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

Jane Thomas; Anna Fairclough; Josephine Kavanagh; Anthony J Kelly

doi:10.1002/14651858.CD003101.pub3

Scolaris Content Display Scolaris Content Display

Figure 1

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Figure 2

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.

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Figure 3

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 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 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 vs placebo/no treatment (all women), Outcome 3 Caesarean section.

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Analysis 1.4

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

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Analysis 1.8

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

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Analysis 1.10

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

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Analysis 1.11

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

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Analysis 1.12

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

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Analysis 1.13

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

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Analysis 1.15

Comparison 1 (1.1) PGE2 vs placebo/no treatment (all women), Outcome 15 Perinatal death.

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Analysis 1.16

Comparison 1 (1.1) PGE2 vs placebo/no treatment (all women), Outcome 16 Maternal side‐effects (all).

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Analysis 1.17

Comparison 1 (1.1) PGE2 vs placebo/no treatment (all women), Outcome 17 Nausea (maternal).

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Analysis 1.18

Comparison 1 (1.1) PGE2 vs placebo/no treatment (all women), Outcome 18 Vomitting (maternal).

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Analysis 1.19

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

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Analysis 1.20

Comparison 1 (1.1) PGE2 vs placebo/no treatment (all women), Outcome 20 Other maternal side‐effects.

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Analysis 1.21

Comparison 1 (1.1) PGE2 vs placebo/no treatment (all women), Outcome 21 Postpartum haemorrhage.

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Analysis 1.22

Comparison 1 (1.1) PGE2 vs placebo/no treatment (all women), Outcome 22 Serious maternal complication.

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Analysis 1.23

Comparison 1 (1.1) PGE2 vs placebo/no treatment (all women), Outcome 23 Woman not satisfied.

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Analysis 2.1

Comparison 2 (1.2) PGE2 vs placebo/no treatment (primiparae), Outcome 1 Vaginal delivery not achieved within 24 hours.

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Analysis 2.2

Comparison 2 (1.2) PGE2 vs placebo/no treatment (primiparae), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 2.3

Comparison 2 (1.2) PGE2 vs placebo/no treatment (primiparae), Outcome 3 Caesarean section.

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Analysis 2.4

Comparison 2 (1.2) PGE2 vs placebo/no treatment (primiparae), Outcome 4 Serious neonatal morbidity or perinatal death.

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Analysis 2.5

Comparison 2 (1.2) PGE2 vs placebo/no treatment (primiparae), Outcome 5 Serious maternal morbidity or death.

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Analysis 2.6

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

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Analysis 2.7

Comparison 2 (1.2) PGE2 vs placebo/no treatment (primiparae), Outcome 7 Oxytocin augmentation.

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Analysis 2.8

Comparison 2 (1.2) PGE2 vs placebo/no treatment (primiparae), Outcome 8 Uterine hyperstimulation without FHR changes.

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Analysis 2.9

Comparison 2 (1.2) PGE2 vs placebo/no treatment (primiparae), Outcome 9 Uterine rupture.

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Analysis 2.10

Comparison 2 (1.2) PGE2 vs placebo/no treatment (primiparae), Outcome 10 Epidural analgesia.

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Analysis 2.11

Comparison 2 (1.2) PGE2 vs placebo/no treatment (primiparae), Outcome 11 Instrumental vaginal delivery.

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Analysis 2.12

Comparison 2 (1.2) PGE2 vs placebo/no treatment (primiparae), Outcome 12 Meconium‐stained liquor.

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Analysis 2.13

Comparison 2 (1.2) PGE2 vs placebo/no treatment (primiparae), Outcome 13 Apgar score < 7 at 5 minutes.

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Analysis 2.14

Comparison 2 (1.2) PGE2 vs placebo/no treatment (primiparae), Outcome 14 Neonatal intensive care unit admission.

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Analysis 2.15

Comparison 2 (1.2) PGE2 vs placebo/no treatment (primiparae), Outcome 15 Perinatal death.

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Analysis 2.16

Comparison 2 (1.2) PGE2 vs placebo/no treatment (primiparae), Outcome 16 Maternal side‐effects (all).

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Analysis 2.17

Comparison 2 (1.2) PGE2 vs placebo/no treatment (primiparae), Outcome 17 Vomitting (maternal).

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Analysis 2.18

Comparison 2 (1.2) PGE2 vs placebo/no treatment (primiparae), Outcome 18 Diarrhoea (maternal).

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Analysis 2.19

Comparison 2 (1.2) PGE2 vs placebo/no treatment (primiparae), Outcome 19 Other maternal side‐effects.

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Analysis 2.20

Comparison 2 (1.2) PGE2 vs placebo/no treatment (primiparae), Outcome 20 Postpartum haemorrhage.

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Analysis 3.1

Comparison 3 (1.3) PGE2 vs placebo/no treatment (multiparae), Outcome 1 Vaginal delivery not achieved within 24 hours.

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Analysis 3.2

Comparison 3 (1.3) PGE2 vs placebo/no treatment (multiparae), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 3.3

Comparison 3 (1.3) PGE2 vs placebo/no treatment (multiparae), Outcome 3 Caesarean section.

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Analysis 3.4

Comparison 3 (1.3) PGE2 vs placebo/no treatment (multiparae), Outcome 4 Serious neonatal morbidity or perinatal death.

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Analysis 3.5

Comparison 3 (1.3) PGE2 vs placebo/no treatment (multiparae), Outcome 5 Uterine rupture.

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Analysis 3.6

Comparison 3 (1.3) PGE2 vs placebo/no treatment (multiparae), Outcome 6 Epidural analgesia.

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Analysis 3.7

Comparison 3 (1.3) PGE2 vs placebo/no treatment (multiparae), Outcome 7 Oxytocin augmentation.

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Analysis 3.8

Comparison 3 (1.3) PGE2 vs placebo/no treatment (multiparae), Outcome 8 Uterine hyperstimulation without FHR changes.

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Analysis 3.9

Comparison 3 (1.3) PGE2 vs placebo/no treatment (multiparae), Outcome 9 Instrumental vaginal delivery.

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Analysis 3.10

Comparison 3 (1.3) PGE2 vs placebo/no treatment (multiparae), Outcome 10 Meconium‐stained liquor.

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Analysis 3.11

Comparison 3 (1.3) PGE2 vs placebo/no treatment (multiparae), Outcome 11 Perinatal death.

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Analysis 3.12

Comparison 3 (1.3) PGE2 vs placebo/no treatment (multiparae), Outcome 12 Maternal side‐effects (all).

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Analysis 3.13

Comparison 3 (1.3) PGE2 vs placebo/no treatment (multiparae), Outcome 13 Vomitting (maternal).

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Analysis 3.14

Comparison 3 (1.3) PGE2 vs placebo/no treatment (multiparae), Outcome 14 Diarrhoea (maternal).

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Analysis 3.15

Comparison 3 (1.3) PGE2 vs placebo/no treatment (multiparae), Outcome 15 Postpartum haemorrhage.

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Analysis 4.1

Comparison 4 (1.4) PGE2 vs placebo/no treatment (women with intact membranes), Outcome 1 Vaginal delivery not achieved within 24 hours.

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Analysis 4.2

Comparison 4 (1.4) PGE2 vs placebo/no treatment (women with intact membranes), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 4.3

Comparison 4 (1.4) PGE2 vs placebo/no treatment (women with intact membranes), Outcome 3 Caesarean section.

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Analysis 4.4

Comparison 4 (1.4) PGE2 vs placebo/no treatment (women with intact membranes), Outcome 4 Serious neonatal morbidity or perinatal death.

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Analysis 4.5

Comparison 4 (1.4) PGE2 vs placebo/no treatment (women with intact membranes), Outcome 5 Cervix unfavourable/unchanged after 12 to 24 hours.

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Analysis 4.6

Comparison 4 (1.4) PGE2 vs placebo/no treatment (women with intact membranes), Outcome 6 Oxytocin augmentation.

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Analysis 4.7

Comparison 4 (1.4) PGE2 vs placebo/no treatment (women with intact membranes), Outcome 7 Uterine hyperstimulation without FHR changes.

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Analysis 4.8

Comparison 4 (1.4) PGE2 vs placebo/no treatment (women with intact membranes), Outcome 8 Instrumental vaginal delivery.

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Analysis 4.9

Comparison 4 (1.4) PGE2 vs placebo/no treatment (women with intact membranes), Outcome 9 Apgar score < 7 at 5 minutes.

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Analysis 4.10

Comparison 4 (1.4) PGE2 vs placebo/no treatment (women with intact membranes), Outcome 10 Neonatal intensive care unit admission.

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Analysis 4.11

Comparison 4 (1.4) PGE2 vs placebo/no treatment (women with intact membranes), Outcome 11 Maternal side‐effects (all).

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Analysis 4.12

Comparison 4 (1.4) PGE2 vs placebo/no treatment (women with intact membranes), Outcome 12 Postpartum haemorrhage.

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Analysis 4.13

Comparison 4 (1.4) PGE2 vs placebo/no treatment (women with intact membranes), Outcome 13 Perinatal death.

