 0%	1.01 (0.83 to 1.24) I² = 0%
Repeated PGE2	0.83 (0.70 to 0.99) I² = 0%	0.84 (0.71 to 0.99) I² = 0%
Sustained release PGE2	0.84 (0.64 to 1.10) I² = 0%	0.83 (0.64 to 1.10) I² = 0%
		Test for subgroup difference Chi² = 2.21 df = 2 (P = 0.33), I² = 9.5%
Oxytocin augmentation
Once only PGE2	0.91 (0.76 to 1.10) I² = 82%	1.00 (0.85 to 1.17) I² = 82%
Repeated PGE2	0.85 (0.71 to 1.02) I² = 59%	0.85 (0.71 to 1.03) I² = 59%
Sustained release PGE2	0.36 (0.20 to 0.64) I² = n/a	0.36 (0.20 to 0.64) I² = n/a
		Test for subgroup difference Chi² = 11.41 df = 2 (P = 0.003), I² = 82.5%
Uterine hyperstimulation without fetal heart rate changes
Once only PGE2	1.26 (0.33 to 4.84) I² = 11%	0.92 (0.19 to 4.42) I² = 4%
Repeated PGE2	2.34 (0.78 to 7.03) I² = 0%	2.33 (0.77 to 7.02) I² = 0%
Sustained release PGE2	7.85 (1.05 to 58.82) I² = 0%	7.49 (0.97 to 57.64) I² = 0%
		Test for subgroup difference Chi² = 2.58 df = 2 (P = 0.28), I² = 22.4%

Table 1. Tests for subgroup differences (within comparison of vaginal PGE2 versus placeb0)

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Table 2. Methodological quality of trials

Methodological item	Adequate	Inadequate
Generation of random sequence	Computer‐generated sequence, random number tables, lot drawing, coin tossing, shuffling cards, throwing dice.	Case number, date of birth, date of admission, alternation.
Concealment of allocation	Central randomisation, coded drug boxes, sequentially sealed opaque envelopes.	Open allocation sequence, any procedure based on inadequate generation.

Table 2. Methodological quality of trials

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Comparison 1. (1.1) PGE2 (all regimens) vs placebo/no treatment (all women)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Vaginal delivery not achieved within 24 hours Show forest plot	2	384	Risk Ratio (M‐H, Fixed, 95% CI)	0.19 [0.14, 0.25]

1.1 PGE2 (once only) vs placebo/no treatment	1	39	Risk Ratio (M‐H, Fixed, 95% CI)	0.88 [0.67, 1.15]
1.2 PGE2 (repeated doses) vs placebo/no treatment	1	345	Risk Ratio (M‐H, Fixed, 95% CI)	0.12 [0.08, 0.18]
2 Uterine hyperstimulation with FHR changes Show forest plot	14	1259	Risk Ratio (M‐H, Fixed, 95% CI)	4.14 [1.93, 8.90]

2.1 PGE2 (once only) vs placebo/no treatment	7	515	Risk Ratio (M‐H, Fixed, 95% CI)	1.38 [0.46, 4.15]
2.2 PGE2 (repeated doses) vs placebo/no treatment	3	208	Risk Ratio (M‐H, Fixed, 95% CI)	5.34 [0.27, 106.70]
2.3 PGE2 (sustained release) vs placebo/no treatment	4	536	Risk Ratio (M‐H, Fixed, 95% CI)	10.87 [2.69, 43.92]
3 Caesarean section Show forest plot	34	6399	Risk Ratio (IV, Fixed, 95% CI)	0.89 [0.79, 1.00]

3.1 PGE2 (once only) vs placebo/no treatment	16	1405	Risk Ratio (IV, Fixed, 95% CI)	1.01 [0.83, 1.24]
3.2 PGE2 (repeated doses) vs placebo/no treatment	14	4423	Risk Ratio (IV, Fixed, 95% CI)	0.84 [0.71, 0.99]
3.3 PGE2 (sustained release) vs placebo/no treatment	4	571	Risk Ratio (IV, Fixed, 95% CI)	0.83 [0.64, 1.10]
4 Serious neonatal morbidity or perinatal death Show forest plot	9	3638	Risk Ratio (M‐H, Fixed, 95% CI)	0.46 [0.09, 2.31]

4.1 PGE2 (once only) vs placebo/no treatment	2	85	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.2 PGE2 (repeated doses) vs placebo/no treatment	5	3269	Risk Ratio (M‐H, Fixed, 95% CI)	0.46 [0.09, 2.31]
4.3 PGE2 (sustained release) vs placebo/no treatment	2	284	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5 Serious maternal morbidity or death Show forest plot	3	530	Risk Ratio (M‐H, Fixed, 95% CI)	2.23 [0.34, 14.76]

5.1 PGE2 (once only) vs placebo	2	461	Risk Ratio (M‐H, Fixed, 95% CI)	2.23 [0.34, 14.76]
5.3 PGE2 (sustained release) vs placebo/no treatment	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
6 Cervix unfavourable/unchanged after 12 to 24 hours Show forest plot	5	467	Risk Ratio (M‐H, Fixed, 95% CI)	0.46 [0.35, 0.62]

6.1 PGE2 (once only) vs placebo/no treatment	3	232	Risk Ratio (M‐H, Fixed, 95% CI)	0.55 [0.40, 0.75]
6.2 PGE2 (repeated doses) vs placebo/no treatment	2	235	Risk Ratio (M‐H, Fixed, 95% CI)	0.34 [0.19, 0.61]
7 Oxytocin augmentation Show forest plot	12	1321	Risk Ratio (M‐H, Fixed, 95% CI)	0.83 [0.73, 0.94]

7.1 PGE2 (once only) vs placebo/no treatment	7	545	Risk Ratio (M‐H, Fixed, 95% CI)	0.91 [0.76, 1.10]
7.2 PGE2 (repeated doses) vs placebo/no treatment	4	695	Risk Ratio (M‐H, Fixed, 95% CI)	0.85 [0.71, 1.02]
7.3 PGE2 (sustained release) vs placebo/no treatment	1	81	Risk Ratio (M‐H, Fixed, 95% CI)	0.36 [0.20, 0.64]
8 Uterine hyperstimulation without FHR changes Show forest plot	13	3636	Risk Ratio (M‐H, Fixed, 95% CI)	2.48 [1.17, 5.26]

8.1 PGE2 (once only) vs placebo/no treatment	6	443	Risk Ratio (M‐H, Fixed, 95% CI)	1.26 [0.33, 4.84]
8.2 PGE2 (repeated doses) vs placebo/no treatment	5	2953	Risk Ratio (M‐H, Fixed, 95% CI)	2.34 [0.78, 7.03]
8.3 PGE2 (sustained release) vs placebo/no treatment	2	240	Risk Ratio (M‐H, Fixed, 95% CI)	7.85 [1.05, 58.82]
9 Uterine rupture Show forest plot	2	2579	Risk Ratio (M‐H, Fixed, 95% CI)	2.90 [0.12, 68.50]

9.1 PGE2 (once only) vs placebo/no treatment	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	2.90 [0.12, 68.50]
9.2 PGE2 (repeated doses) vs placebo/no treatment	1	2520	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10 Epidural analgesia Show forest plot	7	3555	Risk Ratio (M‐H, Fixed, 95% CI)	1.09 [1.01, 1.16]

10.1 PGE2 (once only) vs placebo/no treatment	2	434	Risk Ratio (M‐H, Fixed, 95% CI)	0.98 [0.76, 1.25]
10.2 PGE2 (repeated doses) vs placebo/no treatment	4	3040	Risk Ratio (M‐H, Fixed, 95% CI)	1.10 [1.02, 1.18]
10.3 PGE2 (sustained release) vs placebo/no treatment	1	81	Risk Ratio (M‐H, Fixed, 95% CI)	1.18 [0.83, 1.68]
11 Instrumental vaginal delivery Show forest plot	13	4219	Risk Ratio (M‐H, Fixed, 95% CI)	0.95 [0.82, 1.10]

11.1 PGE2 (once only) vs placebo/no treatment	6	721	Risk Ratio (M‐H, Fixed, 95% CI)	0.84 [0.55, 1.28]
11.2 PGE2 (repeated doses) vs placebo/no treatment	5	3348	Risk Ratio (M‐H, Fixed, 95% CI)	0.97 [0.83, 1.13]
11.3 PGE2 (sustained release) vs placebo/no treatment	2	150	Risk Ratio (M‐H, Fixed, 95% CI)	1.01 [0.55, 1.86]
12 Meconium‐stained liquor Show forest plot	12	4245	Risk Ratio (M‐H, Fixed, 95% CI)	0.82 [0.68, 0.98]

12.1 PGE2 (once only) vs placebo/no treatment	5	704	Risk Ratio (M‐H, Fixed, 95% CI)	0.95 [0.65, 1.40]
12.2 PGE2 (repeated doses) vs placebo/no treatment	7	3541	Risk Ratio (M‐H, Fixed, 95% CI)	0.79 [0.64, 0.97]
13 Apgar score < 7 at 5 minutes Show forest plot	15	4381	Risk Ratio (M‐H, Fixed, 95% CI)	1.30 [0.86, 1.96]

13.1 PGE2 (once only) vs placebo/no treatment	9	1046	Risk Ratio (M‐H, Fixed, 95% CI)	0.56 [0.24, 1.30]
13.2 PGE2 (repeated doses) vs placebo/no treatment	5	3120	Risk Ratio (M‐H, Fixed, 95% CI)	1.38 [0.80, 2.37]
13.3 PGE2 (sustained release) vs placebo/no treatment	1	215	Risk Ratio (M‐H, Fixed, 95% CI)	6.21 [1.41, 27.34]
14 Neonatal intensive care unit admission Show forest plot	11	3922	Risk Ratio (M‐H, Fixed, 95% CI)	0.95 [0.78, 1.15]

14.1 PGE2 (once only) vs placebo/no treatment	4	681	Risk Ratio (M‐H, Fixed, 95% CI)	1.23 [0.70, 2.15]
14.2 PGE2 (repeated doses) vs placebo/no treatment	6	3172	Risk Ratio (M‐H, Fixed, 95% CI)	0.90 [0.73, 1.11]
14.3 PGE2 (sustained release) vs placebo/no treatment	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	3.27 [0.36, 29.93]
16 Perinatal death Show forest plot	7	3648	Risk Ratio (M‐H, Fixed, 95% CI)	0.56 [0.14, 2.22]

16.1 PGE2 (once only) vs placebo/no treatment	2	431	Risk Ratio (M‐H, Fixed, 95% CI)	1.06 [0.07, 16.85]
16.2 PGE2 (repeated doses) vs placebo/no treatment	4	3148	Risk Ratio (M‐H, Fixed, 95% CI)	0.46 [0.09, 2.31]
16.3 PGE2 (sustained release) vs placebo/no treatment	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
18 Maternal side‐effects (all) Show forest plot	12	6780	Risk Ratio (M‐H, Fixed, 95% CI)	1.15 [0.80, 1.67]

18.1 PGE2 (once only) vs placebo/no treatment	6	577	Risk Ratio (M‐H, Fixed, 95% CI)	1.95 [1.02, 3.74]
18.2 PGE2 (repeated doses) vs placebo/no treatment	5	5558	Risk Ratio (M‐H, Fixed, 95% CI)	0.84 [0.53, 1.34]
18.3 PGE2 (sustained release) vs placebo/no treatment	1	645	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
19 Nausea (maternal) Show forest plot	1	84	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

19.2 PGE2 (repeated doses) vs placebo/no treatment	1	84	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
20 Vomitting (maternal) Show forest plot	3	2794	Risk Ratio (M‐H, Fixed, 95% CI)	1.16 [0.39, 3.39]

20.1 PGE2 (once only) vs placebo/no treatment	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	0.97 [0.15, 6.41]
20.2 PGE2 (repeated doses) vs placebo/no treatment	1	2520	Risk Ratio (M‐H, Fixed, 95% CI)	1.25 [0.34, 4.65]
20.3 PGE2 (sustained release) vs placebo/no treatment	1	215	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
21 Diarrhoea (maternal) Show forest plot	3	2819	Risk Ratio (M‐H, Fixed, 95% CI)	7.01 [0.36, 135.59]

21.2 PGE2 (repeated doses) vs placebo/no treatment	2	2604	Risk Ratio (M‐H, Fixed, 95% CI)	7.01 [0.36, 135.59]
21.3 PGE2 (sustained release) vs placebo/no treatment	1	215	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
22 Other maternal side‐effects Show forest plot	7	871	Risk Ratio (M‐H, Fixed, 95% CI)	0.97 [0.62, 1.51]

22.1 PGE2 (once only) vs placebo/no treatment	4	356	Risk Ratio (M‐H, Fixed, 95% CI)	2.78 [0.97, 8.02]
22.2 PGE2 (repeated doses) vs placebo/no treatment	2	300	Risk Ratio (M‐H, Fixed, 95% CI)	0.69 [0.42, 1.15]
22.3 PGE2 (sustained release) vs placebo/no treatment	1	215	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
23 Postpartum haemorrhage Show forest plot	9	3537	Risk Ratio (M‐H, Fixed, 95% CI)	1.47 [1.04, 2.09]

23.1 PGE2 (once only) vs placebo/no treatment	4	282	Risk Ratio (M‐H, Fixed, 95% CI)	1.14 [0.33, 3.97]
23.2 PGE2 (repeated doses) vs placebo/no treatment	4	3040	Risk Ratio (M‐H, Fixed, 95% CI)	1.46 [1.01, 2.11]
23.3 PGE2 (sustained release) vs placebo/no treatment	1	215	Risk Ratio (M‐H, Fixed, 95% CI)	5.64 [0.27, 116.05]
24 Serious maternal complication Show forest plot	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	2.90 [0.12, 68.50]

24.1 PGE2 (once only) vs placebo/no treatment	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	2.90 [0.12, 68.50]
26 Woman not satisfied Show forest plot	2	2922	Risk Ratio (M‐H, Fixed, 95% CI)	0.56 [0.44, 0.71]

26.1 PGE2 (once only) vs placebo/no treatment	1	402	Risk Ratio (M‐H, Fixed, 95% CI)	1.40 [0.83, 2.35]
26.2 PGE2 (repeated doses) vs placebo/no treatment	1	2520	Risk Ratio (M‐H, Fixed, 95% CI)	0.44 [0.33, 0.58]

Comparison 1. (1.1) PGE2 (all regimens) vs placebo/no treatment (all women)

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Comparison 2. (1.2) PGE2 (all regimens) vs placebo/no treatment (all women, unfavourable cervix)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Vaginal delivery not achieved within 24 hours Show forest plot	1	39	Risk Ratio (M‐H, Fixed, 95% CI)	0.88 [0.67, 1.15]

1.1 PGE2 (once only) vs placebo/no treatment	1	39	Risk Ratio (M‐H, Fixed, 95% CI)	0.88 [0.67, 1.15]
2 Uterine hyperstimulation with FHR changes Show forest plot	12	1143	Risk Ratio (M‐H, Fixed, 95% CI)	4.47 [2.01, 9.93]

2.1 PGE2 (once only) vs placebo/no treatment	5	399	Risk Ratio (M‐H, Fixed, 95% CI)	1.44 [0.44, 4.65]
2.2 PGE2 (repeated doses) vs placebo/no treatment	3	208	Risk Ratio (M‐H, Fixed, 95% CI)	5.34 [0.27, 106.70]
2.3 PGE2 (sustained release) vs placebo/no treatment	4	536	Risk Ratio (M‐H, Fixed, 95% CI)	10.87 [2.69, 43.92]
3 Caesarean section Show forest plot	22	2173	Risk Ratio (M‐H, Fixed, 95% CI)	0.87 [0.75, 1.02]