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Analysis 5.1

Comparison 5 (1.5) PGE2 vs placebo/no treatment ( women with ruptured membranes), Outcome 1 Caesarean section.

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Analysis 5.2

Comparison 5 (1.5) PGE2 vs placebo/no treatment ( women with ruptured membranes), Outcome 2 Serious neonatal morbidity or perinatal death.

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Analysis 5.3

Comparison 5 (1.5) PGE2 vs placebo/no treatment ( women with ruptured membranes), Outcome 3 Uterine hyperstimulation without FHR changes.

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Analysis 5.4

Comparison 5 (1.5) PGE2 vs placebo/no treatment ( women with ruptured membranes), Outcome 4 Uterine rupture.

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Analysis 5.5

Comparison 5 (1.5) PGE2 vs placebo/no treatment ( women with ruptured membranes), Outcome 5 Epidural analgesia.

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Analysis 5.6

Comparison 5 (1.5) PGE2 vs placebo/no treatment ( women with ruptured membranes), Outcome 6 Instrumental vaginal delivery.

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Analysis 5.7

Comparison 5 (1.5) PGE2 vs placebo/no treatment ( women with ruptured membranes), Outcome 7 Meconium‐stained liquor.

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Analysis 5.8

Comparison 5 (1.5) PGE2 vs placebo/no treatment ( women with ruptured membranes), Outcome 8 Apgar score < 7 at 5 minutes.

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Analysis 5.9

Comparison 5 (1.5) PGE2 vs placebo/no treatment ( women with ruptured membranes), Outcome 9 Neonatal intensive care unit admission.

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Analysis 5.10

Comparison 5 (1.5) PGE2 vs placebo/no treatment ( women with ruptured membranes), Outcome 10 Perinatal death.

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Analysis 5.11

Comparison 5 (1.5) PGE2 vs placebo/no treatment ( women with ruptured membranes), Outcome 11 Maternal side‐effects (all).

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Analysis 5.12

Comparison 5 (1.5) PGE2 vs placebo/no treatment ( women with ruptured membranes), Outcome 12 Vomitting (maternal).

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Analysis 5.13

Comparison 5 (1.5) PGE2 vs placebo/no treatment ( women with ruptured membranes), Outcome 13 Diarrhoea (maternal).

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Analysis 5.14

Comparison 5 (1.5) PGE2 vs placebo/no treatment ( women with ruptured membranes), Outcome 14 Postpartum haemorrhage.

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Analysis 5.15

Comparison 5 (1.5) PGE2 vs placebo/no treatment ( women with ruptured membranes), Outcome 15 Woman not satisfied.

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Analysis 5.16

Comparison 5 (1.5) PGE2 vs placebo/no treatment ( women with ruptured membranes), Outcome 16 Uterine hyperstimulation with FHR changes.

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Analysis 5.17

Comparison 5 (1.5) PGE2 vs placebo/no treatment ( women with ruptured membranes), Outcome 17 Serious maternal morbidity or death.

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Analysis 5.18

Comparison 5 (1.5) PGE2 vs placebo/no treatment ( women with ruptured membranes), Outcome 18 Oxytocin augmentation.

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Analysis 5.19

Comparison 5 (1.5) PGE2 vs placebo/no treatment ( women with ruptured membranes), Outcome 19 Other maternal side‐effects.

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Analysis 6.1

Comparison 6 (1.6) PGE2 vs placebo/no treatment (women with an unfavourable cervix), Outcome 1 Vaginal delivery not achieved within 24 hours.

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Analysis 6.2

Comparison 6 (1.6) PGE2 vs placebo/no treatment (women with an unfavourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 6.3

Comparison 6 (1.6) PGE2 vs placebo/no treatment (women with an unfavourable cervix), Outcome 3 Caesarean section.

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Analysis 6.4

Comparison 6 (1.6) PGE2 vs placebo/no treatment (women with an unfavourable cervix), Outcome 4 Serious neonatal morbidity or perinatal death.

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Analysis 6.5

Comparison 6 (1.6) PGE2 vs placebo/no treatment (women with an unfavourable cervix), Outcome 5 Serious maternal morbidity or death.

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Analysis 6.6

Comparison 6 (1.6) PGE2 vs placebo/no treatment (women with an unfavourable cervix), Outcome 6 Cervix unfavourable/unchanged after 12 to 24 hours.

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Analysis 6.7

Comparison 6 (1.6) PGE2 vs placebo/no treatment (women with an unfavourable cervix), Outcome 7 Oxytocin augmentation.

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Analysis 6.8

Comparison 6 (1.6) PGE2 vs placebo/no treatment (women with an unfavourable cervix), Outcome 8 Uterine hyperstimulation without FHR changes.

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Analysis 6.9

Comparison 6 (1.6) PGE2 vs placebo/no treatment (women with an unfavourable cervix), Outcome 9 Uterine rupture.

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Analysis 6.10

Comparison 6 (1.6) PGE2 vs placebo/no treatment (women with an unfavourable cervix), Outcome 10 Epidural analgesia.

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Analysis 6.11

Comparison 6 (1.6) PGE2 vs placebo/no treatment (women with an unfavourable cervix), Outcome 11 Instrumental vaginal delivery.

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Analysis 6.12

Comparison 6 (1.6) PGE2 vs placebo/no treatment (women with an unfavourable cervix), Outcome 12 Meconium‐stained liquor.

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Analysis 6.13

Comparison 6 (1.6) PGE2 vs placebo/no treatment (women with an unfavourable cervix), Outcome 13 Apgar score < 7 at 5 minutes.

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Analysis 6.14

Comparison 6 (1.6) PGE2 vs placebo/no treatment (women with an unfavourable cervix), Outcome 14 Neonatal intensive care unit admission.

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Analysis 6.15

Comparison 6 (1.6) PGE2 vs placebo/no treatment (women with an unfavourable cervix), Outcome 15 Perinatal death.

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Analysis 6.16

Comparison 6 (1.6) PGE2 vs placebo/no treatment (women with an unfavourable cervix), Outcome 16 Maternal side‐effects (all).

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Analysis 6.17

Comparison 6 (1.6) PGE2 vs placebo/no treatment (women with an unfavourable cervix), Outcome 17 Nausea (maternal).

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Analysis 6.18

Comparison 6 (1.6) PGE2 vs placebo/no treatment (women with an unfavourable cervix), Outcome 18 Vomitting (maternal).

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Analysis 6.19

Comparison 6 (1.6) PGE2 vs placebo/no treatment (women with an unfavourable cervix), Outcome 19 Diarrhoea (maternal).

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Analysis 6.20

Comparison 6 (1.6) PGE2 vs placebo/no treatment (women with an unfavourable cervix), Outcome 20 Other maternal side‐effects.

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Analysis 6.21

Comparison 6 (1.6) PGE2 vs placebo/no treatment (women with an unfavourable cervix), Outcome 21 Postpartum haemorrhage.

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Analysis 6.22

Comparison 6 (1.6) PGE2 vs placebo/no treatment (women with an unfavourable cervix), Outcome 22 Serious maternal complication.

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Analysis 7.1

Comparison 7 (1.7) PGE2 vs placebo/no treatment (women with a favourable cervix), Outcome 1 Uterine hyperstimulation without FHR changes.

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Analysis 7.2

Comparison 7 (1.7) PGE2 vs placebo/no treatment (women with a favourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 7.3

Comparison 7 (1.7) PGE2 vs placebo/no treatment (women with a favourable cervix), Outcome 3 Caesarean section.

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Analysis 7.4

Comparison 7 (1.7) PGE2 vs placebo/no treatment (women with a favourable cervix), Outcome 4 Serious neonatal morbidity or perinatal death.

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Analysis 7.5

Comparison 7 (1.7) PGE2 vs placebo/no treatment (women with a favourable cervix), Outcome 5 Oxytocin augmentation.

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Analysis 7.6

Comparison 7 (1.7) PGE2 vs placebo/no treatment (women with a favourable cervix), Outcome 6 Vaginal delivery not achieved within 24 hours.

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Analysis 7.7

Comparison 7 (1.7) PGE2 vs placebo/no treatment (women with a favourable cervix), Outcome 7 Instrumental vaginal delivery.

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Analysis 7.8

Comparison 7 (1.7) PGE2 vs placebo/no treatment (women with a favourable cervix), Outcome 8 Perinatal death.

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Analysis 8.1

Comparison 8 (2.1) PGF2a vs placebo (all women), Outcome 1 Uterine hyperstimulation with FHR changes.

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Analysis 8.2

Comparison 8 (2.1) PGF2a vs placebo (all women), Outcome 2 Caesarean section.

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Analysis 8.3

Comparison 8 (2.1) PGF2a vs placebo (all women), Outcome 3 Cervix unfavourable/unchanged after 12 to 24 hours.

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Analysis 8.4

Comparison 8 (2.1) PGF2a vs placebo (all women), Outcome 4 Oxytocin augmentation.

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Analysis 8.5

Comparison 8 (2.1) PGF2a vs placebo (all women), Outcome 5 Epidural analgesia.

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Analysis 8.6

Comparison 8 (2.1) PGF2a vs placebo (all women), Outcome 6 Instrumental vaginal delivery.

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Analysis 9.1

Comparison 9 (2.2) PGF2a vs placebo (primiparae), Outcome 1 Uterine hyperstimulation with FHR changes.

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Analysis 9.2

Comparison 9 (2.2) PGF2a vs placebo (primiparae), Outcome 2 Caesarean section.

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Analysis 9.3

Comparison 9 (2.2) PGF2a vs placebo (primiparae), Outcome 3 Oxytocin augmentation.

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Analysis 9.4

Comparison 9 (2.2) PGF2a vs placebo (primiparae), Outcome 4 Epidural analgesia.

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Analysis 10.1

Comparison 10 (2.3) PGF2a vs placebo (women with an unfavourable cervix), Outcome 1 Cervix unfavourable/unchanged after 12‐24 hours.

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Analysis 10.2

Comparison 10 (2.3) PGF2a vs placebo (women with an unfavourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 10.3

Comparison 10 (2.3) PGF2a vs placebo (women with an unfavourable cervix), Outcome 3 Caesarean section.

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Analysis 10.4

Comparison 10 (2.3) PGF2a vs placebo (women with an unfavourable cervix), Outcome 4 Instrumental Vaginal Delivery.

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Analysis 10.5

Comparison 10 (2.3) PGF2a vs placebo (women with an unfavourable cervix), Outcome 5 Oxytocin augmentation.

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Analysis 10.6

Comparison 10 (2.3) PGF2a vs placebo (women with an unfavourable cervix), Outcome 6 Epidural analgesia.

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Analysis 11.1

Comparison 11 (3.1) PGF2a vs PGE2 ( All women), Outcome 1 Vaginal delivery not achieved within 24 hours.

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Analysis 11.2

Comparison 11 (3.1) PGF2a vs PGE2 ( All women), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 11.3

Comparison 11 (3.1) PGF2a vs PGE2 ( All women), Outcome 3 Caesarean section.

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Analysis 11.4

Comparison 11 (3.1) PGF2a vs PGE2 ( All women), Outcome 4 Oxytocin augmentation.

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Analysis 11.5

Comparison 11 (3.1) PGF2a vs PGE2 ( All women), Outcome 5 Epidural analgesia.

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Analysis 11.6

Comparison 11 (3.1) PGF2a vs PGE2 ( All women), Outcome 6 Apgar score < 7 at 5 minutes.

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Analysis 12.1

Comparison 12 (3.2) PGF2a vs PGE2 (primiparae), Outcome 1 Uterine hyperstimulation with FHR changes.

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Analysis 12.2

Comparison 12 (3.2) PGF2a vs PGE2 (primiparae), Outcome 2 Caesarean section.

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Analysis 12.3

Comparison 12 (3.2) PGF2a vs PGE2 (primiparae), Outcome 3 Oxytocin augmentation.

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Analysis 12.4

Comparison 12 (3.2) PGF2a vs PGE2 (primiparae), Outcome 4 Epidural analgesia.

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Analysis 13.1

Comparison 13 (3.3) PGF2a vs PGE2 (women with an unfavourable cervix), Outcome 1 Vaginal delivery not achieved within 24 hours.

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Analysis 13.2

Comparison 13 (3.3) PGF2a vs PGE2 (women with an unfavourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 13.3

Comparison 13 (3.3) PGF2a vs PGE2 (women with an unfavourable cervix), Outcome 3 Caesarean section.

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Analysis 13.4

Comparison 13 (3.3) PGF2a vs PGE2 (women with an unfavourable cervix), Outcome 4 Oxytocin augmentation.

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Analysis 13.5

Comparison 13 (3.3) PGF2a vs PGE2 (women with an unfavourable cervix), Outcome 5 Epidural analgesia.

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Analysis 13.6

Comparison 13 (3.3) PGF2a vs PGE2 (women with an unfavourable cervix), Outcome 6 Apgar score < 7 at 5 minutes.

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Analysis 14.1

Comparison 14 (4.1) PGE2 gel vs PGE2 tablet ( all women), Outcome 1 Vaginal delivery not achieved within 24 hours.

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Analysis 14.2

Comparison 14 (4.1) PGE2 gel vs PGE2 tablet ( all women), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 14.3

Comparison 14 (4.1) PGE2 gel vs PGE2 tablet ( all women), Outcome 3 Caesarean section.

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Analysis 14.4

Comparison 14 (4.1) PGE2 gel vs PGE2 tablet ( all women), Outcome 4 Serious maternal morbidity or death.

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Analysis 14.5

Comparison 14 (4.1) PGE2 gel vs PGE2 tablet ( all women), Outcome 5 Cervix unfavourable/unchanged after 12 to 24 hours.

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Analysis 14.6

Comparison 14 (4.1) PGE2 gel vs PGE2 tablet ( all women), Outcome 6 Oxytocin augmentation.

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Analysis 14.7

Comparison 14 (4.1) PGE2 gel vs PGE2 tablet ( all women), Outcome 7 Epidural analgesia.

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Analysis 14.8

Comparison 14 (4.1) PGE2 gel vs PGE2 tablet ( all women), Outcome 8 Instrumental vaginal delivery.

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Analysis 14.9

Comparison 14 (4.1) PGE2 gel vs PGE2 tablet ( all women), Outcome 9 Meconium Stained Liquor.

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Analysis 14.10

Comparison 14 (4.1) PGE2 gel vs PGE2 tablet ( all women), Outcome 10 Apgar score < 7 at 5 minutes.

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Analysis 14.11

Comparison 14 (4.1) PGE2 gel vs PGE2 tablet ( all women), Outcome 11 Neonatal Intensive Care Unit Admission.

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Analysis 14.12

Comparison 14 (4.1) PGE2 gel vs PGE2 tablet ( all women), Outcome 12 Postpartum haemorrhage.

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Analysis 15.1

Comparison 15 (4.1) PGE2 gel vs PGE2 tablet (primiparae), Outcome 1 Vaginal delivery not achieved within 24 hours.

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Analysis 15.2

Comparison 15 (4.1) PGE2 gel vs PGE2 tablet (primiparae), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 15.3

Comparison 15 (4.1) PGE2 gel vs PGE2 tablet (primiparae), Outcome 3 Caesarean section.

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Analysis 15.4

Comparison 15 (4.1) PGE2 gel vs PGE2 tablet (primiparae), Outcome 4 Serious maternal morbidity or death.

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Analysis 15.5

Comparison 15 (4.1) PGE2 gel vs PGE2 tablet (primiparae), Outcome 5 Cervix unfavourable/unchanged after 12 to 24 hours.

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Analysis 15.6

Comparison 15 (4.1) PGE2 gel vs PGE2 tablet (primiparae), Outcome 6 Oxytocin augmentation.

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Analysis 15.7

Comparison 15 (4.1) PGE2 gel vs PGE2 tablet (primiparae), Outcome 7 Epidural analgesia.

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Analysis 15.8

Comparison 15 (4.1) PGE2 gel vs PGE2 tablet (primiparae), Outcome 8 Instrumental vaginal delivery.

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Analysis 15.9

Comparison 15 (4.1) PGE2 gel vs PGE2 tablet (primiparae), Outcome 9 Apgar score < 7 at 5 minutes.

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Analysis 15.10

Comparison 15 (4.1) PGE2 gel vs PGE2 tablet (primiparae), Outcome 10 Postpartum haemorrhage.

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Analysis 16.1

Comparison 16 (4.2) PGE2 gel vs PGE2 tablet (multiparae), Outcome 1 Vaginal delivery not achieved within 24 hours.

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Analysis 16.2

Comparison 16 (4.2) PGE2 gel vs PGE2 tablet (multiparae), Outcome 2 Caesarean section.

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Analysis 17.1

Comparison 17 (4.3) PGE2 gel vs PGE2 tablet (women with intact membranes), Outcome 1 Vaginal delivery not achieved within 24 hours.

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Analysis 17.2

Comparison 17 (4.3) PGE2 gel vs PGE2 tablet (women with intact membranes), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 17.3

Comparison 17 (4.3) PGE2 gel vs PGE2 tablet (women with intact membranes), Outcome 3 Caesarean section.

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Analysis 17.4

Comparison 17 (4.3) PGE2 gel vs PGE2 tablet (women with intact membranes), Outcome 4 Serious maternal morbidity or death.

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Analysis 17.5

Comparison 17 (4.3) PGE2 gel vs PGE2 tablet (women with intact membranes), Outcome 5 Cervix unfavourable/unchanged after 12 to 24 hours.

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Analysis 17.6

Comparison 17 (4.3) PGE2 gel vs PGE2 tablet (women with intact membranes), Outcome 6 Oxytocin augmentation.

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Analysis 17.7

Comparison 17 (4.3) PGE2 gel vs PGE2 tablet (women with intact membranes), Outcome 7 Epidural analgesia.