3.1 PGE2 (once only) vs placebo/no treatment	11	828	Risk Ratio (M‐H, Fixed, 95% CI)	0.92 [0.73, 1.17]
3.2 PGE2 (repeated doses) vs placebo/no treatment	7	774	Risk Ratio (M‐H, Fixed, 95% CI)	0.84 [0.61, 1.15]
3.3 PGE2 (sustained release) vs placebo/no treatment	4	571	Risk Ratio (M‐H, Fixed, 95% CI)	0.84 [0.64, 1.10]
4 Serious neonatal morbidity or perinatal death Show forest plot	4	533	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

4.1 PGE2 (once only) vs placebo/no treatment	1	29	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.2 PGE2 (repeated doses) vs placebo/no treatment	1	220	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.3 PGE2 (sustained release) vs placebo/no treatment	2	284	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5 Serious maternal morbidity or death Show forest plot	2	128	Risk Ratio (M‐H, Fixed, 95% CI)	4.84 [0.24, 96.66]

5.1 PGE2 (once only) vs placebo	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	4.84 [0.24, 96.66]
5.3 PGE2 (sustained release) vs placebo/no treatment	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
6 Cervix unfavourable/unchanged after 12 to 24 hours Show forest plot	2	172	Risk Ratio (M‐H, Fixed, 95% CI)	0.53 [0.35, 0.79]

6.1 PGE2 (once only) vs placebo/no treatment	2	172	Risk Ratio (M‐H, Fixed, 95% CI)	0.53 [0.35, 0.79]
7 Oxytocin augmentation Show forest plot	8	813	Risk Ratio (M‐H, Fixed, 95% CI)	0.72 [0.61, 0.85]

7.1 PGE2 (once only) vs placebo/no treatment	4	382	Risk Ratio (M‐H, Fixed, 95% CI)	0.87 [0.67, 1.13]
7.2 PGE2 (repeated doses) vs placebo/no treatment	3	350	Risk Ratio (M‐H, Fixed, 95% CI)	0.70 [0.55, 0.89]
7.3 PGE2 (sustained release) vs placebo/no treatment	1	81	Risk Ratio (M‐H, Fixed, 95% CI)	0.36 [0.20, 0.64]
8 Uterine hyperstimulation without FHR changes Show forest plot	9	777	Risk Ratio (M‐H, Fixed, 95% CI)	2.63 [0.99, 7.01]

8.1 PGE2 (once only) vs placebo/no treatment	5	387	Risk Ratio (M‐H, Fixed, 95% CI)	1.26 [0.33, 4.84]
8.2 PGE2 (repeated doses) vs placebo/no treatment	2	150	Risk Ratio (M‐H, Fixed, 95% CI)	3.0 [0.13, 71.92]
8.3 PGE2 (sustained release) vs placebo/no treatment	2	240	Risk Ratio (M‐H, Fixed, 95% CI)	7.85 [1.05, 58.82]
9 Uterine rupture Show forest plot	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	2.90 [0.12, 68.50]

9.1 PGE2 (once only) vs placebo/no treatment	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	2.90 [0.12, 68.50]
10 Epidural analgesia Show forest plot	5	633	Risk Ratio (M‐H, Fixed, 95% CI)	1.46 [1.22, 1.75]

10.1 PGE2 (once only) vs placebo/no treatment	1	32	Risk Ratio (M‐H, Fixed, 95% CI)	0.54 [0.29, 0.98]
10.2 PGE2 (repeated doses) vs placebo/no treatment	3	520	Risk Ratio (M‐H, Fixed, 95% CI)	1.69 [1.36, 2.10]
10.3 PGE2 (sustained release) vs placebo/no treatment	1	81	Risk Ratio (M‐H, Fixed, 95% CI)	1.18 [0.83, 1.68]
11 Instrumental vaginal delivery Show forest plot	7	643	Risk Ratio (M‐H, Fixed, 95% CI)	0.88 [0.61, 1.27]

11.1 PGE2 (once only) vs placebo/no treatment	4	293	Risk Ratio (M‐H, Fixed, 95% CI)	0.87 [0.45, 1.69]
11.2 PGE2 (repeated doses) vs placebo/no treatment	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.79 [0.43, 1.46]
11.3 PGE2 (sustained release) vs placebo/no treatment	2	150	Risk Ratio (M‐H, Fixed, 95% CI)	1.01 [0.55, 1.86]
12 Meconium‐stained liquor Show forest plot	5	697	Risk Ratio (M‐H, Fixed, 95% CI)	0.65 [0.47, 0.89]

12.1 PGE2 (once only) vs placebo/no treatment	2	177	Risk Ratio (M‐H, Fixed, 95% CI)	0.90 [0.51, 1.57]
12.2 PGE2 (repeated doses) vs placebo/no treatment	3	520	Risk Ratio (M‐H, Fixed, 95% CI)	0.55 [0.37, 0.81]
13 Apgar score < 7 at 5 minutes Show forest plot	11	1194	Risk Ratio (M‐H, Fixed, 95% CI)	1.08 [0.59, 1.99]

13.1 PGE2 (once only) vs placebo/no treatment	7	579	Risk Ratio (M‐H, Fixed, 95% CI)	0.48 [0.17, 1.36]
13.2 PGE2 (repeated doses) vs placebo/no treatment	3	400	Risk Ratio (M‐H, Fixed, 95% CI)	0.55 [0.15, 1.98]
13.3 PGE2 (sustained release) vs placebo/no treatment	1	215	Risk Ratio (M‐H, Fixed, 95% CI)	6.21 [1.41, 27.34]
14 Neonatal intensive care unit admission Show forest plot	7	735	Risk Ratio (M‐H, Fixed, 95% CI)	0.80 [0.51, 1.27]

14.1 PGE2 (once only) vs placebo/no treatment	2	214	Risk Ratio (M‐H, Fixed, 95% CI)	0.96 [0.51, 1.82]
14.2 PGE2 (repeated doses) vs placebo/no treatment	4	452	Risk Ratio (M‐H, Fixed, 95% CI)	0.55 [0.27, 1.14]
14.3 PGE2 (sustained release) vs placebo/no treatment	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	3.27 [0.36, 29.93]
16 Perinatal death Show forest plot	3	298	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

16.1 PGE2 (once only) vs placebo/no treatment	1	29	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
16.2 PGE2 (repeated doses) vs placebo/no treatment	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
16.3 PGE2 (sustained release) vs placebo/no treatment	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
18 Maternal side‐effects (all) Show forest plot	10	1572	Risk Ratio (M‐H, Fixed, 95% CI)	1.08 [0.73, 1.59]

18.1 PGE2 (once only) vs placebo/no treatment	6	577	Risk Ratio (M‐H, Fixed, 95% CI)	1.95 [1.02, 3.74]
18.2 PGE2 (repeated doses) vs placebo/no treatment	3	350	Risk Ratio (M‐H, Fixed, 95% CI)	0.69 [0.42, 1.15]
18.3 PGE2 (sustained release) vs placebo/no treatment	1	645	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
19 Nausea (maternal) Show forest plot	1	116	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

19.2 PGE2 (repeated doses) vs placebo/no treatment	1	116	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
20 Vomitting (maternal) Show forest plot	2	274	Risk Ratio (M‐H, Fixed, 95% CI)	0.97 [0.15, 6.41]

20.1 PGE2 (once only) vs placebo/no treatment	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	0.97 [0.15, 6.41]
20.3 PGE2 (sustained release) vs placebo/no treatment	1	215	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
21 Diarrhoea (maternal) Show forest plot	2	331	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

21.2 PGE2 (repeated doses) vs placebo/no treatment	1	116	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
21.3 PGE2 (sustained release) vs placebo/no treatment	1	215	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
22 Other maternal side‐effects Show forest plot	7	871	Risk Ratio (M‐H, Fixed, 95% CI)	0.97 [0.62, 1.51]

22.1 PGE2 (once only) vs placebo/no treatment	4	356	Risk Ratio (M‐H, Fixed, 95% CI)	2.78 [0.97, 8.02]
22.2 PGE2 (repeated doses) vs placebo/no treatment	2	300	Risk Ratio (M‐H, Fixed, 95% CI)	0.69 [0.42, 1.15]
22.3 PGE2 (sustained release) vs placebo/no treatment	1	215	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
23 Postpartum haemorrhage Show forest plot	7	917	Risk Ratio (M‐H, Fixed, 95% CI)	0.99 [0.47, 2.05]

23.1 PGE2 (once only) vs placebo/no treatment	4	282	Risk Ratio (M‐H, Fixed, 95% CI)	1.14 [0.33, 3.97]
23.2 PGE2 (repeated doses) vs placebo/no treatment	2	420	Risk Ratio (M‐H, Fixed, 95% CI)	0.67 [0.24, 1.84]
23.3 PGE2 (sustained release) vs placebo/no treatment	1	215	Risk Ratio (M‐H, Fixed, 95% CI)	5.64 [0.27, 116.05]
24 Serious maternal complication Show forest plot	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	2.90 [0.12, 68.50]

24.1 PGE2 (once only) vs placebo/no treatment	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	2.90 [0.12, 68.50]

Comparison 2. (1.2) PGE2 (all regimens) vs placebo/no treatment (all women, unfavourable cervix)

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Comparison 3. (1.3) PGE2 (all regimens) vs placebo/no treatment (all women, favourable cervix)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Vaginal delivery not achieved within 24 hours Show forest plot	1	345	Risk Ratio (M‐H, Fixed, 95% CI)	0.12 [0.08, 0.18]

1.2 PGE2 (repeated doses) vs placebo/no treatment	1	345	Risk Ratio (M‐H, Fixed, 95% CI)	0.12 [0.08, 0.18]
2 Uterine hyperstimulation with FHR changes Show forest plot	1	56	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

2.1 PGE2 (once only) vs placebo/no treatment	1	56	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3 Caesarean section Show forest plot	2	401	Risk Ratio (M‐H, Fixed, 95% CI)	1.13 [0.40, 3.18]

3.1 PGE2 (once only) vs placebo/no treatment	1	56	Risk Ratio (M‐H, Fixed, 95% CI)	1.67 [0.44, 6.31]
3.2 PGE2 (repeated doses) vs placebo/no treatment	1	345	Risk Ratio (M‐H, Fixed, 95% CI)	0.61 [0.10, 3.61]
4 Serious neonatal morbidity or perinatal death Show forest plot	2	401	Risk Ratio (M‐H, Fixed, 95% CI)	0.31 [0.01, 7.45]

4.1 PGE2 (once only) vs placebo/no treatment	1	56	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.2 PGE2 (repeated doses) vs placebo/no treatment	1	345	Risk Ratio (M‐H, Fixed, 95% CI)	0.31 [0.01, 7.45]
5 Oxytocin augmentation Show forest plot	3	443	Risk Ratio (M‐H, Fixed, 95% CI)	1.04 [0.85, 1.27]

5.1 PGE2 (once only) vs placebo/no treatment	2	98	Risk Ratio (M‐H, Fixed, 95% CI)	0.97 [0.75, 1.26]
5.2 PGE2 (repeated doses) vs placebo/no treatment	1	345	Risk Ratio (M‐H, Fixed, 95% CI)	1.07 [0.81, 1.42]
7 Uterine hyperstimulation without FHR changes Show forest plot	1	56	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

7.1 PGE2 (once only) vs placebo/no treatment	1	56	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
11 Instrumental vaginal delivery Show forest plot	1	345	Risk Ratio (M‐H, Fixed, 95% CI)	1.22 [0.28, 5.38]

11.2 PGE2 (repeated doses) vs placebo/no treatment	1	345	Risk Ratio (M‐H, Fixed, 95% CI)	1.22 [0.28, 5.38]
16 Perinatal death Show forest plot	1	345	Risk Ratio (M‐H, Fixed, 95% CI)	0.31 [0.01, 7.45]

16.2 PGE2 (repeated doses) vs placebo/no treatment	1	345	Risk Ratio (M‐H, Fixed, 95% CI)	0.31 [0.01, 7.45]

Comparison 3. (1.3) PGE2 (all regimens) vs placebo/no treatment (all women, favourable cervix)

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Comparison 4. (1.5) PGE2 (all regimens) vs placebo/no treatment (all women, intact membranes, unfavourable cervix)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
2 Uterine hyperstimulation with FHR changes Show forest plot	5	425	Risk Ratio (M‐H, Fixed, 95% CI)	2.16 [0.57, 8.21]

2.1 PGE2 (once only) vs placebo/no treatment	2	135	Risk Ratio (M‐H, Fixed, 95% CI)	0.95 [0.14, 6.69]
2.2 PGE2 (repeated doses) vs placebo/no treatment	1	50	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.3 PGE2 (sustained release) vs placebo/no treatment	2	240	Risk Ratio (M‐H, Fixed, 95% CI)	4.44 [0.55, 35.61]
3 Caesarean section Show forest plot	5	471	Risk Ratio (M‐H, Fixed, 95% CI)	1.17 [0.84, 1.63]

3.1 PGE2 (once only) vs placebo/no treatment	3	215	Risk Ratio (M‐H, Fixed, 95% CI)	1.28 [0.77, 2.11]
3.2 PGE2 (repeated doses) vs placebo/no treatment	1	50	Risk Ratio (M‐H, Fixed, 95% CI)	1.63 [0.52, 5.07]
3.3 PGE2 (sustained release) vs placebo/no treatment	1	206	Risk Ratio (M‐H, Fixed, 95% CI)	1.02 [0.63, 1.65]
6 Cervix unfavourable/unchanged after 12 to 24 hours Show forest plot	1	54	Risk Ratio (M‐H, Fixed, 95% CI)	0.40 [0.24, 0.68]

6.1 PGE2 (once only) vs placebo/no treatment	1	54	Risk Ratio (M‐H, Fixed, 95% CI)	0.40 [0.24, 0.68]
7 Oxytocin augmentation Show forest plot	1	50	Risk Ratio (M‐H, Fixed, 95% CI)	1.01 [0.60, 1.68]

7.2 PGE2 (repeated doses) vs placebo/no treatment	1	50	Risk Ratio (M‐H, Fixed, 95% CI)	1.01 [0.60, 1.68]
8 Uterine hyperstimulation without FHR changes Show forest plot	5	424	Risk Ratio (M‐H, Fixed, 95% CI)	6.76 [1.32, 34.54]

8.1 PGE2 (once only) vs placebo/no treatment	2	134	Risk Ratio (M‐H, Fixed, 95% CI)	5.16 [0.31, 86.59]
8.2 PGE2 (repeated doses) vs placebo/no treatment	1	50	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
8.3 PGE2 (sustained release) vs placebo/no treatment	2	240	Risk Ratio (M‐H, Fixed, 95% CI)	7.85 [1.05, 58.82]
13 Apgar score < 7 at 5 minutes Show forest plot	2	161	Risk Ratio (M‐H, Fixed, 95% CI)	0.54 [0.14, 2.05]

13.1 PGE2 (once only) vs placebo/no treatment	2	161	Risk Ratio (M‐H, Fixed, 95% CI)	0.54 [0.14, 2.05]
14 Neonatal intensive care unit admission Show forest plot	1	50	Risk Ratio (M‐H, Fixed, 95% CI)	0.22 [0.01, 4.28]

14.2 PGE2 (repeated doses) vs placebo/no treatment	1	50	Risk Ratio (M‐H, Fixed, 95% CI)	0.22 [0.01, 4.28]
18 Maternal side‐effects (all) Show forest plot	3	212	Risk Ratio (M‐H, Fixed, 95% CI)	1.68 [0.66, 4.31]

18.1 PGE2 (once only) vs placebo/no treatment	2	162	Risk Ratio (M‐H, Fixed, 95% CI)	1.68 [0.66, 4.31]
18.2 PGE2 (repeated doses) vs placebo/no treatment	1	50	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
23 Postpartum haemorrhage Show forest plot	1	81	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

23.1 PGE2 (once only) vs placebo/no treatment	1	81	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 4. (1.5) PGE2 (all regimens) vs placebo/no treatment (all women, intact membranes, unfavourable cervix)