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Analysis 17.8

Comparison 17 (4.3) PGE2 gel vs PGE2 tablet (women with intact membranes), Outcome 8 Instrumental vaginal delivery.

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Analysis 17.9

Comparison 17 (4.3) PGE2 gel vs PGE2 tablet (women with intact membranes), Outcome 9 Postpartum haemorrhage.

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Analysis 18.1

Comparison 18 (4.4) PGE2 gel vs PGE2 tablet (women with an unfavourable cervix), Outcome 1 Vaginal delivery not achieved within 24 hours.

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Analysis 18.2

Comparison 18 (4.4) PGE2 gel vs PGE2 tablet (women with an unfavourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 18.3

Comparison 18 (4.4) PGE2 gel vs PGE2 tablet (women with an unfavourable cervix), Outcome 3 Caesarean section.

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Analysis 18.4

Comparison 18 (4.4) PGE2 gel vs PGE2 tablet (women with an unfavourable cervix), Outcome 4 Serious maternal morbidity or death.

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Analysis 18.5

Comparison 18 (4.4) PGE2 gel vs PGE2 tablet (women with an unfavourable cervix), Outcome 5 Cervix unfavourable/unchanged after 12 to 24 hours.

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Analysis 18.6

Comparison 18 (4.4) PGE2 gel vs PGE2 tablet (women with an unfavourable cervix), Outcome 6 Oxytocin augmentation.

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Analysis 18.7

Comparison 18 (4.4) PGE2 gel vs PGE2 tablet (women with an unfavourable cervix), Outcome 7 Epidural analgesia.

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Analysis 18.8

Comparison 18 (4.4) PGE2 gel vs PGE2 tablet (women with an unfavourable cervix), Outcome 8 Instrumental vaginal delivery.

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Analysis 18.9

Comparison 18 (4.4) PGE2 gel vs PGE2 tablet (women with an unfavourable cervix), Outcome 9 Apgar score < 7 at 5 minutes.

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Analysis 18.10

Comparison 18 (4.4) PGE2 gel vs PGE2 tablet (women with an unfavourable cervix), Outcome 10 Postpartum haemorrhage.

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Analysis 19.1

Comparison 19 (4.5) PGE2 gel vs PGE2 tablet (women with a favourable cervix), Outcome 1 Vaginal delivery not achieved within 24 hours.

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Analysis 19.2

Comparison 19 (4.5) PGE2 gel vs PGE2 tablet (women with a favourable cervix), Outcome 2 Caesarean section.

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Analysis 19.3

Comparison 19 (4.5) PGE2 gel vs PGE2 tablet (women with a favourable cervix), Outcome 3 Oxytocin augmentation.

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Analysis 19.4

Comparison 19 (4.5) PGE2 gel vs PGE2 tablet (women with a favourable cervix), Outcome 4 Apgar score < 7 at 5 minutes.

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Analysis 20.1

Comparison 20 (5.1) PGE2 gel vs PGE2 suppository/pessary (all women), Outcome 1 Uterine hyperstimulation with FHR changes.

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Analysis 20.2

Comparison 20 (5.1) PGE2 gel vs PGE2 suppository/pessary (all women), Outcome 2 Caesarean section.

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Analysis 20.3

Comparison 20 (5.1) PGE2 gel vs PGE2 suppository/pessary (all women), Outcome 3 Uterine hyperstimulation without FHR changes.

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Analysis 20.4

Comparison 20 (5.1) PGE2 gel vs PGE2 suppository/pessary (all women), Outcome 4 Apgar score < 7 at 5 minutes.

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Analysis 20.5

Comparison 20 (5.1) PGE2 gel vs PGE2 suppository/pessary (all women), Outcome 5 Maternal side‐effects (all).

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Analysis 20.6

Comparison 20 (5.1) PGE2 gel vs PGE2 suppository/pessary (all women), Outcome 6 Nausea (maternal).

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Analysis 20.7

Comparison 20 (5.1) PGE2 gel vs PGE2 suppository/pessary (all women), Outcome 7 Vomitting (maternal).

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Analysis 20.8

Comparison 20 (5.1) PGE2 gel vs PGE2 suppository/pessary (all women), Outcome 8 Diarrhoea (maternal).

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Analysis 20.9

Comparison 20 (5.1) PGE2 gel vs PGE2 suppository/pessary (all women), Outcome 9 Other maternal side‐effects.

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Analysis 21.1

Comparison 21 (5.2) PGE2 gel vs PGE2 suppository/pessary (women with an unfavourable cervix), Outcome 1 Uterine hyperstimulation with FHR changes.

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Analysis 21.2

Comparison 21 (5.2) PGE2 gel vs PGE2 suppository/pessary (women with an unfavourable cervix), Outcome 2 Caesarean section.

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Analysis 21.3

Comparison 21 (5.2) PGE2 gel vs PGE2 suppository/pessary (women with an unfavourable cervix), Outcome 3 Uterine hyperstimulation without FHR changes.

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Analysis 21.4

Comparison 21 (5.2) PGE2 gel vs PGE2 suppository/pessary (women with an unfavourable cervix), Outcome 4 Apgar score < 7 at 5 minutes.

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Analysis 21.5

Comparison 21 (5.2) PGE2 gel vs PGE2 suppository/pessary (women with an unfavourable cervix), Outcome 5 Maternal side‐effects (all).

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Analysis 21.6

Comparison 21 (5.2) PGE2 gel vs PGE2 suppository/pessary (women with an unfavourable cervix), Outcome 6 Nausea (maternal).

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Analysis 21.7

Comparison 21 (5.2) PGE2 gel vs PGE2 suppository/pessary (women with an unfavourable cervix), Outcome 7 Vomitting (maternal).

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Analysis 21.8

Comparison 21 (5.2) PGE2 gel vs PGE2 suppository/pessary (women with an unfavourable cervix), Outcome 8 Diarrhoea (maternal).

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Analysis 21.9

Comparison 21 (5.2) PGE2 gel vs PGE2 suppository/pessary (women with an unfavourable cervix), Outcome 9 Other maternal side‐effects.

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Analysis 22.1

Comparison 22 (6.1) PGE2 tablet vs PGE2 pessary/suppository (all women), Outcome 1 Caesarean section.

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Analysis 22.2

Comparison 22 (6.1) PGE2 tablet vs PGE2 pessary/suppository (all women), Outcome 2 Oxytocin augmentation.

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Analysis 22.3

Comparison 22 (6.1) PGE2 tablet vs PGE2 pessary/suppository (all women), Outcome 3 Uterine hyperstimulation without FHR changes.

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Analysis 22.4

Comparison 22 (6.1) PGE2 tablet vs PGE2 pessary/suppository (all women), Outcome 4 Epidural analgesia.

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Analysis 22.5

Comparison 22 (6.1) PGE2 tablet vs PGE2 pessary/suppository (all women), Outcome 5 Instrumental vaginal delivery.

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Analysis 22.6

Comparison 22 (6.1) PGE2 tablet vs PGE2 pessary/suppository (all women), Outcome 6 Apgar score < 7 at 5 minutes.

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Analysis 22.7

Comparison 22 (6.1) PGE2 tablet vs PGE2 pessary/suppository (all women), Outcome 7 Maternal side‐effects (all).

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Analysis 22.8

Comparison 22 (6.1) PGE2 tablet vs PGE2 pessary/suppository (all women), Outcome 8 Vomitting (maternal).

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Analysis 22.9

Comparison 22 (6.1) PGE2 tablet vs PGE2 pessary/suppository (all women), Outcome 9 Diarrhoea (maternal).

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Analysis 22.10

Comparison 22 (6.1) PGE2 tablet vs PGE2 pessary/suppository (all women), Outcome 10 Postpartum haemorrhage.

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Analysis 23.1

Comparison 23 (6.2) PGE2 tablet vs PGE2 pessary/suppository (primiparae), Outcome 1 Caesarean section.

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Analysis 23.2

Comparison 23 (6.2) PGE2 tablet vs PGE2 pessary/suppository (primiparae), Outcome 2 Oxytocin augmentation.

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Analysis 24.1

Comparison 24 (6.3) PGE2 tablet vs PGE2 pessary/suppository (multiparae), Outcome 1 Caesarean section.

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Analysis 24.2

Comparison 24 (6.3) PGE2 tablet vs PGE2 pessary/suppository (multiparae), Outcome 2 Oxytocin augmentation.

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Analysis 25.1

Comparison 25 (6.4) PGE2 tablet vs PGE2 pessary/suppository (women with an unfavourable cervix), Outcome 1 Caesarean section.

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Analysis 25.2

Comparison 25 (6.4) PGE2 tablet vs PGE2 pessary/suppository (women with an unfavourable cervix), Outcome 2 Oxytocin augmentation.

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Analysis 25.3

Comparison 25 (6.4) PGE2 tablet vs PGE2 pessary/suppository (women with an unfavourable cervix), Outcome 3 Uterine hyperstimulation without FHR changes.

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Analysis 25.4

Comparison 25 (6.4) PGE2 tablet vs PGE2 pessary/suppository (women with an unfavourable cervix), Outcome 4 Instrumental vaginal delivery.

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Analysis 25.5

Comparison 25 (6.4) PGE2 tablet vs PGE2 pessary/suppository (women with an unfavourable cervix), Outcome 5 Apgar score < 7 at 5 minutes.

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Analysis 25.6

Comparison 25 (6.4) PGE2 tablet vs PGE2 pessary/suppository (women with an unfavourable cervix), Outcome 6 Maternal side‐effects (all).

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Analysis 25.7

Comparison 25 (6.4) PGE2 tablet vs PGE2 pessary/suppository (women with an unfavourable cervix), Outcome 7 Vomitting (maternal).

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Analysis 25.8

Comparison 25 (6.4) PGE2 tablet vs PGE2 pessary/suppository (women with an unfavourable cervix), Outcome 8 Diarrhoea (maternal).

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Analysis 26.1

Comparison 26 (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 26.2

Comparison 26 (7.1) PGE2 (controlled release) vs all PGE2 delivery systems (all women), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 26.3

Comparison 26 (7.1) PGE2 (controlled release) vs all PGE2 delivery systems (all women), Outcome 3 Caesarean section.

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Analysis 26.4

Comparison 26 (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 26.5

Comparison 26 (7.1) PGE2 (controlled release) vs all PGE2 delivery systems (all women), Outcome 5 Serious maternal morbidity or death.

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Analysis 26.6

Comparison 26 (7.1) PGE2 (controlled release) vs all PGE2 delivery systems (all women), Outcome 6 Cervix unfavourable/unchanged after 12 ‐24 hours (BS < 3).

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Analysis 26.7

Comparison 26 (7.1) PGE2 (controlled release) vs all PGE2 delivery systems (all women), Outcome 7 Oxytocin augmentation.

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Analysis 26.8

Comparison 26 (7.1) PGE2 (controlled release) vs all PGE2 delivery systems (all women), Outcome 8 Uterine hyperstimulation without FHR changes.

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Analysis 26.9

Comparison 26 (7.1) PGE2 (controlled release) vs all PGE2 delivery systems (all women), Outcome 9 Uterine rupture.

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Analysis 26.10

Comparison 26 (7.1) PGE2 (controlled release) vs all PGE2 delivery systems (all women), Outcome 10 Epidural analgesia.

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Analysis 26.11

Comparison 26 (7.1) PGE2 (controlled release) vs all PGE2 delivery systems (all women), Outcome 11 Instrumental vaginal delivery.

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Analysis 26.12

Comparison 26 (7.1) PGE2 (controlled release) vs all PGE2 delivery systems (all women), Outcome 12 Postpartum haemorrhage.

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Analysis 26.13

Comparison 26 (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 26.14

Comparison 26 (7.1) PGE2 (controlled release) vs all PGE2 delivery systems (all women), Outcome 14 Vomitting (maternal).

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Analysis 26.15

Comparison 26 (7.1) PGE2 (controlled release) vs all PGE2 delivery systems (all women), Outcome 15 Diarrhoea (maternal).

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Analysis 27.1

Comparison 27 (7.2) PGE2 (controlled release) vs all PGE2 delivery systems (primiparae), Outcome 1 Vaginal delivery not achieved within 24 hours.

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Analysis 27.2

Comparison 27 (7.2) PGE2 (controlled release) vs all PGE2 delivery systems (primiparae), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 27.3

Comparison 27 (7.2) PGE2 (controlled release) vs all PGE2 delivery systems (primiparae), Outcome 3 Caesarean section.

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Analysis 27.4

Comparison 27 (7.2) PGE2 (controlled release) vs all PGE2 delivery systems (primiparae), Outcome 4 Cervix unfavourable/unchanged after 12‐24 hours.

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Analysis 27.5

Comparison 27 (7.2) PGE2 (controlled release) vs all PGE2 delivery systems (primiparae), Outcome 5 Oxytocin augmentation.

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Analysis 27.6

Comparison 27 (7.2) PGE2 (controlled release) vs all PGE2 delivery systems (primiparae), Outcome 6 Uterine hyperstimulation without FHR changes.

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Analysis 27.7

Comparison 27 (7.2) PGE2 (controlled release) vs all PGE2 delivery systems (primiparae), Outcome 7 Epidural analgesia.

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Analysis 27.8

Comparison 27 (7.2) PGE2 (controlled release) vs all PGE2 delivery systems (primiparae), Outcome 8 Instrumental vaginal delivery.

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Analysis 28.1

Comparison 28 (7.3) PGE2 (controlled release) vs all PGE2 delivery systems (multiparae), Outcome 1 Vaginal delivery not achieved within 24 hours.

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Analysis 28.2

Comparison 28 (7.3) PGE2 (controlled release) vs all PGE2 delivery systems (multiparae), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 28.3

Comparison 28 (7.3) PGE2 (controlled release) vs all PGE2 delivery systems (multiparae), Outcome 3 Caesarean section.

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Analysis 28.4

Comparison 28 (7.3) PGE2 (controlled release) vs all PGE2 delivery systems (multiparae), Outcome 4 Oxytocin augmentation.

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Analysis 28.5

Comparison 28 (7.3) PGE2 (controlled release) vs all PGE2 delivery systems (multiparae), Outcome 5 Instrumental vaginal delivery.

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Analysis 29.1

Comparison 29 (7.4) PGE2 (controlled release) vs all PGE2 delivery systems (women with an unfavourable cervix), Outcome 1 Vaginal delivery not achieved within 24 hours.

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Analysis 29.2

Comparison 29 (7.4) PGE2 (controlled release) vs all PGE2 delivery systems (women with an unfavourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.

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Analysis 29.3

Comparison 29 (7.4) PGE2 (controlled release) vs all PGE2 delivery systems (women with an unfavourable cervix), Outcome 3 Caesarean section.

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Analysis 29.4

Comparison 29 (7.4) PGE2 (controlled release) vs all PGE2 delivery systems (women with an unfavourable cervix), Outcome 4 Serious neonatal morbidity or perinatal death.

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Analysis 29.5

Comparison 29 (7.4) PGE2 (controlled release) vs all PGE2 delivery systems (women with an unfavourable cervix), Outcome 5 Serious maternal morbidity or death.

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Analysis 29.6

Comparison 29 (7.4) PGE2 (controlled release) vs all PGE2 delivery systems (women with an unfavourable cervix), Outcome 6 Cervix unfavourable/unchanged after 12‐24 hours.

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Analysis 29.7

Comparison 29 (7.4) PGE2 (controlled release) vs all PGE2 delivery systems (women with an unfavourable cervix), Outcome 7 Oxytocin augmentation.

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Analysis 29.8

Comparison 29 (7.4) PGE2 (controlled release) vs all PGE2 delivery systems (women with an unfavourable cervix), Outcome 8 Uterine hyperstimulation without FHR changes.

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Analysis 29.9

Comparison 29 (7.4) PGE2 (controlled release) vs all PGE2 delivery systems (women with an unfavourable cervix), Outcome 9 Uterine rupture.

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Analysis 29.10

Comparison 29 (7.4) PGE2 (controlled release) vs all PGE2 delivery systems (women with an unfavourable cervix), Outcome 10 Epidural analgesia.

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Analysis 29.11

Comparison 29 (7.4) PGE2 (controlled release) vs all PGE2 delivery systems (women with an unfavourable cervix), Outcome 11 Instrumental vaginal delivery.

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Analysis 29.12

Comparison 29 (7.4) PGE2 (controlled release) vs all PGE2 delivery systems (women with an unfavourable cervix), Outcome 12 Apgar score < 7 at 5 minutes.

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Analysis 29.13

Comparison 29 (7.4) PGE2 (controlled release) vs all PGE2 delivery systems (women with an unfavourable cervix), Outcome 13 Postpartum haemorrhage.

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Analysis 30.1

Comparison 30 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 1 Uterine hyperstimulation with FHR changes.

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Analysis 30.2

Comparison 30 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 2 Caesarean section.

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Analysis 30.3

Comparison 30 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 3 Serious neonatal morbidity or perinatal death.

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Analysis 30.4

Comparison 30 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 4 Cervix unfavourable/unchanged after 12‐24hrs .

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Analysis 30.5

Comparison 30 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 5 Oxytocin augmentation.

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Analysis 30.6

Comparison 30 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 6 Uterine hyperstimulation without FHR changes.

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Analysis 30.7

Comparison 30 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 7 Epidural analgesia.

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Analysis 30.8

Comparison 30 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 8 Instrumental vaginal delivery.

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Analysis 30.9

Comparison 30 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 9 Meconium‐stained liquor.

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Analysis 30.10

Comparison 30 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 10 Apgar score < 7 at 5 minutes.

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Analysis 30.11

Comparison 30 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 11 Neonatal intensive care unit admission.

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Analysis 30.12

Comparison 30 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 12 Perinatal death.

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Analysis 30.13

Comparison 30 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 13 Maternal side‐effects (all).

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Analysis 30.14

Comparison 30 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 14 Nausea (maternal).