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Comparison 5. (1.6) PGE2 (all regimens) vs placebo/no treatment (all women, intact membranes, favourable cervix)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Vaginal delivery not achieved within 24 hours Show forest plot	1	345	Risk Ratio (M‐H, Fixed, 95% CI)	0.12 [0.08, 0.18]

1.2 PGE2 (repeated doses) vs placebo/no treatment	1	345	Risk Ratio (M‐H, Fixed, 95% CI)	0.12 [0.08, 0.18]
3 Caesarean section Show forest plot	1	345	Risk Ratio (M‐H, Fixed, 95% CI)	0.61 [0.10, 3.61]

3.2 PGE2 (repeated doses) vs placebo/no treatment	1	345	Risk Ratio (M‐H, Fixed, 95% CI)	0.61 [0.10, 3.61]
4 Serious neonatal morbidity or perinatal death Show forest plot	1	345	Risk Ratio (M‐H, Fixed, 95% CI)	0.31 [0.01, 7.45]

4.2 PGE2 (repeated doses) vs placebo/no treatment	1	345	Risk Ratio (M‐H, Fixed, 95% CI)	0.31 [0.01, 7.45]
7 Oxytocin augmentation Show forest plot	1	345	Risk Ratio (M‐H, Fixed, 95% CI)	1.07 [0.81, 1.42]

7.2 PGE2 (repeated doses) vs placebo/no treatment	1	345	Risk Ratio (M‐H, Fixed, 95% CI)	1.07 [0.81, 1.42]
11 Instrumental vaginal delivery Show forest plot	1	345	Risk Ratio (M‐H, Fixed, 95% CI)	1.22 [0.28, 5.38]

11.2 PGE2 (repeated doses) vs placebo/no treatment	1	345	Risk Ratio (M‐H, Fixed, 95% CI)	1.22 [0.28, 5.38]
16 Perinatal death Show forest plot	1	345	Risk Ratio (M‐H, Fixed, 95% CI)	0.31 [0.01, 7.45]

16.2 PGE2 (repeated doses) vs placebo/no treatment	1	345	Risk Ratio (M‐H, Fixed, 95% CI)	0.31 [0.01, 7.45]

Comparison 5. (1.6) PGE2 (all regimens) vs placebo/no treatment (all women, intact membranes, favourable cervix)

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Comparison 6. (1.7) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, variable/undefined cervix)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
3 Caesarean section Show forest plot	2	2620	Risk Ratio (M‐H, Fixed, 95% CI)	0.87 [0.69, 1.09]

3.2 PGE2 (repeated doses) vs placebo/no treatment	2	2620	Risk Ratio (M‐H, Fixed, 95% CI)	0.87 [0.69, 1.09]
4 Serious neonatal morbidity or perinatal death Show forest plot	2	2620	Risk Ratio (M‐H, Fixed, 95% CI)	0.20 [0.01, 4.17]

4.2 PGE2 (repeated doses) vs placebo/no treatment	2	2620	Risk Ratio (M‐H, Fixed, 95% CI)	0.20 [0.01, 4.17]
8 Uterine hyperstimulation without FHR changes Show forest plot	1	2520	Risk Ratio (M‐H, Fixed, 95% CI)	2.25 [0.70, 7.30]

8.2 PGE2 (repeated doses) vs placebo/no treatment	1	2520	Risk Ratio (M‐H, Fixed, 95% CI)	2.25 [0.70, 7.30]
9 Uterine rupture Show forest plot	1	2520	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

9.2 PGE2 (repeated doses) vs placebo/no treatment	1	2520	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10 Epidural analgesia Show forest plot	1	2520	Risk Ratio (M‐H, Fixed, 95% CI)	1.02 [0.94, 1.10]

10.2 PGE2 (repeated doses) vs placebo/no treatment	1	2520	Risk Ratio (M‐H, Fixed, 95% CI)	1.02 [0.94, 1.10]
11 Instrumental vaginal delivery Show forest plot	1	2520	Risk Ratio (M‐H, Fixed, 95% CI)	0.96 [0.80, 1.14]

11.2 PGE2 (repeated doses) vs placebo/no treatment	1	2520	Risk Ratio (M‐H, Fixed, 95% CI)	0.96 [0.80, 1.14]
12 Meconium‐stained liquor Show forest plot	2	2620	Risk Ratio (M‐H, Fixed, 95% CI)	1.04 [0.80, 1.36]

12.2 PGE2 (repeated doses) vs placebo/no treatment	2	2620	Risk Ratio (M‐H, Fixed, 95% CI)	1.04 [0.80, 1.36]
13 Apgar score < 7 at 5 minutes Show forest plot	1	2519	Risk Ratio (M‐H, Fixed, 95% CI)	1.67 [0.89, 3.15]

13.2 PGE2 (repeated doses) vs placebo/no treatment	1	2519	Risk Ratio (M‐H, Fixed, 95% CI)	1.67 [0.89, 3.15]
14 Neonatal intensive care unit admission Show forest plot	1	2519	Risk Ratio (M‐H, Fixed, 95% CI)	0.91 [0.72, 1.15]

14.2 PGE2 (repeated doses) vs placebo/no treatment	1	2519	Risk Ratio (M‐H, Fixed, 95% CI)	0.91 [0.72, 1.15]
16 Perinatal death Show forest plot	1	2519	Risk Ratio (M‐H, Fixed, 95% CI)	0.20 [0.01, 4.17]

16.2 PGE2 (repeated doses) vs placebo/no treatment	1	2519	Risk Ratio (M‐H, Fixed, 95% CI)	0.20 [0.01, 4.17]
18 Maternal side‐effects (all) Show forest plot	1	5040	Risk Ratio (M‐H, Fixed, 95% CI)	2.00 [0.60, 6.64]

18.2 PGE2 (repeated doses) vs placebo/no treatment	1	5040	Risk Ratio (M‐H, Fixed, 95% CI)	2.00 [0.60, 6.64]
20 Vomitting (maternal) Show forest plot	1	2520	Risk Ratio (M‐H, Fixed, 95% CI)	1.25 [0.34, 4.65]

20.2 PGE2 (repeated doses) vs placebo/no treatment	1	2520	Risk Ratio (M‐H, Fixed, 95% CI)	1.25 [0.34, 4.65]
21 Diarrhoea (maternal) Show forest plot	1	2520	Risk Ratio (M‐H, Fixed, 95% CI)	7.01 [0.36, 135.59]

21.2 PGE2 (repeated doses) vs placebo/no treatment	1	2520	Risk Ratio (M‐H, Fixed, 95% CI)	7.01 [0.36, 135.59]
23 Postpartum haemorrhage Show forest plot	2	2620	Risk Ratio (M‐H, Fixed, 95% CI)	1.65 [1.11, 2.47]

23.2 PGE2 (repeated doses) vs placebo/no treatment	2	2620	Risk Ratio (M‐H, Fixed, 95% CI)	1.65 [1.11, 2.47]
26 Woman not satisfied Show forest plot	1	2520	Risk Ratio (M‐H, Fixed, 95% CI)	0.44 [0.33, 0.58]

26.2 PGE2 (repeated doses) vs placebo/no treatment	1	2520	Risk Ratio (M‐H, Fixed, 95% CI)	0.44 [0.33, 0.58]

Comparison 6. (1.7) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, variable/undefined cervix)

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Comparison 7. (1.8) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, unfavourable cervix)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
2 Uterine hyperstimulation with FHR changes Show forest plot	1	155	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

2.1 PGE2 (once only) vs placebo/no treatment	1	155	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3 Caesarean section Show forest plot	5	700	Risk Ratio (M‐H, Fixed, 95% CI)	0.96 [0.66, 1.40]

3.1 PGE2 (once only) vs placebo/no treatment	2	214	Risk Ratio (M‐H, Fixed, 95% CI)	1.02 [0.57, 1.82]
3.2 PGE2 (repeated doses) vs placebo/no treatment	3	486	Risk Ratio (M‐H, Fixed, 95% CI)	0.92 [0.56, 1.51]
4 Serious neonatal morbidity or perinatal death Show forest plot	1	220	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

4.2 PGE2 (repeated doses) vs placebo/no treatment	1	220	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5 Serious maternal morbidity or death Show forest plot	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	4.84 [0.24, 96.66]

5.1 PGE2 (once only) vs placebo	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	4.84 [0.24, 96.66]
7 Oxytocin augmentation Show forest plot	2	375	Risk Ratio (M‐H, Fixed, 95% CI)	0.62 [0.49, 0.79]

7.1 PGE2 (once only) vs placebo/no treatment	1	155	Risk Ratio (M‐H, Fixed, 95% CI)	0.63 [0.45, 0.90]
7.2 PGE2 (repeated doses) vs placebo/no treatment	1	220	Risk Ratio (M‐H, Fixed, 95% CI)	0.61 [0.43, 0.85]
8 Uterine hyperstimulation without FHR changes Show forest plot	2	214	Risk Ratio (M‐H, Fixed, 95% CI)	0.48 [0.05, 5.05]

8.1 PGE2 (once only) vs placebo/no treatment	2	214	Risk Ratio (M‐H, Fixed, 95% CI)	0.48 [0.05, 5.05]
9 Uterine rupture Show forest plot	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	2.90 [0.12, 68.50]

9.1 PGE2 (once only) vs placebo/no treatment	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	2.90 [0.12, 68.50]
10 Epidural analgesia Show forest plot	2	420	Risk Ratio (M‐H, Fixed, 95% CI)	2.35 [1.75, 3.16]

10.2 PGE2 (repeated doses) vs placebo/no treatment	2	420	Risk Ratio (M‐H, Fixed, 95% CI)	2.35 [1.75, 3.16]
11 Instrumental vaginal delivery Show forest plot	2	259	Risk Ratio (M‐H, Fixed, 95% CI)	0.99 [0.57, 1.73]

11.1 PGE2 (once only) vs placebo/no treatment	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	2.9 [0.64, 13.22]
11.2 PGE2 (repeated doses) vs placebo/no treatment	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.79 [0.43, 1.46]
12 Meconium‐stained liquor Show forest plot	3	479	Risk Ratio (M‐H, Fixed, 95% CI)	0.60 [0.32, 1.10]

12.1 PGE2 (once only) vs placebo/no treatment	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	0.73 [0.18, 2.96]
12.2 PGE2 (repeated doses) vs placebo/no treatment	2	420	Risk Ratio (M‐H, Fixed, 95% CI)	0.57 [0.29, 1.13]
13 Apgar score < 7 at 5 minutes Show forest plot	2	375	Risk Ratio (M‐H, Fixed, 95% CI)	0.74 [0.17, 3.27]

13.1 PGE2 (once only) vs placebo/no treatment	1	155	Risk Ratio (M‐H, Fixed, 95% CI)	0.96 [0.06, 15.11]
13.2 PGE2 (repeated doses) vs placebo/no treatment	1	220	Risk Ratio (M‐H, Fixed, 95% CI)	0.67 [0.11, 3.91]
14 Neonatal intensive care unit admission Show forest plot	3	434	Risk Ratio (M‐H, Fixed, 95% CI)	0.93 [0.55, 1.59]

14.1 PGE2 (once only) vs placebo/no treatment	2	214	Risk Ratio (M‐H, Fixed, 95% CI)	0.96 [0.51, 1.82]
14.2 PGE2 (repeated doses) vs placebo/no treatment	1	220	Risk Ratio (M‐H, Fixed, 95% CI)	0.88 [0.33, 2.33]
16 Perinatal death Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

16.2 PGE2 (repeated doses) vs placebo/no treatment	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
18 Maternal side‐effects (all) Show forest plot	3	493	Risk Ratio (M‐H, Fixed, 95% CI)	1.03 [0.63, 1.69]

18.1 PGE2 (once only) vs placebo/no treatment	2	273	Risk Ratio (M‐H, Fixed, 95% CI)	1.54 [0.52, 4.57]
18.2 PGE2 (repeated doses) vs placebo/no treatment	1	220	Risk Ratio (M‐H, Fixed, 95% CI)	0.90 [0.52, 1.59]
20 Vomitting (maternal) Show forest plot	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	0.97 [0.15, 6.41]

20.1 PGE2 (once only) vs placebo/no treatment	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	0.97 [0.15, 6.41]
22 Other maternal side‐effects Show forest plot	1	155	Risk Ratio (M‐H, Fixed, 95% CI)	0.48 [0.04, 5.20]

22.1 PGE2 (once only) vs placebo/no treatment	1	155	Risk Ratio (M‐H, Fixed, 95% CI)	0.48 [0.04, 5.20]
23 Postpartum haemorrhage Show forest plot	3	479	Risk Ratio (M‐H, Fixed, 95% CI)	0.79 [0.31, 2.02]

23.1 PGE2 (once only) vs placebo/no treatment	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	2.90 [0.12, 68.50]
23.2 PGE2 (repeated doses) vs placebo/no treatment	2	420	Risk Ratio (M‐H, Fixed, 95% CI)	0.67 [0.24, 1.84]
24 Serious maternal complication Show forest plot	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	2.90 [0.12, 68.50]

24.1 PGE2 (once only) vs placebo/no treatment	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	2.90 [0.12, 68.50]

Comparison 7. (1.8) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, unfavourable cervix)

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Comparison 8. (1.10) PGE2 (all regimens) vs placebo/no treatment (all primiparae)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Vaginal delivery not achieved within 24 hours Show forest plot	2	226	Risk Ratio (M‐H, Fixed, 95% CI)	0.30 [0.23, 0.40]

1.1 PGE2 (once only) vs placebo/no treatment	1	39	Risk Ratio (M‐H, Fixed, 95% CI)	0.88 [0.67, 1.15]
1.2 PGE2 (repeated doses) vs placebo/no treatment	1	187	Risk Ratio (M‐H, Fixed, 95% CI)	0.20 [0.13, 0.29]
2 Uterine hyperstimulation with FHR changes Show forest plot	3	217	Risk Ratio (M‐H, Fixed, 95% CI)	3.0 [0.13, 68.57]

2.1 PGE2 (once only) vs placebo/no treatment	2	187	Risk Ratio (M‐H, Fixed, 95% CI)	3.0 [0.13, 68.57]
2.2 PGE2 (repeated doses) vs placebo/no treatment	1	30	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3 Caesarean section Show forest plot	10	2486	Risk Ratio (M‐H, Fixed, 95% CI)	0.93 [0.77, 1.12]

3.1 PGE2 (once only) vs placebo/no treatment	4	273	Risk Ratio (M‐H, Fixed, 95% CI)	0.98 [0.66, 1.46]
3.2 PGE2 (repeated doses) vs placebo/no treatment	5	2144	Risk Ratio (M‐H, Fixed, 95% CI)	0.93 [0.75, 1.16]
3.3 PGE2 (sustained release) vs placebo/no treatment	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.79 [0.36, 1.73]
4 Serious neonatal morbidity or perinatal death Show forest plot	3	1796	Risk Ratio (M‐H, Fixed, 95% CI)	0.34 [0.01, 8.22]

4.2 PGE2 (repeated doses) vs placebo/no treatment	2	1727	Risk Ratio (M‐H, Fixed, 95% CI)	0.34 [0.01, 8.22]
4.3 PGE2 (sustained release) vs placebo/no treatment	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5 Serious maternal morbidity or death Show forest plot	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

5.3 PGE2 (sustained release) vs placebo/no treatment	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
6 Cervix unfavourable/unchanged after 12 to 24 hours Show forest plot	1	36	Risk Ratio (M‐H, Fixed, 95% CI)	0.13 [0.03, 0.47]

6.2 PGE2 (repeated doses) vs placebo/no treatment	1	36	Risk Ratio (M‐H, Fixed, 95% CI)	0.13 [0.03, 0.47]
7 Oxytocin augmentation Show forest plot	3	407	Risk Ratio (M‐H, Fixed, 95% CI)	0.59 [0.47, 0.74]

7.1 PGE2 (once only) vs placebo/no treatment	2	187	Risk Ratio (M‐H, Fixed, 95% CI)	0.57 [0.42, 0.77]
7.2 PGE2 (repeated doses) vs placebo/no treatment	1	220	Risk Ratio (M‐H, Fixed, 95% CI)	0.61 [0.43, 0.85]
8 Uterine hyperstimulation without FHR changes Show forest plot	3	1701	Risk Ratio (M‐H, Fixed, 95% CI)	0.35 [0.02, 8.10]

8.1 PGE2 (once only) vs placebo/no treatment	2	194	Risk Ratio (M‐H, Fixed, 95% CI)	0.35 [0.02, 8.10]
8.2 PGE2 (repeated doses) vs placebo/no treatment	1	1507	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9 Uterine rupture Show forest plot	1	1507	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

9.2 PGE2 (repeated doses) vs placebo/no treatment	1	1507	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10 Epidural analgesia Show forest plot	4	1959	Risk Ratio (M‐H, Fixed, 95% CI)	1.12 [1.03, 1.21]

10.1 PGE2 (once only) vs placebo/no treatment	1	32	Risk Ratio (M‐H, Fixed, 95% CI)	0.54 [0.29, 0.98]
10.2 PGE2 (repeated doses) vs placebo/no treatment	3	1927	Risk Ratio (M‐H, Fixed, 95% CI)	1.13 [1.05, 1.23]
11 Instrumental vaginal delivery Show forest plot	4	1815	Risk Ratio (M‐H, Fixed, 95% CI)	0.97 [0.83, 1.14]

11.1 PGE2 (once only) vs placebo/no treatment	1	39	Risk Ratio (M‐H, Fixed, 95% CI)	0.70 [0.23, 2.10]
11.2 PGE2 (repeated doses) vs placebo/no treatment	2	1707	Risk Ratio (M‐H, Fixed, 95% CI)	0.96 [0.82, 1.14]
11.3 PGE2 (sustained release) vs placebo/no treatment	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	1.56 [0.67, 3.62]
12 Meconium‐stained liquor Show forest plot	2	420	Risk Ratio (M‐H, Fixed, 95% CI)	0.57 [0.29, 1.13]

12.2 PGE2 (repeated doses) vs placebo/no treatment	2	420	Risk Ratio (M‐H, Fixed, 95% CI)	0.57 [0.29, 1.13]
13 Apgar score < 7 at 5 minutes Show forest plot	3	414	Risk Ratio (M‐H, Fixed, 95% CI)	0.74 [0.17, 3.27]

13.1 PGE2 (once only) vs placebo/no treatment	2	194	Risk Ratio (M‐H, Fixed, 95% CI)	0.96 [0.06, 15.11]
13.2 PGE2 (repeated doses) vs placebo/no treatment	1	220	Risk Ratio (M‐H, Fixed, 95% CI)	0.67 [0.11, 3.91]
14 Neonatal intensive care unit admission Show forest plot	3	444	Risk Ratio (M‐H, Fixed, 95% CI)	1.06 [0.54, 2.09]

14.1 PGE2 (once only) vs placebo/no treatment	1	155	Risk Ratio (M‐H, Fixed, 95% CI)	0.96 [0.32, 2.85]
14.2 PGE2 (repeated doses) vs placebo/no treatment	1	220	Risk Ratio (M‐H, Fixed, 95% CI)	0.88 [0.33, 2.33]
14.3 PGE2 (sustained release) vs placebo/no treatment	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	3.27 [0.36, 29.93]
16 Perinatal death Show forest plot	3	1776	Risk Ratio (M‐H, Fixed, 95% CI)	0.34 [0.01, 8.22]

16.1 PGE2 (repeated doses) vs placebo/no treatment	2	1707	Risk Ratio (M‐H, Fixed, 95% CI)	0.34 [0.01, 8.22]
16.3 PGE2 (sustained release) vs placebo/no treatment	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
18 Maternal side‐effects (all) Show forest plot	3	1882	Risk Ratio (M‐H, Fixed, 95% CI)	1.04 [0.63, 1.71]

18.1 PGE2 (once only) vs placebo/no treatment	1	155	Risk Ratio (M‐H, Fixed, 95% CI)	0.48 [0.04, 5.20]
18.2 PGE2 (repeated doses) vs placebo/no treatment	2	1727	Risk Ratio (M‐H, Fixed, 95% CI)	1.08 [0.65, 1.81]
20 Vomitting (maternal) Show forest plot	1	1507	Risk Ratio (M‐H, Fixed, 95% CI)	1.68 [0.40, 7.00]

20.2 PGE2 (repeated doses) vs placebo/no treatment	1	1507	Risk Ratio (M‐H, Fixed, 95% CI)	1.68 [0.40, 7.00]
21 Diarrhoea (maternal) Show forest plot	1	1507	Risk Ratio (M‐H, Fixed, 95% CI)	5.03 [0.24, 104.66]

21.2 PGE2 (repeated doses) vs placebo/no treatment	1	1507	Risk Ratio (M‐H, Fixed, 95% CI)	5.03 [0.24, 104.66]
22 Other maternal side‐effects Show forest plot	2	375	Risk Ratio (M‐H, Fixed, 95% CI)	0.87 [0.50, 1.50]

22.1 PGE2 (once only) vs placebo/no treatment	1	155	Risk Ratio (M‐H, Fixed, 95% CI)	0.48 [0.04, 5.20]
22.2 PGE2 (repeated doses) vs placebo/no treatment	1	220	Risk Ratio (M‐H, Fixed, 95% CI)	0.90 [0.52, 1.59]
23 Postpartum haemorrhage Show forest plot	3	1927	Risk Ratio (M‐H, Fixed, 95% CI)	1.51 [0.97, 2.34]

23.2 PGE2 (repeated doses) vs placebo/no treatment	3	1927	Risk Ratio (M‐H, Fixed, 95% CI)	1.51 [0.97, 2.34]

Comparison 8. (1.10) PGE2 (all regimens) vs placebo/no treatment (all primiparae)

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Comparison 9. (1.11) PGE2 (all regimens) vs placebo/no treatment (all primiparae, unfavourable cervix)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Vaginal delivery not achieved within 24 hours Show forest plot	1	39	Risk Ratio (M‐H, Fixed, 95% CI)	0.88 [0.67, 1.15]

1.1 PGE2 (once only) vs placebo/no treatment	1	39	Risk Ratio (M‐H, Fixed, 95% CI)	0.88 [0.67, 1.15]
2 Uterine hyperstimulation with FHR changes Show forest plot	3	217	Risk Ratio (M‐H, Fixed, 95% CI)	3.0 [0.13, 68.57]

2.1 PGE2 (once only) vs placebo/no treatment	2	187	Risk Ratio (M‐H, Fixed, 95% CI)	3.0 [0.13, 68.57]
2.2 PGE2 (repeated doses) vs placebo/no treatment	1	30	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3 Caesarean section Show forest plot	8	792	Risk Ratio (M‐H, Fixed, 95% CI)	0.88 [0.66, 1.17]

3.1 PGE2 (once only) vs placebo/no treatment	4	273	Risk Ratio (M‐H, Fixed, 95% CI)	0.98 [0.66, 1.46]
3.2 PGE2 (repeated doses) vs placebo/no treatment	3	450	Risk Ratio (M‐H, Fixed, 95% CI)	0.81 [0.51, 1.29]
3.3 PGE2 (sustained release) vs placebo/no treatment	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.79 [0.36, 1.73]
4 Serious neonatal morbidity or perinatal death Show forest plot	2	289	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

4.2 PGE2 (repeated doses) vs placebo/no treatment	1	220	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.3 PGE2 (sustained release) vs placebo/no treatment	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5 Serious maternal morbidity or death Show forest plot	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

5.3 PGE2 (sustained release) vs placebo/no treatment	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
7 Oxytocin augmentation Show forest plot	3	407	Risk Ratio (M‐H, Fixed, 95% CI)	0.59 [0.47, 0.74]

7.1 PGE2 (once only) vs placebo/no treatment	2	187	Risk Ratio (M‐H, Fixed, 95% CI)	0.57 [0.42, 0.77]
7.2 PGE2 (repeated doses) vs placebo/no treatment	1	220	Risk Ratio (M‐H, Fixed, 95% CI)	0.61 [0.43, 0.85]
8 Uterine hyperstimulation without FHR changes Show forest plot	2	194	Risk Ratio (M‐H, Fixed, 95% CI)	0.35 [0.02, 8.10]

8.1 PGE2 (once only) vs placebo/no treatment	2	194	Risk Ratio (M‐H, Fixed, 95% CI)	0.35 [0.02, 8.10]
10 Epidural analgesia Show forest plot	3	452	Risk Ratio (M‐H, Fixed, 95% CI)	1.95 [1.50, 2.54]

10.1 PGE2 (once only) vs placebo/no treatment	1	32	Risk Ratio (M‐H, Fixed, 95% CI)	0.54 [0.29, 0.98]
10.2 PGE2 (repeated doses) vs placebo/no treatment	2	420	Risk Ratio (M‐H, Fixed, 95% CI)	2.35 [1.75, 3.16]
11 Instrumental vaginal delivery Show forest plot	3	308	Risk Ratio (M‐H, Fixed, 95% CI)	0.94 [0.60, 1.47]

11.1 PGE2 (once only) vs placebo/no treatment	1	39	Risk Ratio (M‐H, Fixed, 95% CI)	0.70 [0.23, 2.10]
11.2 PGE2 (repeated doses) vs placebo/no treatment	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.79 [0.43, 1.46]
11.3 PGE2 (sustained release) vs placebo/no treatment	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	1.56 [0.67, 3.62]
12 Meconium‐stained liquor Show forest plot	2	420	Risk Ratio (M‐H, Fixed, 95% CI)	0.57 [0.29, 1.13]

12.2 PGE2 (repeated doses) vs placebo/no treatment	2	420	Risk Ratio (M‐H, Fixed, 95% CI)	0.57 [0.29, 1.13]
13 Apgar score < 7 at 5 minutes Show forest plot	3	414	Risk Ratio (M‐H, Fixed, 95% CI)	0.74 [0.17, 3.27]

13.1 PGE2 (once only) vs placebo/no treatment	2	194	Risk Ratio (M‐H, Fixed, 95% CI)	0.96 [0.06, 15.11]
13.2 PGE2 (repeated doses) vs placebo/no treatment	1	220	Risk Ratio (M‐H, Fixed, 95% CI)	0.67 [0.11, 3.91]
14 Neonatal intensive care unit admission Show forest plot	3	444	Risk Ratio (M‐H, Fixed, 95% CI)	1.06 [0.54, 2.09]

14.1 PGE2 (once only) vs placebo/no treatment	1	155	Risk Ratio (M‐H, Fixed, 95% CI)	0.96 [0.32, 2.85]
14.2 PGE2 (repeated doses) vs placebo/no treatment	1	220	Risk Ratio (M‐H, Fixed, 95% CI)	0.88 [0.33, 2.33]
14.3 PGE2 (sustained release) vs placebo/no treatment	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	3.27 [0.36, 29.93]
16 Perinatal death Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

16.1 PGE2 (repeated doses) vs placebo/no treatment	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
18 Maternal side‐effects (all) Show forest plot	2	375	Risk Ratio (M‐H, Fixed, 95% CI)	0.87 [0.50, 1.50]

18.1 PGE2 (once only) vs placebo/no treatment	1	155	Risk Ratio (M‐H, Fixed, 95% CI)	0.48 [0.04, 5.20]
18.2 PGE2 (repeated doses) vs placebo/no treatment	1	220	Risk Ratio (M‐H, Fixed, 95% CI)	0.90 [0.52, 1.59]
22 Other maternal side‐effects Show forest plot	2	375	Risk Ratio (M‐H, Fixed, 95% CI)	0.87 [0.50, 1.50]

22.1 PGE2 (once only) vs placebo/no treatment	1	155	Risk Ratio (M‐H, Fixed, 95% CI)	0.48 [0.04, 5.20]
22.2 PGE2 (repeated doses) vs placebo/no treatment	1	220	Risk Ratio (M‐H, Fixed, 95% CI)	0.90 [0.52, 1.59]
23 Postpartum haemorrhage Show forest plot	2	420	Risk Ratio (M‐H, Fixed, 95% CI)	0.67 [0.24, 1.84]

23.2 PGE2 (repeated doses) vs placebo/no treatment	2	420	Risk Ratio (M‐H, Fixed, 95% CI)	0.67 [0.24, 1.84]

Comparison 9. (1.11) PGE2 (all regimens) vs placebo/no treatment (all primiparae, unfavourable cervix)

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Comparison 10. (1.12) PGE2 (all regimens) vs placebo/no treatment (all primiparae, favourable cervix)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Vaginal delivery not achieved within 24 hours Show forest plot	1	187	Risk Ratio (M‐H, Fixed, 95% CI)	0.20 [0.13, 0.29]

1.2 PGE2 (repeated doses) vs placebo/no treatment	1	187	Risk Ratio (M‐H, Fixed, 95% CI)	0.20 [0.13, 0.29]
3 Caesarean section Show forest plot	1	187	Risk Ratio (M‐H, Fixed, 95% CI)	0.30 [0.03, 2.80]

3.2 PGE2 (repeated doses) vs placebo/no treatment	1	187	Risk Ratio (M‐H, Fixed, 95% CI)	0.30 [0.03, 2.80]

Comparison 10. (1.12) PGE2 (all regimens) vs placebo/no treatment (all primiparae, favourable cervix)

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Comparison 11. (1.14) PGE2 (all regimens) vs placebo/no treatment (all primiparae, intact membranes, unfavourable cervix)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
2 Uterine hyperstimulation with FHR changes Show forest plot	1	30	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

2.2 PGE2 (repeated doses) vs placebo/no treatment	1	30	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3 Caesarean section Show forest plot	2	77	Risk Ratio (M‐H, Fixed, 95% CI)	0.84 [0.51, 1.38]

3.1 PGE2 (once only) vs placebo/no treatment	1	47	Risk Ratio (M‐H, Fixed, 95% CI)	0.95 [0.56, 1.63]
3.2 PGE2 (repeated doses) vs placebo/no treatment	1	30	Risk Ratio (M‐H, Fixed, 95% CI)	0.57 [0.17, 1.87]

Comparison 11. (1.14) PGE2 (all regimens) vs placebo/no treatment (all primiparae, intact membranes, unfavourable cervix)

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Comparison 12. (1.15) PGE2 (all regimens) vs placebo/no treatment (all primiparae, intact membranes, favourable cervix)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Vaginal delivery not achieved within 24 hours Show forest plot	1	187	Risk Ratio (M‐H, Fixed, 95% CI)	0.20 [0.13, 0.29]

1.2 PGE2 (repeated doses) vs placebo/no treatment	1	187	Risk Ratio (M‐H, Fixed, 95% CI)	0.20 [0.13, 0.29]
3 Caesarean section Show forest plot	1	187	Risk Ratio (M‐H, Fixed, 95% CI)	0.30 [0.03, 2.80]

3.2 PGE2 (repeated doses) vs placebo/no treatment	1	187	Risk Ratio (M‐H, Fixed, 95% CI)	0.30 [0.03, 2.80]

Comparison 12. (1.15) PGE2 (all regimens) vs placebo/no treatment (all primiparae, intact membranes, favourable cervix)

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Comparison 13. (1.16) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured memb., variable/undefined cervix)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
3 Caesarean section Show forest plot	1	1507	Risk Ratio (M‐H, Fixed, 95% CI)	0.99 [0.77, 1.27]

3.2 PGE2 (repeated doses) vs placebo/no treatment	1	1507	Risk Ratio (M‐H, Fixed, 95% CI)	0.99 [0.77, 1.27]
4 Serious neonatal morbidity or perinatal death Show forest plot	1	1507	Risk Ratio (M‐H, Fixed, 95% CI)	0.34 [0.01, 8.22]