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Analysis 30.15

Comparison 30 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 15 Vomitting (maternal).

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Analysis 30.16

Comparison 30 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 16 Diarrhoea (maternal).

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Analysis 30.17

Comparison 30 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 17 Other maternal side‐effects.

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Analysis 30.18

Comparison 30 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 18 Postpartum haemorrhage.

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Analysis 31.1

Comparison 31 (8.2) PGE2 low dose vs PGE2 high dose (primiparae), Outcome 1 Caesarean section.

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Analysis 31.2

Comparison 31 (8.2) PGE2 low dose vs PGE2 high dose (primiparae), Outcome 2 Serious neonatal morbidity or perinatal death.

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Analysis 31.3

Comparison 31 (8.2) PGE2 low dose vs PGE2 high dose (primiparae), Outcome 3 Cervix unfavourable/unchanged after 12‐24hrs .

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Analysis 31.4

Comparison 31 (8.2) PGE2 low dose vs PGE2 high dose (primiparae), Outcome 4 Oxytocin augmentation.

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Analysis 31.5

Comparison 31 (8.2) PGE2 low dose vs PGE2 high dose (primiparae), Outcome 5 Epidural analgesia.

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Analysis 31.6

Comparison 31 (8.2) PGE2 low dose vs PGE2 high dose (primiparae), Outcome 6 Instrumental vaginal delivery.

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Analysis 31.7

Comparison 31 (8.2) PGE2 low dose vs PGE2 high dose (primiparae), Outcome 7 Meconium‐stained liquor.

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Analysis 31.8

Comparison 31 (8.2) PGE2 low dose vs PGE2 high dose (primiparae), Outcome 8 Apgar score < 7 at 5 minutes.

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Analysis 31.9

Comparison 31 (8.2) PGE2 low dose vs PGE2 high dose (primiparae), Outcome 9 Neonatal intensive care unit admission.

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Analysis 31.10

Comparison 31 (8.2) PGE2 low dose vs PGE2 high dose (primiparae), Outcome 10 Perinatal death.

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Analysis 31.11

Comparison 31 (8.2) PGE2 low dose vs PGE2 high dose (primiparae), Outcome 11 Postpartum haemorrhage.

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Analysis 32.1

Comparison 32 (8.3) PGE2 low dose vs PGE2 high dose (multiparae), Outcome 1 Caesarean section.

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Analysis 32.2

Comparison 32 (8.3) PGE2 low dose vs PGE2 high dose (multiparae), Outcome 2 Serious neonatal morbidity or perinatal death.

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Analysis 32.3

Comparison 32 (8.3) PGE2 low dose vs PGE2 high dose (multiparae), Outcome 3 Oxytocin augmentation.

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Analysis 32.4

Comparison 32 (8.3) PGE2 low dose vs PGE2 high dose (multiparae), Outcome 4 Epidural analgesia.

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Analysis 32.5

Comparison 32 (8.3) PGE2 low dose vs PGE2 high dose (multiparae), Outcome 5 Instrumental vaginal delivery.

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Analysis 32.6

Comparison 32 (8.3) PGE2 low dose vs PGE2 high dose (multiparae), Outcome 6 Meconium‐stained liquor.

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Analysis 32.7

Comparison 32 (8.3) PGE2 low dose vs PGE2 high dose (multiparae), Outcome 7 Apgar score < 7 at 5 minutes.

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Analysis 32.8

Comparison 32 (8.3) PGE2 low dose vs PGE2 high dose (multiparae), Outcome 8 Neonatal intensive care unit admission.

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Analysis 32.9

Comparison 32 (8.3) PGE2 low dose vs PGE2 high dose (multiparae), Outcome 9 Perinatal death.

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Analysis 32.10

Comparison 32 (8.3) PGE2 low dose vs PGE2 high dose (multiparae), Outcome 10 Postpartum haemorrhage.

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Analysis 33.1

Comparison 33 (8.4) PGE2 low dose vs PGE2 high dose (all women with intact membranes), Outcome 1 Caesarean section.

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Analysis 33.2

Comparison 33 (8.4) PGE2 low dose vs PGE2 high dose (all women with intact membranes), Outcome 2 Oxytocin augmentation.

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Analysis 33.3

Comparison 33 (8.4) PGE2 low dose vs PGE2 high dose (all women with intact membranes), Outcome 3 Epidural analgesia.

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Analysis 33.4

Comparison 33 (8.4) PGE2 low dose vs PGE2 high dose (all women with intact membranes), Outcome 4 Instrumental vaginal delivery.

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Analysis 33.5

Comparison 33 (8.4) PGE2 low dose vs PGE2 high dose (all women with intact membranes), Outcome 5 Postpartum haemorrhage.

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Analysis 33.6

Comparison 33 (8.4) PGE2 low dose vs PGE2 high dose (all women with intact membranes), Outcome 6 Uterine hyperstimulation with FHR changes.

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Analysis 33.7

Comparison 33 (8.4) PGE2 low dose vs PGE2 high dose (all women with intact membranes), Outcome 7 Apgar score < 7 at 5 minutes.

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Analysis 33.8

Comparison 33 (8.4) PGE2 low dose vs PGE2 high dose (all women with intact membranes), Outcome 8 Maternal side‐effects (all).

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Analysis 33.9

Comparison 33 (8.4) PGE2 low dose vs PGE2 high dose (all women with intact membranes), Outcome 9 Nausea (maternal).

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Analysis 33.10

Comparison 33 (8.4) PGE2 low dose vs PGE2 high dose (all women with intact membranes), Outcome 10 Vomitting (maternal).

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Analysis 33.11

Comparison 33 (8.4) PGE2 low dose vs PGE2 high dose (all women with intact membranes), Outcome 11 Diarrhoea (maternal).

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Analysis 33.12

Comparison 33 (8.4) PGE2 low dose vs PGE2 high dose (all women with intact membranes), Outcome 12 Other maternal side‐effects.

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Analysis 34.1

Comparison 34 (8.5) PGE2 low dose vs PGE2 high dose (all women, unfavourable cervix), Outcome 1 Uterine hyperstimulation with FHR changes.

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Analysis 34.2

Comparison 34 (8.5) PGE2 low dose vs PGE2 high dose (all women, unfavourable cervix), Outcome 2 Caesarean section.

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Analysis 34.3

Comparison 34 (8.5) PGE2 low dose vs PGE2 high dose (all women, unfavourable cervix), Outcome 3 Oxytocin augmentation.

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Analysis 34.4

Comparison 34 (8.5) PGE2 low dose vs PGE2 high dose (all women, unfavourable cervix), Outcome 4 Uterine hyperstimulation without FHR changes.

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Analysis 34.5

Comparison 34 (8.5) PGE2 low dose vs PGE2 high dose (all women, unfavourable cervix), Outcome 5 Apgar score < 7 at 5 minutes.

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Analysis 34.6

Comparison 34 (8.5) PGE2 low dose vs PGE2 high dose (all women, unfavourable cervix), Outcome 6 Maternal side‐effects (all).

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Analysis 34.7

Comparison 34 (8.5) PGE2 low dose vs PGE2 high dose (all women, unfavourable cervix), Outcome 7 Nausea (maternal).

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Analysis 34.8

Comparison 34 (8.5) PGE2 low dose vs PGE2 high dose (all women, unfavourable cervix), Outcome 8 Vomitting (maternal).

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Analysis 34.9

Comparison 34 (8.5) PGE2 low dose vs PGE2 high dose (all women, unfavourable cervix), Outcome 9 Diarrhoea (maternal).

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Analysis 34.10

Comparison 34 (8.5) PGE2 low dose vs PGE2 high dose (all women, unfavourable cervix), Outcome 10 Other maternal side‐effects.

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Analysis 35.1

Comparison 35 PGE2 (all regimens) vs placebo/no treatment (all women, outpatient ripening), Outcome 1 Uterine hyperstimulation with FHR changes.

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Analysis 35.2

Comparison 35 PGE2 (all regimens) vs placebo/no treatment (all women, outpatient ripening), Outcome 2 Caesarean section.

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Analysis 35.3

Comparison 35 PGE2 (all regimens) vs placebo/no treatment (all women, outpatient ripening), Outcome 3 Cervix unfavourable/unchanged after 12 to 24 hours.

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Analysis 35.4

Comparison 35 PGE2 (all regimens) vs placebo/no treatment (all women, outpatient ripening), Outcome 4 Uterine hyperstimulation without FHR changes.

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Analysis 35.5

Comparison 35 PGE2 (all regimens) vs placebo/no treatment (all women, outpatient ripening), Outcome 5 Epidural analgesia.

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Analysis 35.6

Comparison 35 PGE2 (all regimens) vs placebo/no treatment (all women, outpatient ripening), Outcome 6 Meconium‐stained liquor.

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Analysis 35.7

Comparison 35 PGE2 (all regimens) vs placebo/no treatment (all women, outpatient ripening), Outcome 7 Apgar score < 7 at 5 minutes.