4.2 PGE2 (repeated doses) vs placebo/no treatment	1	1507	Risk Ratio (M‐H, Fixed, 95% CI)	0.34 [0.01, 8.22]
8 Uterine hyperstimulation without FHR changes Show forest plot	1	1507	Risk Ratio (M‐H, Fixed, 95% CI)	1.01 [0.25, 4.01]

8.2 PGE2 (repeated doses) vs placebo/no treatment	1	1507	Risk Ratio (M‐H, Fixed, 95% CI)	1.01 [0.25, 4.01]
9 Uterine rupture Show forest plot	1	1507	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

9.2 PGE2 (repeated doses) vs placebo/no treatment	1	1507	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10 Epidural analgesia Show forest plot	1	1507	Risk Ratio (M‐H, Fixed, 95% CI)	1.01 [0.93, 1.10]

10.2 PGE2 (repeated doses) vs placebo/no treatment	1	1507	Risk Ratio (M‐H, Fixed, 95% CI)	1.01 [0.93, 1.10]
11 Instrumental vaginal delivery Show forest plot	1	1507	Risk Ratio (M‐H, Fixed, 95% CI)	0.98 [0.83, 1.16]

11.2 PGE2 (repeated doses) vs placebo/no treatment	1	1507	Risk Ratio (M‐H, Fixed, 95% CI)	0.98 [0.83, 1.16]
16 Perinatal death Show forest plot	1	1507	Risk Ratio (M‐H, Fixed, 95% CI)	0.34 [0.01, 8.22]

16.2 PGE2 (repeated doses) vs placebo/no treatment	1	1507	Risk Ratio (M‐H, Fixed, 95% CI)	0.34 [0.01, 8.22]
18 Maternal side‐effects (all) Show forest plot	1	1507	Risk Ratio (M‐H, Fixed, 95% CI)	2.35 [0.61, 9.05]

18.2 PGE2 (repeated doses) vs placebo/no treatment	1	1507	Risk Ratio (M‐H, Fixed, 95% CI)	2.35 [0.61, 9.05]
20 Vomitting (maternal) Show forest plot	1	1507	Risk Ratio (M‐H, Fixed, 95% CI)	1.68 [0.40, 7.00]

20.2 PGE2 (repeated doses) vs placebo/no treatment	1	1507	Risk Ratio (M‐H, Fixed, 95% CI)	1.68 [0.40, 7.00]
21 Diarrhoea (maternal) Show forest plot	1	1507	Risk Ratio (M‐H, Fixed, 95% CI)	5.03 [0.24, 104.66]

21.2 PGE2 (repeated doses) vs placebo/no treatment	1	1507	Risk Ratio (M‐H, Fixed, 95% CI)	5.03 [0.24, 104.66]
23 Postpartum haemorrhage Show forest plot	1	1507	Risk Ratio (M‐H, Fixed, 95% CI)	1.84 [1.12, 3.03]

23.2 PGE2 (repeated doses) vs placebo/no treatment	1	1507	Risk Ratio (M‐H, Fixed, 95% CI)	1.84 [1.12, 3.03]

Comparison 13. (1.16) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured memb., variable/undefined cervix)

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Comparison 14. (1.17) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured membranes, unfavourable cervix)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
2 Uterine hyperstimulation with FHR changes Show forest plot	1	155	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

2.1 PGE2 (once only) vs placebo/no treatment	1	155	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3 Caesarean section Show forest plot	3	575	Risk Ratio (M‐H, Fixed, 95% CI)	0.91 [0.60, 1.39]

3.1 PGE2 (once only) vs placebo/no treatment	1	155	Risk Ratio (M‐H, Fixed, 95% CI)	1.05 [0.49, 2.23]
3.2 PGE2 (repeated doses) vs placebo/no treatment	2	420	Risk Ratio (M‐H, Fixed, 95% CI)	0.86 [0.51, 1.43]
4 Serious neonatal morbidity or perinatal death Show forest plot	1	220	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

4.2 PGE2 (repeated doses) vs placebo/no treatment	1	220	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
7 Oxytocin augmentation Show forest plot	2	375	Risk Ratio (M‐H, Fixed, 95% CI)	0.62 [0.49, 0.79]

7.1 PGE2 (once only) vs placebo/no treatment	1	155	Risk Ratio (M‐H, Fixed, 95% CI)	0.63 [0.45, 0.90]
7.2 PGE2 (repeated doses) vs placebo/no treatment	1	220	Risk Ratio (M‐H, Fixed, 95% CI)	0.61 [0.43, 0.85]
8 Uterine hyperstimulation without FHR changes Show forest plot	1	155	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

8.1 PGE2 (once only) vs placebo/no treatment	1	155	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10 Epidural analgesia Show forest plot	2	420	Risk Ratio (M‐H, Fixed, 95% CI)	2.35 [1.75, 3.16]

10.2 PGE2 (repeated doses) vs placebo/no treatment	2	420	Risk Ratio (M‐H, Fixed, 95% CI)	2.35 [1.75, 3.16]
11 Instrumental vaginal delivery Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.79 [0.43, 1.46]

11.2 PGE2 (repeated doses) vs placebo/no treatment	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.79 [0.43, 1.46]
12 Meconium‐stained liquor Show forest plot	2	420	Risk Ratio (M‐H, Fixed, 95% CI)	0.57 [0.29, 1.13]

12.2 PGE2 (repeated doses) vs placebo/no treatment	2	420	Risk Ratio (M‐H, Fixed, 95% CI)	0.57 [0.29, 1.13]
13 Apgar score < 7 at 5 minutes Show forest plot	2	375	Risk Ratio (M‐H, Fixed, 95% CI)	0.74 [0.17, 3.27]

13.1 PGE2 (once only) vs placebo/no treatment	1	155	Risk Ratio (M‐H, Fixed, 95% CI)	0.96 [0.06, 15.11]
13.2 PGE2 (repeated doses) vs placebo/no treatment	1	220	Risk Ratio (M‐H, Fixed, 95% CI)	0.67 [0.11, 3.91]
14 Neonatal intensive care unit admission Show forest plot	2	375	Risk Ratio (M‐H, Fixed, 95% CI)	0.91 [0.44, 1.89]

14.1 PGE2 (once only) vs placebo/no treatment	1	155	Risk Ratio (M‐H, Fixed, 95% CI)	0.96 [0.32, 2.85]
14.2 PGE2 (repeated doses) vs placebo/no treatment	1	220	Risk Ratio (M‐H, Fixed, 95% CI)	0.88 [0.33, 2.33]
16 Perinatal death Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

16.1 PGE2 (repeated doses) vs placebo/no treatment	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
18 Maternal side‐effects (all) Show forest plot	2	375	Risk Ratio (M‐H, Fixed, 95% CI)	0.87 [0.50, 1.50]

18.1 PGE2 (once only) vs placebo/no treatment	1	155	Risk Ratio (M‐H, Fixed, 95% CI)	0.48 [0.04, 5.20]
18.2 PGE2 (repeated doses) vs placebo/no treatment	1	220	Risk Ratio (M‐H, Fixed, 95% CI)	0.90 [0.52, 1.59]
22 Other maternal side‐effects Show forest plot	2	375	Risk Ratio (M‐H, Fixed, 95% CI)	0.87 [0.50, 1.50]

22.1 PGE2 (once only) vs placebo/no treatment	1	155	Risk Ratio (M‐H, Fixed, 95% CI)	0.48 [0.04, 5.20]
22.2 PGE2 (repeated doses) vs placebo/no treatment	1	220	Risk Ratio (M‐H, Fixed, 95% CI)	0.90 [0.52, 1.59]
23 Postpartum haemorrhage Show forest plot	2	420	Risk Ratio (M‐H, Fixed, 95% CI)	0.67 [0.24, 1.84]

23.2 PGE2 (repeated doses) vs placebo/no treatment	2	420	Risk Ratio (M‐H, Fixed, 95% CI)	0.67 [0.24, 1.84]

Comparison 14. (1.17) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured membranes, unfavourable cervix)

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Comparison 15. (1.19) PGE2 (all regimens) vs placebo/no treatment (all multiparae, without previous caesarean section)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Vaginal delivery not achieved within 24 hours Show forest plot	1	158	Risk Ratio (M‐H, Fixed, 95% CI)	0.04 [0.02, 0.12]

1.2 PGE2 (repeated doses) vs placebo/no treatment	1	158	Risk Ratio (M‐H, Fixed, 95% CI)	0.04 [0.02, 0.12]
2 Uterine hyperstimulation with FHR changes Show forest plot	1	20	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

2.2 PGE2 (repeated doses) vs placebo/no treatment	1	20	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3 Caesarean section Show forest plot	5	1298	Risk Ratio (M‐H, Fixed, 95% CI)	0.82 [0.48, 1.42]

3.1 PGE2 (once only) vs placebo/no treatment	1	7	Risk Ratio (M‐H, Fixed, 95% CI)	1.33 [0.13, 13.74]
3.2 PGE2 (repeated doses) vs placebo/no treatment	4	1291	Risk Ratio (M‐H, Fixed, 95% CI)	0.81 [0.46, 1.41]
4 Serious neonatal morbidity or perinatal death Show forest plot	2	1113	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 8.12]

4.2 PGE2 (repeated doses) vs placebo/no treatment	2	1113	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 8.12]
5 Uterine rupture Show forest plot	1	1013	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

5.2 PGE2 (repeated doses) vs placebo/no treatment	1	1013	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
6 Epidural analgesia Show forest plot	1	1013	Risk Ratio (M‐H, Fixed, 95% CI)	1.05 [0.88, 1.24]

6.2 PGE2 (repeated doses) vs placebo/no treatment	1	1013	Risk Ratio (M‐H, Fixed, 95% CI)	1.05 [0.88, 1.24]
7 Oxytocin augmentation Show forest plot	1	42	Risk Ratio (M‐H, Fixed, 95% CI)	0.42 [0.18, 0.97]

7.1 PGE2 (once only) vs placebo/no treatment	1	42	Risk Ratio (M‐H, Fixed, 95% CI)	0.42 [0.18, 0.97]
8 Uterine hyperstimulation without FHR changes Show forest plot	1	1013	Risk Ratio (M‐H, Fixed, 95% CI)	10.94 [0.61, 197.24]

8.2 PGE2 (repeated doses) vs placebo/no treatment	1	1013	Risk Ratio (M‐H, Fixed, 95% CI)	10.94 [0.61, 197.24]
11 Instrumental vaginal delivery Show forest plot	1	1013	Risk Ratio (M‐H, Fixed, 95% CI)	1.23 [0.77, 1.95]

11.2 PGE2 (repeated doses) vs placebo/no treatment	1	1013	Risk Ratio (M‐H, Fixed, 95% CI)	1.23 [0.77, 1.95]
12 Meconium‐stained liquor Show forest plot	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	1.0 [0.15, 6.82]

12.2 PGE2 (repeated doses) vs placebo/no treatment	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	1.0 [0.15, 6.82]
16 Perinatal death Show forest plot	1	1013	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 8.12]

16.2 PGE2 (repeated doses) vs placebo/no treatment	1	1013	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 8.12]
18 Maternal side‐effects (all) Show forest plot	1	2026	Risk Ratio (M‐H, Fixed, 95% CI)	0.99 [0.06, 15.87]

18.2 PGE2 (repeated doses) vs placebo/no treatment	1	2026	Risk Ratio (M‐H, Fixed, 95% CI)	0.99 [0.06, 15.87]
20 Vomitting (maternal) Show forest plot	1	1013	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 8.12]

20.2 PGE2 (repeated doses) vs placebo/no treatment	1	1013	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 8.12]
21 Diarrhoea (maternal) Show forest plot	1	1013	Risk Ratio (M‐H, Fixed, 95% CI)	2.98 [0.12, 73.04]

21.2 PGE2 (repeated doses) vs placebo/no treatment	1	1013	Risk Ratio (M‐H, Fixed, 95% CI)	2.98 [0.12, 73.04]
23 Postpartum haemorrhage Show forest plot	1	1013	Risk Ratio (M‐H, Fixed, 95% CI)	1.22 [0.59, 2.52]

23.2 PGE2 (repeated doses) vs placebo/no treatment	1	1013	Risk Ratio (M‐H, Fixed, 95% CI)	1.22 [0.59, 2.52]

Comparison 15. (1.19) PGE2 (all regimens) vs placebo/no treatment (all multiparae, without previous caesarean section)

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Comparison 16. (1.20) PGE2 (all regimens) vs placebo/no treatment (all multiparae, unfavourable cervix)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
2 Uterine hyperstimulation with FHR changes Show forest plot	1	20	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

2.2 PGE2 (repeated doses) vs placebo/no treatment	1	20	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3 Caesarean section Show forest plot	2	27	Risk Ratio (M‐H, Fixed, 95% CI)	1.95 [0.30, 12.59]

3.1 PGE2 (once only) vs placebo/no treatment	1	7	Risk Ratio (M‐H, Fixed, 95% CI)	1.33 [0.13, 13.74]
3.2 PGE2 (repeated doses) vs placebo/no treatment	1	20	Risk Ratio (M‐H, Fixed, 95% CI)	3.0 [0.14, 65.90]

Comparison 16. (1.20) PGE2 (all regimens) vs placebo/no treatment (all multiparae, unfavourable cervix)

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Comparison 17. (1.21) PGE2 (all regimens) vs placebo/no treatment (all multiparae, favourable cervix)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Vaginal delivery not achieved within 24 hours Show forest plot	1	158	Risk Ratio (M‐H, Fixed, 95% CI)	0.04 [0.02, 0.12]

1.2 PGE2 (repeated doses) vs placebo/no treatment	1	158	Risk Ratio (M‐H, Fixed, 95% CI)	0.04 [0.02, 0.12]
3 Caesarean section Show forest plot	1	158	Risk Ratio (M‐H, Fixed, 95% CI)	2.85 [0.12, 69.00]

3.2 PGE2 (repeated doses) vs placebo/no treatment	1	158	Risk Ratio (M‐H, Fixed, 95% CI)	2.85 [0.12, 69.00]
7 Oxytocin augmentation Show forest plot	1	42	Risk Ratio (M‐H, Fixed, 95% CI)	0.42 [0.18, 0.97]

7.1 PGE2 (once only) vs placebo/no treatment	1	42	Risk Ratio (M‐H, Fixed, 95% CI)	0.42 [0.18, 0.97]

Comparison 17. (1.21) PGE2 (all regimens) vs placebo/no treatment (all multiparae, favourable cervix)

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Comparison 18. (1.23) PGE2 (all regimens) vs placebo/no treatment (all multiparae, intact membranes, unfavourable cervix)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
2 Uterine hyperstimulation with FHR changes Show forest plot	1	20	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

2.2 PGE2 (repeated doses) vs placebo/no treatment	1	20	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3 Caesarean section Show forest plot	2	27	Risk Ratio (M‐H, Fixed, 95% CI)	1.95 [0.30, 12.59]

3.1 PGE2 (once only) vs placebo/no treatment	1	7	Risk Ratio (M‐H, Fixed, 95% CI)	1.33 [0.13, 13.74]
3.2 PGE2 (repeated doses) vs placebo/no treatment	1	20	Risk Ratio (M‐H, Fixed, 95% CI)	3.0 [0.14, 65.90]

Comparison 18. (1.23) PGE2 (all regimens) vs placebo/no treatment (all multiparae, intact membranes, unfavourable cervix)

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Comparison 19. (1.24) PGE2 (all regimens) vs placebo/no treatment (all multiparae, intact membranes, favourable cervix)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Vaginal delivery not achieved within 24 hours Show forest plot	1	158	Risk Ratio (M‐H, Fixed, 95% CI)	0.04 [0.02, 0.12]

1.2 PGE2 (repeated doses) vs placebo/no treatment	1	158	Risk Ratio (M‐H, Fixed, 95% CI)	0.04 [0.02, 0.12]
3 Caesarean section Show forest plot	1	158	Risk Ratio (M‐H, Fixed, 95% CI)	2.85 [0.12, 69.00]