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Analysis 35.8

Comparison 35 PGE2 (all regimens) vs placebo/no treatment (all women, outpatient ripening), Outcome 8 Neonatal intensive care unit admission.

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Summary of findings for the main comparison. PGE2 compared with placebo or no treatment for induction of labour at term (all women)

PGE2 compared with placebo or no treatment for induction of labour at term (all women)
Patient or population: patients with induction of labour at term Settings: Mainly inpatients Intervention: PGE2 (all regimens) Comparison: placebo or no treatment (all women)
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of Participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Placebo or no treatment (all women)	PGE2 (all regimens)
Vaginal delivery not achieved within 24 hours	Study population		RR 0.32 (0.02 to 4.83)	384 (2 studies)	⊕⊝⊝⊝ very low	Probable reduction in time to delivery using PGE2. Useable data only available in 2 of 15 studies reporting time as an outcome. 39 studies in this comparison.
	989 per 1000	317 per 1000 (20 to 1000)
	Moderate
	950 per 1000	304 per 1000 (19 to 1000)
Uterine hyperstimulation with FHR changes	Study population		RR 3.16 (1.67 to 5.98)	1359 (15 studies)	⊕⊕⊕⊝ moderate	The risk of bias is "unclear" for most quality domain of the 15 RCT's and this may be a serious limitation.
	10 per 1000	33 per 1000 (18 to 63)
	Moderate
	0 per 1000	0 per 1000 (0 to 0)
Caesarean section	Study population		RR 0.91 (0.81 to 1.02)	6599 (36 studies)	⊕⊕⊕⊕ high	The risk of bias is unclear for most of the studies, but the largest study with a quarter of the participants) has a low risk of bias.
	148 per 1000	134 per 1000 (120 to 151)
	Moderate
	166 per 1000	151 per 1000 (134 to 169)
Serious neonatal morbidity or perinatal death	Study population		RR 0.46 (0.09 to 2.31)	3638 (9 studies)	⊕⊕⊝⊝ low	Neonatal morbidity or mortality is rare, several studies have no events. Underpowered to detect a difference even if one exists.
	2 per 1000	1 per 1000 (0 to 4)
	Moderate
	0 per 1000	0 per 1000 (0 to 0)
Serious maternal morbidity or death	Study population		RR 2.23 (0.34 to 14.76)	530 (3 studies)	⊕⊝⊝⊝ very low	A very rare outcome, so underpowered to detect a difference if one exists.
	4 per 1000	9 per 1000 (1 to 57)
	Moderate
	0 per 1000	0 per 1000 (0 to 0)
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio;
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.

Summary of findings for the main comparison. PGE2 compared with placebo or no treatment for induction of labour at term (all women)

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Summary of findings 2. (4.1) PGE2 gel compared with PGE2 tablet (all women) for induction of labour at term

(4.1) PGE2 gel compared with PGE2 tablet (all women) for induction of labour at term
Patient or population: patients with induction of labour at term Settings: Mainly inpatients Intervention: (4.1) PGE2 gel Comparison: PGE2 tablet (all women)
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of Participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	PGE2 tablet (all women)	(4.1) PGE2 gel
Vaginal delivery not achieved within 24 hours	Study population		RR 1.03 (0.84 to 1.26)	566 (3 studies)	⊕⊕⊕⊝ moderate	Most quality domains unclear or low risk but loss to follow up and reporting bias high in 1 trial.
	369 per 1000	380 per 1000 (310 to 464)
	Moderate
	528 per 1000	544 per 1000 (444 to 665)
Uterine hyperstimulation with FHR changes	Study population		RR 2 (0.18 to 21.71)	200 (1 study)	⊕⊝⊝⊝ very low	Only 1 small trial with an unclear risk of bias reports this outcome.
	10 per 1000	20 per 1000 (2 to 217)
	Moderate
	10 per 1000	20 per 1000 (2 to 217)
Caesarean section	Study population		RR 0.91 (0.72 to 1.17)	1046 (6 studies)	⊕⊕⊕⊕ high	The risk of bias is unclear for most studies, but the largest study has a low risk of bias.
	198 per 1000	180 per 1000 (142 to 231)
	Moderate
	201 per 1000	183 per 1000 (145 to 235)
Serious maternal morbidity or death	Study population		RR 0.33 (0.01 to 8.09)	200 (1 study)	See comment	Study far too small to detect a difference.
	10 per 1000	3 per 1000 (0 to 81)
	Moderate
	10 per 1000	3 per 1000 (0 to 81)
Instrumental vaginal delivery	Study population		RR 0.77 (0.58 to 1.02)	565 (3 studies)	⊕⊕⊕⊝ moderate	The largest study has a high risk of bias. This is a secondary outcome in this review.
	287 per 1000	221 per 1000 (167 to 293)
	Moderate
	241 per 1000	186 per 1000 (140 to 246)
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio;
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.

Summary of findings 2. (4.1) PGE2 gel compared with PGE2 tablet (all women) for induction of labour at term

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Summary of findings 3. (7.1) PGE2 (controlled release) compared with all PGE2 delivery systems (all women) for induction of labour at term

(7.1) PGE2 (controlled release) compared with all PGE2 delivery systems (all women) for induction of labour at term
Patient or population: patients with induction of labour at term Settings: Mainly inpatients Intervention: (7.1) PGE2 (controlled release) Comparison: all PGE2 delivery systems (all women)
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of Participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	All PGE2 delivery systems (all women)	(7.1) PGE2 (controlled release)
Vaginal delivery not achieved within 24 hours	Study population		RR 1.15 (0.92 to 1.45)	450 (3 studies)	⊕⊕⊕⊝ moderate	Although all published after 2002, the risk of bias for most quality domains unclear.
	373 per 1000	429 per 1000 (343 to 541)
	Moderate
	333 per 1000	383 per 1000 (306 to 483)
Uterine hyperstimulation with FHR changes	Study population		RR 2.15 (0.89 to 5.21)	643 (5 studies)	⊕⊕⊕⊝ moderate	4 of the studies are recent but risk of bias unclear.
	22 per 1000	47 per 1000 (20 to 115)
	Moderate
	18 per 1000	39 per 1000 (16 to 94)
Caesarean section	Study population		RR 1.02 (0.82 to 1.26)	1262 (11 studies)	⊕⊕⊕⊝ moderate	Risk of bias unclear, recent studies poorly reported.
	201 per 1000	205 per 1000 (165 to 254)
	Moderate
	177 per 1000	181 per 1000 (145 to 223)
Serious neonatal morbidity or perinatal death	Study population		RR 0.31 (0.01 to 7.62)	320 (2 studies)	⊕⊕⊝⊝ low	Underpowered to detect effect even if exists.
	6 per 1000	2 per 1000 (0 to 49)
	Moderate
	5 per 1000	2 per 1000 (0 to 38)
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio;
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.

Summary of findings 3. (7.1) PGE2 (controlled release) compared with all PGE2 delivery systems (all women) for induction of labour at term

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Table 1. 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 1. Methodological quality of trials

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Comparison 1. (1.1) PGE2 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, Random, 95% CI)	0.32 [0.02, 4.83]

1.1 PGE2 (once only) vs placebo/no treatment	1	39	Risk Ratio (M‐H, Random, 95% CI)	0.88 [0.67, 1.15]
1.2 PGE2 (repeated doses) vs placebo/no treatment	1	345	Risk Ratio (M‐H, Random, 95% CI)	0.12 [0.08, 0.18]
2 Uterine hyperstimulation with FHR changes Show forest plot	15	1359	Risk Ratio (M‐H, Fixed, 95% CI)	3.16 [1.67, 5.98]

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	5	636	Risk Ratio (M‐H, Fixed, 95% CI)	4.53 [1.92, 10.65]
3 Caesarean section Show forest plot	36	6599	Risk Ratio (IV, Fixed, 95% CI)	0.91 [0.81, 1.02]

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	15	4523	Risk Ratio (IV, Fixed, 95% CI)	0.86 [0.73, 1.02]
3.3 PGE2 (sustained release) vs placebo/no treatment	5	671	Risk Ratio (IV, Fixed, 95% CI)	0.85 [0.65, 1.12]
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]
5.2 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	6	567	Risk Ratio (M‐H, Random, 95% CI)	0.41 [0.27, 0.65]

6.1 PGE2 (once only) vs placebo/no treatment	3	232	Risk Ratio (M‐H, Random, 95% CI)	0.54 [0.39, 0.73]
6.2 PGE2 (repeated doses) vs placebo/no treatment	2	235	Risk Ratio (M‐H, Random, 95% CI)	0.28 [0.07, 1.08]
6.3 1.6.3 PGE2 (sustained release) vs placebo/no treatment	1	100	Risk Ratio (M‐H, Random, 95% CI)	0.14 [0.05, 0.45]
7 Oxytocin augmentation Show forest plot	13	1421	Risk Ratio (M‐H, Random, 95% CI)	0.81 [0.63, 1.05]