3.2 PGE2 (repeated doses) vs placebo/no treatment	1	158	Risk Ratio (M‐H, Fixed, 95% CI)	2.85 [0.12, 69.00]

Comparison 19. (1.24) PGE2 (all regimens) vs placebo/no treatment (all multiparae, intact membranes, favourable cervix)

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Comparison 20. (1.25) PGE2 (all regimens) vs placebo/no treatment (all multi., ruptured membranes, variable/undefined cervix)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
3 Caesarean section Show forest plot	2	1113	Risk Ratio (M‐H, Fixed, 95% CI)	0.72 [0.40, 1.30]

3.2 PGE2 (repeated doses) vs placebo/no treatment	2	1113	Risk Ratio (M‐H, Fixed, 95% CI)	0.72 [0.40, 1.30]
4 Serious neonatal morbidity or perinatal death Show forest plot	2	1113	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 8.12]

4.2 PGE2 (repeated doses) vs placebo/no treatment	2	1113	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 8.12]
8 Uterine hyperstimulation without FHR changes Show forest plot	1	1013	Risk Ratio (M‐H, Fixed, 95% CI)	10.94 [0.61, 197.24]

8.2 PGE2 (repeated doses) vs placebo/no treatment	1	1013	Risk Ratio (M‐H, Fixed, 95% CI)	10.94 [0.61, 197.24]
9 Uterine rupture Show forest plot	1	1013	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

9.2 PGE2 (repeated doses) vs placebo/no treatment	1	1013	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10 Epidural analgesia Show forest plot	1	1013	Risk Ratio (M‐H, Fixed, 95% CI)	1.05 [0.88, 1.24]

10.2 PGE2 (repeated doses) vs placebo/no treatment	1	1013	Risk Ratio (M‐H, Fixed, 95% CI)	1.05 [0.88, 1.24]
11 Instrumental vaginal delivery Show forest plot	1	1013	Risk Ratio (M‐H, Fixed, 95% CI)	1.23 [0.77, 1.95]

11.2 PGE2 (repeated doses) vs placebo/no treatment	1	1013	Risk Ratio (M‐H, Fixed, 95% CI)	1.23 [0.77, 1.95]
12 Meconium‐stained liquor Show forest plot	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	1.0 [0.15, 6.82]

12.2 PGE2 (repeated doses) vs placebo/no treatment	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	1.0 [0.15, 6.82]
16 Perinatal death Show forest plot	1	1013	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 8.12]

16.2 PGE2 (repeated doses) vs placebo/no treatment	1	1013	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 8.12]
18 Maternal side‐effects (all) Show forest plot	1	2026	Risk Ratio (M‐H, Fixed, 95% CI)	0.99 [0.06, 15.87]

18.2 PGE2 (repeated doses) vs placebo/no treatment	1	2026	Risk Ratio (M‐H, Fixed, 95% CI)	0.99 [0.06, 15.87]
20 Vomitting (maternal) Show forest plot	1	1013	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 8.12]

20.2 PGE2 (repeated doses) vs placebo/no treatment	1	1013	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 8.12]
21 Diarrhoea (maternal) Show forest plot	1	1013	Risk Ratio (M‐H, Fixed, 95% CI)	2.98 [0.12, 73.04]

21.2 PGE2 (repeated doses) vs placebo/no treatment	1	1013	Risk Ratio (M‐H, Fixed, 95% CI)	2.98 [0.12, 73.04]
23 Postpartum haemorrhage Show forest plot	1	1013	Risk Ratio (M‐H, Fixed, 95% CI)	1.22 [0.59, 2.52]

23.2 PGE2 (repeated doses) vs placebo/no treatment	1	1013	Risk Ratio (M‐H, Fixed, 95% CI)	1.22 [0.59, 2.52]

Comparison 20. (1.25) PGE2 (all regimens) vs placebo/no treatment (all multi., ruptured membranes, variable/undefined cervix)

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Comparison 22. (2.1) PGF2a vs placebo (all women)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
2 Uterine hyperstimulation with FHR changes Show forest plot	1	32	Risk Ratio (M‐H, Fixed, 95% CI)	3.0 [0.13, 68.57]

3 Caesarean section Show forest plot	3	387	Risk Ratio (M‐H, Fixed, 95% CI)	0.58 [0.29, 1.18]

6 Cervix unfavourable/unchanged after 12 to 24 hours Show forest plot	1	90	Risk Ratio (M‐H, Fixed, 95% CI)	0.25 [0.13, 0.49]

7 Oxytocin augmentation Show forest plot	2	122	Risk Ratio (M‐H, Fixed, 95% CI)	0.65 [0.53, 0.81]

10 Epidural analgesia Show forest plot	3	387	Risk Ratio (M‐H, Fixed, 95% CI)	0.72 [0.53, 0.98]

11 Instrumental vaginal delivery Show forest plot	2	355	Risk Ratio (M‐H, Fixed, 95% CI)	0.60 [0.43, 0.84]

Comparison 22. (2.1) PGF2a vs placebo (all women)

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Comparison 23. (2.2) PGF2a vs placebo (all women, unfavourable cervix)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
2 Uterine hyperstimulation with FHR changes Show forest plot	1	32	Risk Ratio (M‐H, Fixed, 95% CI)	3.0 [0.13, 68.57]

3 Caesarean section Show forest plot	1	32	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.04, 2.87]

7 Oxytocin augmentation Show forest plot	1	32	Risk Ratio (M‐H, Fixed, 95% CI)	0.88 [0.71, 1.09]

10 Epidural analgesia Show forest plot	1	32	Risk Ratio (M‐H, Fixed, 95% CI)	0.85 [0.56, 1.27]

Comparison 23. (2.2) PGF2a vs placebo (all women, unfavourable cervix)

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Comparison 24. (2.10) PGF2a vs placebo (all primiparae)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
2 Uterine hyperstimulation with FHR changes Show forest plot	1	32	Risk Ratio (M‐H, Fixed, 95% CI)	3.0 [0.13, 68.57]

3 Caesarean section Show forest plot	1	32	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.04, 2.87]

7 Oxytocin augmentation Show forest plot	1	32	Risk Ratio (M‐H, Fixed, 95% CI)	0.88 [0.71, 1.09]

10 Epidural analgesia Show forest plot	1	32	Risk Ratio (M‐H, Fixed, 95% CI)	0.85 [0.56, 1.27]

Comparison 24. (2.10) PGF2a vs placebo (all primiparae)

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Comparison 25. (2.11) PGF2a vs placebo (all primiparae, unfavourable cervix)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
2 Uterine hyperstimulation with FHR changes Show forest plot	1	32	Risk Ratio (M‐H, Fixed, 95% CI)	3.0 [0.13, 68.57]

3 Caesarean section Show forest plot	1	32	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.04, 2.87]

7 Oxytocin augmentation Show forest plot	1	32	Risk Ratio (M‐H, Fixed, 95% CI)	0.88 [0.71, 1.09]

10 Epidural analgesia Show forest plot	1	32	Risk Ratio (M‐H, Fixed, 95% CI)	0.85 [0.56, 1.27]

Comparison 25. (2.11) PGF2a vs placebo (all primiparae, unfavourable cervix)

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Comparison 26. (3.1) PGF2a vs PGE2 (all women)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Vaginal delivery not achieved within 24 hours Show forest plot	1	75	Risk Ratio (M‐H, Fixed, 95% CI)	0.51 [0.05, 5.42]

2 Uterine hyperstimulation with FHR changes Show forest plot	2	106	Risk Ratio (M‐H, Fixed, 95% CI)	1.0 [0.07, 14.64]

3 Caesarean section Show forest plot	2	107	Risk Ratio (M‐H, Fixed, 95% CI)	1.02 [0.47, 2.22]

7 Oxytocin augmentation Show forest plot	1	32	Risk Ratio (M‐H, Fixed, 95% CI)	2.33 [1.21, 4.51]

10 Epidural analgesia Show forest plot	1	32	Risk Ratio (M‐H, Fixed, 95% CI)	1.57 [0.82, 3.00]

13 Apgar score < 7 at 5 minutes Show forest plot	1	75	Risk Ratio (M‐H, Fixed, 95% CI)	0.21 [0.01, 4.14]

Comparison 26. (3.1) PGF2a vs PGE2 (all women)

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Comparison 27. (3.2) PGF2a vs PGE2 (all women, unfavourable cervix)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Vaginal delivery not achieved within 24 hours Show forest plot	1	75	Risk Ratio (M‐H, Fixed, 95% CI)	0.51 [0.05, 5.42]

2 Uterine hyperstimulation with FHR changes Show forest plot	2	106	Risk Ratio (M‐H, Fixed, 95% CI)	1.0 [0.07, 14.64]

3 Caesarean section Show forest plot	2	107	Risk Ratio (M‐H, Fixed, 95% CI)	1.02 [0.47, 2.22]

7 Oxytocin augmentation Show forest plot	1	32	Risk Ratio (M‐H, Fixed, 95% CI)	2.33 [1.21, 4.51]

10 Epidural analgesia Show forest plot	1	32	Risk Ratio (M‐H, Fixed, 95% CI)	1.57 [0.82, 3.00]

13 Apgar score < 7 at 5 minutes Show forest plot	1	75	Risk Ratio (M‐H, Fixed, 95% CI)	0.21 [0.01, 4.14]

Comparison 27. (3.2) PGF2a vs PGE2 (all women, unfavourable cervix)

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Comparison 28. (3.10) PGF2a vs PGE2 (all primiparae)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
2 Uterine hyperstimulation with FHR changes Show forest plot	1	32	Risk Ratio (M‐H, Fixed, 95% CI)	1.0 [0.07, 14.64]

3 Caesarean section Show forest plot	1	32	Risk Ratio (M‐H, Fixed, 95% CI)	1.0 [0.07, 14.64]

7 Oxytocin augmentation Show forest plot	1	32	Risk Ratio (M‐H, Fixed, 95% CI)	2.33 [1.21, 4.51]

10 Epidural analgesia Show forest plot	1	32	Risk Ratio (M‐H, Fixed, 95% CI)	1.57 [0.82, 3.00]

Comparison 28. (3.10) PGF2a vs PGE2 (all primiparae)

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Comparison 29. (3.11) PGF2a vs PGE2 (all primiparae, unfavourable cervix)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
2 Uterine hyperstimulation with FHR changes Show forest plot	1	32	Risk Ratio (M‐H, Fixed, 95% CI)	1.0 [0.07, 14.64]

3 Caesarean section Show forest plot	1	32	Risk Ratio (M‐H, Fixed, 95% CI)	1.0 [0.07, 14.64]

7 Oxytocin augmentation Show forest plot	1	32	Risk Ratio (M‐H, Fixed, 95% CI)	2.33 [1.21, 4.51]

10 Epidural analgesia Show forest plot	1	32	Risk Ratio (M‐H, Fixed, 95% CI)	1.57 [0.82, 3.00]

Comparison 29. (3.11) PGF2a vs PGE2 (all primiparae, unfavourable cervix)

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Comparison 31. (4.1) PGE2 gel vs PGE2 tablet (all women)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Vaginal delivery not achieved within 24 hours Show forest plot	2	401	Risk Ratio (M‐H, Fixed, 95% CI)	1.12 [0.85, 1.49]

2 Uterine hyperstimulation with FHR changes Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	2.0 [0.18, 21.71]

3 Caesarean section Show forest plot	5	881	Risk Ratio (M‐H, Fixed, 95% CI)	0.87 [0.64, 1.17]

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

6 Cervix unfavourable/unchanged after 12 to 24 hours Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.77 [0.56, 1.07]

7 Oxytocin augmentation Show forest plot	5	577	Risk Ratio (M‐H, Fixed, 95% CI)	0.84 [0.72, 0.97]

10 Epidural analgesia Show forest plot	2	400	Risk Ratio (M‐H, Fixed, 95% CI)	1.02 [0.89, 1.19]

11 Instrumental vaginal delivery Show forest plot	2	400	Risk Ratio (M‐H, Fixed, 95% CI)	0.81 [0.59, 1.10]

13 Apgar score < 7 at 5 minutes Show forest plot	3	432	Risk Ratio (M‐H, Fixed, 95% CI)	0.72 [0.18, 2.87]

23 Postpartum haemorrhage Show forest plot	2	280	Risk Ratio (M‐H, Fixed, 95% CI)	0.65 [0.16, 2.65]

Comparison 31. (4.1) PGE2 gel vs PGE2 tablet (all women)

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Comparison 33. (4.2) PGE2 gel vs PGE2 tablet (all women, unfavourable cervix)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Vaginal delivery not achieved within 24 hours Show forest plot	1	73	Risk Ratio (M‐H, Fixed, 95% CI)	1.28 [0.87, 1.87]

2 Uterine hyperstimulation with FHR changes Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	2.0 [0.18, 21.71]

3 Caesarean section Show forest plot	3	353	Risk Ratio (M‐H, Fixed, 95% CI)	0.93 [0.63, 1.38]

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

6 Cervix unfavourable/unchanged after 12 to 24 hours Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.77 [0.56, 1.07]

7 Oxytocin augmentation Show forest plot	4	377	Risk Ratio (M‐H, Fixed, 95% CI)	0.85 [0.71, 1.02]

10 Epidural analgesia Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.96 [0.85, 1.10]

11 Instrumental vaginal delivery Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.88 [0.61, 1.25]

13 Apgar score < 7 at 5 minutes Show forest plot	2	104	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 7.95]

23 Postpartum haemorrhage Show forest plot	1	80	Risk Ratio (M‐H, Fixed, 95% CI)	0.5 [0.05, 5.30]

Comparison 33. (4.2) PGE2 gel vs PGE2 tablet (all women, unfavourable cervix)

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Comparison 34. (4.3) PGE2 gel vs PGE2 tablet (all women, favourable cervix)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Vaginal delivery not achieved within 24 hours Show forest plot	1	328	Risk Ratio (M‐H, Fixed, 95% CI)	1.05 [0.71, 1.54]

2 Caesarean section Show forest plot	1	328	Risk Ratio (M‐H, Fixed, 95% CI)	0.75 [0.40, 1.41]

7 Oxytocin augmentation Show forest plot	1	24	Risk Ratio (M‐H, Fixed, 95% CI)	1.0 [0.39, 2.58]

13 Apgar score < 7 at 5 minutes Show forest plot	2	352	Risk Ratio (M‐H, Fixed, 95% CI)	0.90 [0.18, 4.37]

Comparison 34. (4.3) PGE2 gel vs PGE2 tablet (all women, favourable cervix)

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Comparison 35. (4.4) PGE2 gel vs PGE2 tablet (all women, intact membranes, variable or undefined cervix)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
3 Caesarean section Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.85 [0.42, 1.69]

7 Oxytocin augmentation Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.81 [0.63, 1.05]

10 Epidural analgesia Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	1.20 [0.80, 1.82]

11 Instrumental vaginal delivery Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.69 [0.38, 1.26]

23 Postpartum haemorrhage Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.75 [0.13, 4.40]

Comparison 35. (4.4) PGE2 gel vs PGE2 tablet (all women, intact membranes, variable or undefined cervix)

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Comparison 36. (4.5) PGE2 gel vs PGE2 tablet (all women, intact membranes, unfavourable cervix)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Vaginal delivery not achieved within 24 hours Show forest plot	1	73	Risk Ratio (M‐H, Fixed, 95% CI)	1.28 [0.87, 1.87]

2 Uterine hyperstimulation with FHR changes Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	2.0 [0.18, 21.71]

3 Caesarean section Show forest plot	2	273	Risk Ratio (M‐H, Fixed, 95% CI)	1.11 [0.71, 1.74]

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

6 Cervix unfavourable/unchanged after 12 to 24 hours Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.77 [0.56, 1.07]

7 Oxytocin augmentation Show forest plot	2	273	Risk Ratio (M‐H, Fixed, 95% CI)	0.98 [0.82, 1.18]

10 Epidural analgesia Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.96 [0.85, 1.10]

11 Instrumental vaginal delivery Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.88 [0.61, 1.25]

Comparison 36. (4.5) PGE2 gel vs PGE2 tablet (all women, intact membranes, unfavourable cervix)

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Comparison 37. (4.10) PGE2 gel vs PGE2 tablet (all primiparae)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Vaginal delivery not achieved within 24 hours Show forest plot	1	73	Risk Ratio (M‐H, Fixed, 95% CI)	1.28 [0.87, 1.87]

2 Uterine hyperstimulation with FHR changes Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	2.0 [0.18, 21.71]

3 Caesarean section Show forest plot	3	353	Risk Ratio (M‐H, Fixed, 95% CI)	0.93 [0.63, 1.38]

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

6 Cervix unfavourable/unchanged after 12 to 24 hours Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.77 [0.56, 1.07]

7 Oxytocin augmentation Show forest plot	3	353	Risk Ratio (M‐H, Fixed, 95% CI)	0.84 [0.70, 1.01]

10 Epidural analgesia Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.96 [0.85, 1.10]

11 Instrumental vaginal delivery Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.88 [0.61, 1.25]

13 Apgar score < 7 at 5 minutes Show forest plot	1	80	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 7.95]

23 Postpartum haemorrhage Show forest plot	1	80	Risk Ratio (M‐H, Fixed, 95% CI)	0.5 [0.05, 5.30]

Comparison 37. (4.10) PGE2 gel vs PGE2 tablet (all primiparae)

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Comparison 38. (4.11) PGE2 gel vs PGE2 tablet (all primiparae, unfavourable cervix)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Vaginal delivery not achieved within 24 hours Show forest plot	1	73	Risk Ratio (M‐H, Fixed, 95% CI)	1.28 [0.87, 1.87]

2 Uterine hyperstimulation with FHR changes Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	2.0 [0.18, 21.71]

3 Caesarean section Show forest plot	3	353	Risk Ratio (M‐H, Fixed, 95% CI)	0.93 [0.63, 1.38]

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

6 Cervix unfavourable/unchanged after 12 to 24 hours Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.77 [0.56, 1.07]

7 Oxytocin augmentation Show forest plot	3	353	Risk Ratio (M‐H, Fixed, 95% CI)	0.84 [0.70, 1.01]

10 Epidural analgesia Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.96 [0.85, 1.10]

11 Instrumental vaginal delivery Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.88 [0.61, 1.25]

13 Apgar score < 7 at 5 minutes Show forest plot	1	80	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 7.95]

23 Postpartum haemorrhage Show forest plot	1	80	Risk Ratio (M‐H, Fixed, 95% CI)	0.5 [0.05, 5.30]

Comparison 38. (4.11) PGE2 gel vs PGE2 tablet (all primiparae, unfavourable cervix)

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Comparison 39. (4.14) PGE2 gel vs PGE2 tablet (all primiparae, intact membranes, unfavourable cervix)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Vaginal delivery not achieved within 24 hours Show forest plot	1	73	Risk Ratio (M‐H, Fixed, 95% CI)	1.28 [0.87, 1.87]

2 Uterine hyperstimulation with FHR changes Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	2.0 [0.18, 21.71]

3 Caesarean section Show forest plot	2	273	Risk Ratio (M‐H, Fixed, 95% CI)	1.11 [0.71, 1.74]

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

6 Cervix unfavourable/unchanged after 12 to 24 hours Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.77 [0.56, 1.07]

7 Oxytocin augmentation Show forest plot	2	273	Risk Ratio (M‐H, Fixed, 95% CI)	0.98 [0.82, 1.18]

10 Epidural analgesia Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.96 [0.85, 1.10]

11 Instrumental vaginal delivery Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.88 [0.61, 1.25]

Comparison 39. (4.14) PGE2 gel vs PGE2 tablet (all primiparae, intact membranes, unfavourable cervix)

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Comparison 40. (5.1) PGE2 gel vs PGE2 suppository/pessary (all women)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
2 Uterine hyperstimulation with FHR changes Show forest plot	2	159	Risk Ratio (M‐H, Fixed, 95% CI)	0.16 [0.03, 0.87]

3 Caesarean section Show forest plot	2	159	Risk Ratio (M‐H, Fixed, 95% CI)	0.65 [0.38, 1.11]

8 Uterine hyperstimulation without FHR changes Show forest plot	1	90	Risk Ratio (M‐H, Fixed, 95% CI)	0.2 [0.01, 4.05]

13 Apgar score < 7 at 5 minutes Show forest plot	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.21 [0.01, 4.13]

18 Maternal side‐effects (all) Show forest plot	2	460	Risk Ratio (M‐H, Fixed, 95% CI)	0.2 [0.02, 1.70]

19 Nausea (maternal) Show forest plot	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.34 [0.01, 8.13]

20 Vomitting (maternal) Show forest plot	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.34 [0.01, 8.13]

21 Diarrhoea (maternal) Show forest plot	2	159	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 7.97]

22 Other maternal side‐effects Show forest plot	2	159	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 7.97]

Comparison 40. (5.1) PGE2 gel vs PGE2 suppository/pessary (all women)

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Comparison 41. (5.2) PGE2 gel vs PGE2 suppository/pessary (all women, unfavourable cervix)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
2 Uterine hyperstimulation with FHR changes Show forest plot	2	159	Risk Ratio (M‐H, Fixed, 95% CI)	0.16 [0.03, 0.87]

3 Caesarean section Show forest plot	2	159	Risk Ratio (M‐H, Fixed, 95% CI)	0.65 [0.38, 1.11]

8 Uterine hyperstimulation without FHR changes Show forest plot	1	90	Risk Ratio (M‐H, Fixed, 95% CI)	0.2 [0.01, 4.05]

13 Apgar score < 7 at 5 minutes Show forest plot	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.21 [0.01, 4.13]

18 Maternal side‐effects (all) Show forest plot	2	460	Risk Ratio (M‐H, Fixed, 95% CI)	0.2 [0.02, 1.70]

19 Nausea (maternal) Show forest plot	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.34 [0.01, 8.13]

20 Vomitting (maternal) Show forest plot	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.34 [0.01, 8.13]

21 Diarrhoea (maternal) Show forest plot	2	159	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 7.97]

22 Other maternal side‐effects Show forest plot	2	159	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 7.97]

Comparison 41. (5.2) PGE2 gel vs PGE2 suppository/pessary (all women, unfavourable cervix)

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Comparison 42. (5.5) PGE2 gel vs PGE2 suppository/pessary (all women, intact membranes, unfavourable cervix)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
2 Uterine hyperstimulation with FHR changes Show forest plot	2	159	Risk Ratio (M‐H, Fixed, 95% CI)	0.16 [0.03, 0.87]

3 Caesarean section Show forest plot	2	159	Risk Ratio (M‐H, Fixed, 95% CI)	0.65 [0.38, 1.11]

8 Uterine hyperstimulation without FHR changes Show forest plot	1	90	Risk Ratio (M‐H, Fixed, 95% CI)	0.2 [0.01, 4.05]

13 Apgar score < 7 at 5 minutes Show forest plot	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.21 [0.01, 4.13]

18 Maternal side‐effects (all) Show forest plot	2	460	Risk Ratio (M‐H, Fixed, 95% CI)	0.2 [0.02, 1.70]

19 Nausea (maternal) Show forest plot	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.34 [0.01, 8.13]

20 Vomitting (maternal) Show forest plot	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.34 [0.01, 8.13]

21 Diarrhoea (maternal) Show forest plot	2	159	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 7.97]

22 Other maternal side‐effects Show forest plot	2	159	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 7.97]

Comparison 42. (5.5) PGE2 gel vs PGE2 suppository/pessary (all women, intact membranes, unfavourable cervix)

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Comparison 43. (6.1) PGE2 tablet vs PGE2 pessary/suppository (all women)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
3 Caesarean section Show forest plot	3	491	Risk Ratio (M‐H, Fixed, 95% CI)	1.13 [0.64, 1.99]

7 Oxytocin augmentation Show forest plot	3	491	Risk Ratio (M‐H, Fixed, 95% CI)	0.73 [0.56, 0.96]

8 Uterine hyperstimulation without FHR changes Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

10 Epidural analgesia Show forest plot	1	24	Risk Ratio (M‐H, Fixed, 95% CI)	0.67 [0.25, 1.78]

11 Instrumental vaginal delivery Show forest plot	3	491	Risk Ratio (M‐H, Fixed, 95% CI)	1.72 [1.09, 2.70]

13 Apgar score < 7 at 5 minutes Show forest plot	2	467	Risk Ratio (M‐H, Fixed, 95% CI)	1.33 [0.58, 3.05]

18 Maternal side‐effects (all) Show forest plot	1	400	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

20 Vomitting (maternal) Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

21 Diarrhoea (maternal) Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

23 Postpartum haemorrhage Show forest plot	1	267	Risk Ratio (M‐H, Fixed, 95% CI)	1.12 [0.57, 2.20]

Comparison 43. (6.1) PGE2 tablet vs PGE2 pessary/suppository (all women)

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Comparison 44. (6.2) PGE2 tablet vs PGE2 pessary/suppository (all women, unfavourable cervix)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
3 Caesarean section Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	1.0 [0.26, 3.89]

7 Oxytocin augmentation Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.35 [0.19, 0.64]

8 Uterine hyperstimulation without FHR changes Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

11 Instrumental vaginal delivery Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	1.11 [0.47, 2.62]

13 Apgar score < 7 at 5 minutes Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	1.25 [0.51, 3.04]

18 Maternal side‐effects (all) Show forest plot	1	400	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

20 Vomitting (maternal) Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

21 Diarrhoea (maternal) Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 44. (6.2) PGE2 tablet vs PGE2 pessary/suppository (all women, unfavourable cervix)

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Comparison 45. (6.10) PGE2 tablet vs PGE2 pessary/suppository (all primiparae)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
3 Caesarean section Show forest plot	1	141	Risk Ratio (M‐H, Fixed, 95% CI)	1.21 [0.57, 2.58]

7 Oxytocin augmentation Show forest plot	1	141	Risk Ratio (M‐H, Fixed, 95% CI)	1.27 [0.85, 1.88]

Comparison 45. (6.10) PGE2 tablet vs PGE2 pessary/suppository (all primiparae)

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Comparison 46. (6.19) PGE2 tablet vs PGE2 pessary/suppository (all multiparae)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
3 Caesarean section Show forest plot	1	126	Risk Ratio (M‐H, Fixed, 95% CI)	0.83 [0.23, 2.93]

7 Oxytocin augmentation Show forest plot	1	126	Risk Ratio (M‐H, Fixed, 95% CI)	0.66 [0.37, 1.16]

Comparison 46. (6.19) PGE2 tablet vs PGE2 pessary/suppository (all multiparae)

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Comparison 47. (7.1) PGE2 (controlled release) vs all PGE2 delivery systems (all women)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Vaginal delivery not achieved within 24 hours Show forest plot	2	320	Risk Ratio (M‐H, Fixed, 95% CI)	1.02 [0.84, 1.25]

2 Uterine hyperstimulation with FHR changes Show forest plot	4	513	Risk Ratio (M‐H, Fixed, 95% CI)	2.15 [0.89, 5.21]

3 Caesarean section Show forest plot	8	929	Risk Ratio (M‐H, Fixed, 95% CI)	1.10 [0.83, 1.46]

4 Serious neonatal morbidity or perinatal death Show forest plot	2	320	Risk Ratio (M‐H, Fixed, 95% CI)	0.31 [0.01, 7.62]

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

7 Oxytocin augmentation Show forest plot	5	681	Risk Ratio (M‐H, Fixed, 95% CI)	0.87 [0.72, 1.05]

8 Uterine hyperstimulation without FHR changes Show forest plot	7	778	Risk Ratio (M‐H, Fixed, 95% CI)	1.59 [0.81, 3.14]

9 Uterine rupture Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 8.09]

10 Epidural analgesia Show forest plot	2	164	Risk Ratio (M‐H, Fixed, 95% CI)	0.97 [0.78, 1.21]

11 Instrumental vaginal delivery Show forest plot	5	661	Risk Ratio (M‐H, Fixed, 95% CI)	0.51 [0.35, 0.76]

13 Apgar score < 7 at 5 minutes Show forest plot	2	240	Risk Ratio (M‐H, Fixed, 95% CI)	3.0 [0.12, 72.77]

20 Vomitting (maternal) Show forest plot	1	120	Risk Ratio (M‐H, Fixed, 95% CI)	5.0 [0.25, 102.00]

21 Diarrhoea (maternal) Show forest plot	1	120	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 8.02]

Comparison 47. (7.1) PGE2 (controlled release) vs all PGE2 delivery systems (all women)

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Comparison 48. (7.2) PGE2 (controlled release) vs all PGE2 delivery systems (all women, unfavourable cervix)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
2 Uterine hyperstimulation with FHR changes Show forest plot	2	193	Risk Ratio (M‐H, Fixed, 95% CI)	6.67 [0.86, 51.67]

3 Caesarean section Show forest plot	5	540	Risk Ratio (M‐H, Fixed, 95% CI)	1.12 [0.76, 1.66]

4 Serious neonatal morbidity or perinatal death Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.31 [0.01, 7.62]

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

7 Oxytocin augmentation Show forest plot	3	361	Risk Ratio (M‐H, Fixed, 95% CI)	0.71 [0.52, 0.96]

8 Uterine hyperstimulation without FHR changes Show forest plot	4	407	Risk Ratio (M‐H, Fixed, 95% CI)	5.81 [0.71, 47.25]

10 Epidural analgesia Show forest plot	2	135	Risk Ratio (M‐H, Fixed, 95% CI)	1.05 [0.85, 1.30]

11 Instrumental vaginal delivery Show forest plot	2	272	Risk Ratio (M‐H, Fixed, 95% CI)	0.38 [0.21, 0.69]

13 Apgar score < 7 at 5 minutes Show forest plot	1	40	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 48. (7.2) PGE2 (controlled release) vs all PGE2 delivery systems (all women, unfavourable cervix)

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Comparison 49. (7.1) PGE2 (controlled release) vs all PGE2 delivery systems (all women, intact, variable cervix)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
3 Caesarean section Show forest plot	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	1.54 [0.48, 4.99]

10 Epidural analgesia Show forest plot	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	1.13 [0.55, 2.31]

11 Instrumental vaginal delivery Show forest plot	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.94 [0.46, 1.91]

Comparison 49. (7.1) PGE2 (controlled release) vs all PGE2 delivery systems (all women, intact, variable cervix)

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Comparison 50. (7.5) PGE2 (controlled release) vs all PGE2 delivery systems (all women, intact membranes, unfav. cervix)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
2 Uterine hyperstimulation with FHR changes Show forest plot	1	121	Risk Ratio (M‐H, Fixed, 95% CI)	6.67 [0.86, 51.67]

3 Caesarean section Show forest plot	2	321	Risk Ratio (M‐H, Fixed, 95% CI)	1.23 [0.74, 2.05]

4 Serious neonatal morbidity or perinatal death Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.31 [0.01, 7.62]

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

7 Oxytocin augmentation Show forest plot	2	321	Risk Ratio (M‐H, Fixed, 95% CI)	0.65 [0.48, 0.89]

8 Uterine hyperstimulation without FHR changes Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	6.60 [0.35, 126.07]

11 Instrumental vaginal delivery Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.35 [0.17, 0.72]

Comparison 50. (7.5) PGE2 (controlled release) vs all PGE2 delivery systems (all women, intact membranes, unfav. cervix)

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Comparison 51. (7.10) PGE2 (controlled release) vs all PGE2 delivery systems (all primiparae)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
2 Uterine hyperstimulation with FHR changes Show forest plot	2	98	Risk Ratio (M‐H, Fixed, 95% CI)	7.44 [0.43, 128.16]

3 Caesarean section Show forest plot	2	98	Risk Ratio (M‐H, Fixed, 95% CI)	0.88 [0.27, 2.79]

7 Oxytocin augmentation Show forest plot	1	55	Risk Ratio (M‐H, Fixed, 95% CI)	0.44 [0.22, 0.91]

8 Uterine hyperstimulation without FHR changes Show forest plot	1	95	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

10 Epidural analgesia Show forest plot	1	95	Risk Ratio (M‐H, Fixed, 95% CI)	1.0 [0.82, 1.22]

11 Instrumental vaginal delivery Show forest plot	1	43	Risk Ratio (M‐H, Fixed, 95% CI)	0.70 [0.23, 2.13]

Comparison 51. (7.10) PGE2 (controlled release) vs all PGE2 delivery systems (all primiparae)

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Comparison 52. (7.11) PGE2 (controlled release) vs all PGE2 delivery systems (all primiparae, unfavourable cervix)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
2 Uterine hyperstimulation with FHR changes Show forest plot	2	98	Risk Ratio (M‐H, Fixed, 95% CI)	7.44 [0.43, 128.16]

3 Caesarean section Show forest plot	2	98	Risk Ratio (M‐H, Fixed, 95% CI)	0.88 [0.27, 2.79]

7 Oxytocin augmentation Show forest plot	1	55	Risk Ratio (M‐H, Fixed, 95% CI)	0.44 [0.22, 0.91]

8 Uterine hyperstimulation without FHR changes Show forest plot	1	95	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

10 Epidural analgesia Show forest plot	1	95	Risk Ratio (M‐H, Fixed, 95% CI)	1.0 [0.82, 1.22]

11 Instrumental vaginal delivery Show forest plot	1	43	Risk Ratio (M‐H, Fixed, 95% CI)	0.70 [0.23, 2.13]

Comparison 52. (7.11) PGE2 (controlled release) vs all PGE2 delivery systems (all primiparae, unfavourable cervix)

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Comparison 53. (7.14) PGE2 (controlled release) vs all PGE2 delivery systems (all prim., intact membranes, unfav. cervix)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
2 Uterine hyperstimulation with FHR changes Show forest plot	1	55	Risk Ratio (M‐H, Fixed, 95% CI)	7.44 [0.43, 128.16]

3 Caesarean section Show forest plot	1	55	Risk Ratio (M‐H, Fixed, 95% CI)	0.67 [0.10, 4.39]

7 Oxytocin augmentation Show forest plot	1	55	Risk Ratio (M‐H, Fixed, 95% CI)	0.44 [0.22, 0.91]

Comparison 53. (7.14) PGE2 (controlled release) vs all PGE2 delivery systems (all prim., intact membranes, unfav. cervix)

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Comparison 54. (7.19) PGE2 (controlled release) vs all PGE2 delivery systems (all multiparae)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
2 Uterine hyperstimulation with FHR changes Show forest plot	2	95	Risk Ratio (M‐H, Fixed, 95% CI)	3.0 [0.33, 27.38]

3 Caesarean section Show forest plot	2	95	Risk Ratio (M‐H, Fixed, 95% CI)	1.53 [0.33, 7.14]

7 Oxytocin augmentation Show forest plot	1	66	Risk Ratio (M‐H, Fixed, 95% CI)	0.41 [0.20, 0.86]

11 Instrumental vaginal delivery Show forest plot	1	29	Risk Ratio (M‐H, Fixed, 95% CI)	0.62 [0.13, 2.85]

Comparison 54. (7.19) PGE2 (controlled release) vs all PGE2 delivery systems (all multiparae)

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Comparison 55. (7.20) PGE2 (controlled release) vs all PGE2 delivery systems (all multiparae, unfavourable cervix)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
2 Uterine hyperstimulation with FHR changes Show forest plot	2	95	Risk Ratio (M‐H, Fixed, 95% CI)	3.0 [0.33, 27.38]

3 Caesarean section Show forest plot	2	95	Risk Ratio (M‐H, Fixed, 95% CI)	1.53 [0.33, 7.14]

7 Oxytocin augmentation Show forest plot	1	66	Risk Ratio (M‐H, Fixed, 95% CI)	0.41 [0.20, 0.86]

11 Instrumental vaginal delivery Show forest plot	1	29	Risk Ratio (M‐H, Fixed, 95% CI)	0.62 [0.13, 2.85]

Comparison 55. (7.20) PGE2 (controlled release) vs all PGE2 delivery systems (all multiparae, unfavourable cervix)

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Comparison 56. (7.23) PGE2 (controlled release) vs all PGE2 delivery systems (all multi., intact membranes, unfav. cervix)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
2 Uterine hyperstimulation with FHR changes Show forest plot	1	66	Risk Ratio (M‐H, Fixed, 95% CI)	3.0 [0.33, 27.38]

3 Caesarean section Show forest plot	1	66	Risk Ratio (M‐H, Fixed, 95% CI)	0.5 [0.05, 5.25]

7 Oxytocin augmentation Show forest plot	1	66	Risk Ratio (M‐H, Fixed, 95% CI)	0.41 [0.20, 0.86]

Comparison 56. (7.23) PGE2 (controlled release) vs all PGE2 delivery systems (all multi., intact membranes, unfav. cervix)

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Comparison 57. (8.1) PGE2 low dose vs PGE2 high dose (all women)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
2 Uterine hyperstimulation with FHR changes Show forest plot	2	140	Risk Ratio (M‐H, Fixed, 95% CI)	0.18 [0.03, 0.99]

3 Caesarean section Show forest plot	7	1466	Risk Ratio (M‐H, Fixed, 95% CI)	1.07 [0.80, 1.42]

4 Serious neonatal morbidity or perinatal death Show forest plot	1	955	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

7 Oxytocin augmentation Show forest plot	4	1219	Risk Ratio (M‐H, Fixed, 95% CI)	1.09 [0.95, 1.24]

8 Uterine hyperstimulation without FHR changes Show forest plot	1	40	Risk Ratio (M‐H, Fixed, 95% CI)	0.2 [0.01, 3.92]

10 Epidural analgesia Show forest plot	3	1179	Risk Ratio (M‐H, Fixed, 95% CI)	1.11 [0.96, 1.29]

11 Instrumental vaginal delivery Show forest plot	3	1179	Risk Ratio (M‐H, Fixed, 95% CI)	0.89 [0.70, 1.13]

12 Meconium‐stained liquor Show forest plot	1	955	Risk Ratio (M‐H, Fixed, 95% CI)	0.86 [0.67, 1.10]

13 Apgar score < 7 at 5 minutes Show forest plot	3	1064	Risk Ratio (M‐H, Fixed, 95% CI)	0.51 [0.20, 1.31]

14 Neonatal intensive care unit admission Show forest plot	1	955	Risk Ratio (M‐H, Fixed, 95% CI)	0.51 [0.24, 1.09]

16 Perinatal death Show forest plot	1	955	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

18 Maternal side‐effects (all) Show forest plot	2	351	Risk Ratio (M‐H, Fixed, 95% CI)	0.34 [0.08, 1.36]

19 Nausea (maternal) Show forest plot	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.34 [0.01, 8.13]

20 Vomitting (maternal) Show forest plot	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.34 [0.01, 8.13]

21 Diarrhoea (maternal) Show forest plot	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

22 Other maternal side‐effects Show forest plot	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

23 Postpartum haemorrhage Show forest plot	2	1155	Risk Ratio (M‐H, Fixed, 95% CI)	1.28 [0.79, 2.09]

Comparison 57. (8.1) PGE2 low dose vs PGE2 high dose (all women)

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Comparison 58. (8.2) PGE2 low dose vs PGE2 high dose (all women, unfavourable cervix)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
2 Uterine hyperstimulation with FHR changes Show forest plot	2	140	Risk Ratio (M‐H, Fixed, 95% CI)	0.18 [0.03, 0.99]

3 Caesarean section Show forest plot	4	287	Risk Ratio (M‐H, Fixed, 95% CI)	1.13 [0.70, 1.81]

7 Oxytocin augmentation Show forest plot	1	40	Risk Ratio (M‐H, Fixed, 95% CI)	0.4 [0.09, 1.83]

8 Uterine hyperstimulation without FHR changes Show forest plot	1	40	Risk Ratio (M‐H, Fixed, 95% CI)	0.2 [0.01, 3.92]

13 Apgar score < 7 at 5 minutes Show forest plot	2	109	Risk Ratio (M‐H, Fixed, 95% CI)	0.21 [0.01, 4.13]

18 Maternal side‐effects (all) Show forest plot	2	351	Risk Ratio (M‐H, Fixed, 95% CI)	0.34 [0.08, 1.36]

19 Nausea (maternal) Show forest plot	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.34 [0.01, 8.13]

20 Vomitting (maternal) Show forest plot	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.34 [0.01, 8.13]

21 Diarrhoea (maternal) Show forest plot	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

22 Other maternal side‐effects Show forest plot	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 58. (8.2) PGE2 low dose vs PGE2 high dose (all women, unfavourable cervix)

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Comparison 59. (8.4) PGE2 low dose vs PGE2 high dose (all women, intact membranes, variable or undefined cervix)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
3 Caesarean section Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.85 [0.42, 1.69]

7 Oxytocin augmentation Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.81 [0.63, 1.05]

10 Epidural analgesia Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	1.20 [0.80, 1.82]

11 Instrumental vaginal delivery Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.69 [0.38, 1.26]

23 Postpartum haemorrhage Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.75 [0.13, 4.40]

Comparison 59. (8.4) PGE2 low dose vs PGE2 high dose (all women, intact membranes, variable or undefined cervix)

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Comparison 60. (8.5) PGE2 low dose vs PGE2 high dose (all women, intact membranes, unfavourable cervix)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
2 Uterine hyperstimulation with FHR changes Show forest plot	2	140	Risk Ratio (M‐H, Fixed, 95% CI)	0.18 [0.03, 0.99]

3 Caesarean section Show forest plot	2	140	Risk Ratio (M‐H, Fixed, 95% CI)	1.03 [0.54, 1.94]

13 Apgar score < 7 at 5 minutes Show forest plot	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.21 [0.01, 4.13]

18 Maternal side‐effects (all) Show forest plot	2	351	Risk Ratio (M‐H, Fixed, 95% CI)	0.34 [0.08, 1.36]

19 Nausea (maternal) Show forest plot	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.34 [0.01, 8.13]

20 Vomitting (maternal) Show forest plot	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.34 [0.01, 8.13]

21 Diarrhoea (maternal) Show forest plot	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

22 Other maternal side‐effects Show forest plot	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 60. (8.5) PGE2 low dose vs PGE2 high dose (all women, intact membranes, unfavourable cervix)

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Comparison 61. (8.10) PGE2 low dose vs PGE2 high dose (all primiparae)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
3 Caesarean section Show forest plot	1	499	Risk Ratio (M‐H, Fixed, 95% CI)	1.29 [0.82, 2.03]

4 Serious neonatal morbidity or perinatal death Show forest plot	1	499	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

7 Oxytocin augmentation Show forest plot	1	499	Risk Ratio (M‐H, Fixed, 95% CI)	1.10 [0.94, 1.28]

10 Epidural analgesia Show forest plot	1	499	Risk Ratio (M‐H, Fixed, 95% CI)	1.19 [1.03, 1.39]

11 Instrumental vaginal delivery Show forest plot	1	499	Risk Ratio (M‐H, Fixed, 95% CI)	0.92 [0.71, 1.18]

12 Meconium‐stained liquor Show forest plot	1	499	Risk Ratio (M‐H, Fixed, 95% CI)	0.95 [0.72, 1.27]

13 Apgar score < 7 at 5 minutes Show forest plot	1	499	Risk Ratio (M‐H, Fixed, 95% CI)	0.16 [0.02, 1.27]

14 Neonatal intensive care unit admission Show forest plot	1	499	Risk Ratio (M‐H, Fixed, 95% CI)	0.34 [0.11, 1.03]

16 Perinatal death Show forest plot	1	499	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

23 Postpartum haemorrhage Show forest plot	1	499	Risk Ratio (M‐H, Fixed, 95% CI)	1.62 [0.86, 3.05]

Comparison 61. (8.10) PGE2 low dose vs PGE2 high dose (all primiparae)

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Comparison 62. (8.19) PGE2 low dose vs PGE2 high dose (all multiparae)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
3 Caesarean section Show forest plot	1	456	Risk Ratio (M‐H, Fixed, 95% CI)	0.68 [0.19, 2.51]

4 Serious neonatal morbidity or perinatal death Show forest plot	1	456	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

7 Oxytocin augmentation Show forest plot	1	456	Risk Ratio (M‐H, Fixed, 95% CI)	1.94 [1.35, 2.80]

10 Epidural analgesia Show forest plot	1	456	Risk Ratio (M‐H, Fixed, 95% CI)	1.15 [0.77, 1.70]

11 Instrumental vaginal delivery Show forest plot	1	456	Risk Ratio (M‐H, Fixed, 95% CI)	5.98 [1.37, 25.99]

12 Meconium‐stained liquor Show forest plot	1	456	Risk Ratio (M‐H, Fixed, 95% CI)	0.77 [0.48, 1.24]

13 Apgar score < 7 at 5 minutes Show forest plot	1	456	Risk Ratio (M‐H, Fixed, 95% CI)	1.42 [0.34, 5.88]

14 Neonatal intensive care unit admission Show forest plot	1	492	Risk Ratio (M‐H, Fixed, 95% CI)	1.0 [0.33, 3.06]

16 Perinatal death Show forest plot	1	465	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

23 Postpartum haemorrhage Show forest plot	1	456	Risk Ratio (M‐H, Fixed, 95% CI)	1.04 [0.44, 2.47]

Comparison 62. (8.19) PGE2 low dose vs PGE2 high dose (all multiparae)

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Comparison 63. PGE2 (all regimens) vs placebo/no treatment (all women, outpatient ripening)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
2 Uterine hyperstimulation with FHR changes Show forest plot	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

2.2 PGE2 (repeated doses) vs placebo/no treatment	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3 Caesarean section Show forest plot	2	300	Risk Ratio (M‐H, Fixed, 95% CI)	0.70 [0.42, 1.18]

3.2 PGE2 (repeated doses) vs placebo/no treatment	2	300	Risk Ratio (M‐H, Fixed, 95% CI)	0.70 [0.42, 1.18]
6 Cervix unfavourable/unchanged after 12 to 24 hours Show forest plot	1	36	Risk Ratio (M‐H, Fixed, 95% CI)	0.13 [0.03, 0.47]

6.2 PGE2 (repeated doses) vs placebo/no treatment	1	36	Risk Ratio (M‐H, Fixed, 95% CI)	0.13 [0.03, 0.47]
8 Uterine hyperstimulation without FHR changes Show forest plot	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	3.0 [0.13, 71.92]

8.2 PGE2 (repeated doses) vs placebo/no treatment	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	3.0 [0.13, 71.92]
10 Epidural analgesia Show forest plot	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	0.83 [0.62, 1.12]

10.2 PGE2 (repeated doses) vs placebo/no treatment	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	0.83 [0.62, 1.12]
12 Meconium‐stained liquor Show forest plot	2	300	Risk Ratio (M‐H, Fixed, 95% CI)	0.43 [0.28, 0.66]

12.2 PGE2 (repeated doses) vs placebo/no treatment	2	300	Risk Ratio (M‐H, Fixed, 95% CI)	0.43 [0.28, 0.66]
13 Apgar score < 7 at 5 minutes Show forest plot	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	0.2 [0.01, 4.06]

13.2 PGE2 (repeated doses) vs placebo/no treatment	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	0.2 [0.01, 4.06]
14 Neonatal intensive care unit admission Show forest plot	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	0.2 [0.02, 1.65]

14.2 PGE2 (repeated doses) vs placebo/no treatment	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	0.2 [0.02, 1.65]

Comparison 63. PGE2 (all regimens) vs placebo/no treatment (all women, outpatient ripening)

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