7.1 PGE2 (once only) vs placebo/no treatment	7	545	Risk Ratio (M‐H, Random, 95% CI)	0.93 [0.59, 1.47]
7.2 PGE2 (repeated doses) vs placebo/no treatment	5	795	Risk Ratio (M‐H, Random, 95% CI)	0.80 [0.63, 1.01]
7.3 PGE2 (sustained release) vs placebo/no treatment	1	81	Risk Ratio (M‐H, Random, 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, Random, 95% CI)	1.16 [0.85, 1.60]

10.1 PGE2 (once only) vs placebo/no treatment	2	434	Risk Ratio (M‐H, Random, 95% CI)	0.80 [0.41, 1.55]
10.2 PGE2 (repeated doses) vs placebo/no treatment	4	3040	Risk Ratio (M‐H, Random, 95% CI)	1.41 [0.81, 2.44]
10.3 PGE2 (sustained release) vs placebo/no treatment	1	81	Risk Ratio (M‐H, Random, 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	16	4481	Risk Ratio (M‐H, Fixed, 95% CI)	1.28 [0.86, 1.92]

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	6	3220	Risk Ratio (M‐H, Fixed, 95% CI)	1.34 [0.80, 2.27]
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	12	4022	Risk Ratio (M‐H, Fixed, 95% CI)	0.94 [0.78, 1.14]

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	7	3272	Risk Ratio (M‐H, Fixed, 95% CI)	0.90 [0.73, 1.10]
14.3 PGE2 (sustained release) vs placebo/no treatment	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	3.27 [0.36, 29.93]
15 Perinatal death Show forest plot	7	3648	Risk Ratio (M‐H, Fixed, 95% CI)	0.56 [0.14, 2.22]

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

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

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

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

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

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

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

22.1 PGE2 (once only) vs placebo/no treatment	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	2.90 [0.12, 68.50]
23 Woman not satisfied Show forest plot	2	2922	Risk Ratio (M‐H, Random, 95% CI)	0.76 [0.24, 2.40]

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

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

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Comparison 2. (1.2) PGE2 vs placebo/no treatment (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, Random, 95% CI)	0.42 [0.06, 2.80]

2 Uterine hyperstimulation with FHR changes Show forest plot	3	217	Risk Ratio (M‐H, Fixed, 95% CI)	3.0 [0.13, 68.57]

3 Caesarean section Show forest plot	10	2486	Risk Ratio (M‐H, Fixed, 95% CI)	0.93 [0.77, 1.12]

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]

5 Serious maternal morbidity or death Show forest plot	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]

7 Oxytocin augmentation Show forest plot	3	407	Risk Ratio (M‐H, Fixed, 95% CI)	0.59 [0.47, 0.74]

8 Uterine hyperstimulation without FHR changes Show forest plot	3	1701	Risk Ratio (M‐H, Fixed, 95% CI)	0.35 [0.02, 8.10]

9 Uterine rupture Show forest plot	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, Random, 95% CI)	1.32 [0.64, 2.73]

11 Instrumental vaginal delivery Show forest plot	4	1815	Risk Ratio (M‐H, Fixed, 95% CI)	0.97 [0.83, 1.14]

12 Meconium‐stained liquor Show forest plot	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]

14 Neonatal intensive care unit admission Show forest plot	3	444	Risk Ratio (M‐H, Fixed, 95% CI)	1.06 [0.54, 2.09]

15 Perinatal death Show forest plot	3	1776	Risk Ratio (M‐H, Fixed, 95% CI)	0.34 [0.01, 8.22]

16 Maternal side‐effects (all) Show forest plot	3	1882	Risk Ratio (M‐H, Fixed, 95% CI)	1.04 [0.63, 1.71]

17 Vomitting (maternal) Show forest plot	1	1507	Risk Ratio (M‐H, Fixed, 95% CI)	1.68 [0.40, 7.00]

18 Diarrhoea (maternal) Show forest plot	1	1507	Risk Ratio (M‐H, Fixed, 95% CI)	5.03 [0.24, 104.66]

19 Other maternal side‐effects Show forest plot	2	375	Risk Ratio (M‐H, Fixed, 95% CI)	0.87 [0.50, 1.50]

20 Postpartum haemorrhage Show forest plot	3	1927	Risk Ratio (M‐H, Fixed, 95% CI)	1.51 [0.97, 2.34]

Comparison 2. (1.2) PGE2 vs placebo/no treatment (primiparae)

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Comparison 3. (1.3) PGE2 vs placebo/no treatment (multiparae)

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]

2 Uterine hyperstimulation with FHR changes Show forest plot	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]

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]

5 Uterine rupture Show forest plot	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]

7 Oxytocin augmentation Show forest plot	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]

9 Instrumental vaginal delivery Show forest plot	1	1013	Risk Ratio (M‐H, Fixed, 95% CI)	1.23 [0.77, 1.95]

10 Meconium‐stained liquor Show forest plot	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	1.0 [0.15, 6.82]

11 Perinatal death Show forest plot	1	1013	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 8.12]

12 Maternal side‐effects (all) Show forest plot	1	2026	Risk Ratio (M‐H, Fixed, 95% CI)	0.99 [0.06, 15.87]

13 Vomitting (maternal) Show forest plot	1	1013	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 8.12]

14 Diarrhoea (maternal) Show forest plot	1	1013	Risk Ratio (M‐H, Fixed, 95% CI)	2.98 [0.12, 73.04]

15 Postpartum haemorrhage Show forest plot	1	1013	Risk Ratio (M‐H, Fixed, 95% CI)	1.22 [0.59, 2.52]

Comparison 3. (1.3) PGE2 vs placebo/no treatment (multiparae)

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Comparison 4. (1.4) PGE2 vs placebo/no treatment (women with intact membranes)

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]

2 Uterine hyperstimulation with FHR changes Show forest plot	5	425	Risk Ratio (M‐H, Fixed, 95% CI)	2.16 [0.57, 8.21]

3 Caesarean section Show forest plot	6	816	Risk Ratio (M‐H, Fixed, 95% CI)	1.13 [0.82, 1.57]

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]

5 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 Oxytocin augmentation Show forest plot	2	395	Risk Ratio (M‐H, Fixed, 95% CI)	1.06 [0.83, 1.36]

7 Uterine hyperstimulation without FHR changes Show forest plot	5	424	Risk Ratio (M‐H, Fixed, 95% CI)	6.76 [1.32, 34.54]

8 Instrumental vaginal delivery Show forest plot	1	345	Risk Ratio (M‐H, Fixed, 95% CI)	1.22 [0.28, 5.38]

9 Apgar score < 7 at 5 minutes Show forest plot	2	161	Risk Ratio (M‐H, Fixed, 95% CI)	0.54 [0.14, 2.05]

10 Neonatal intensive care unit admission Show forest plot	1	50	Risk Ratio (M‐H, Fixed, 95% CI)	0.22 [0.01, 4.28]

11 Maternal side‐effects (all) Show forest plot	3	212	Risk Ratio (M‐H, Fixed, 95% CI)	1.68 [0.66, 4.31]

12 Postpartum haemorrhage Show forest plot	1	81	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

13 Perinatal death Show forest plot	1	345	Risk Ratio (M‐H, Fixed, 95% CI)	0.31 [0.01, 7.45]

Comparison 4. (1.4) PGE2 vs placebo/no treatment (women with intact membranes)

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Comparison 5. (1.5) PGE2 vs placebo/no treatment ( women with ruptured membranes)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Caesarean section Show forest plot	7	3320	Risk Ratio (M‐H, Fixed, 95% CI)	0.89 [0.73, 1.08]

2 Serious neonatal morbidity or perinatal death Show forest plot	3	2840	Risk Ratio (M‐H, Fixed, 95% CI)	0.20 [0.01, 4.17]

3 Uterine hyperstimulation without FHR changes Show forest plot	3	2734	Risk Ratio (M‐H, Fixed, 95% CI)	1.66 [0.61, 4.52]

4 Uterine rupture Show forest plot	2	2579	Risk Ratio (M‐H, Fixed, 95% CI)	2.90 [0.12, 68.50]

5 Epidural analgesia Show forest plot	3	2940	Risk Ratio (M‐H, Random, 95% CI)	1.73 [0.73, 4.14]

6 Instrumental vaginal delivery Show forest plot	3	2779	Risk Ratio (M‐H, Fixed, 95% CI)	0.96 [0.81, 1.13]

7 Meconium‐stained liquor Show forest plot	5	3099	Risk Ratio (M‐H, Fixed, 95% CI)	0.95 [0.75, 1.21]

8 Apgar score < 7 at 5 minutes Show forest plot	3	2894	Risk Ratio (M‐H, Fixed, 95% CI)	1.47 [0.83, 2.63]

9 Neonatal intensive care unit admission Show forest plot	4	2953	Risk Ratio (M‐H, Fixed, 95% CI)	0.91 [0.73, 1.13]

10 Perinatal death Show forest plot	2	2719	Risk Ratio (M‐H, Fixed, 95% CI)	0.20 [0.01, 4.17]

11 Maternal side‐effects (all) Show forest plot	4	5533	Risk Ratio (M‐H, Fixed, 95% CI)	1.16 [0.73, 1.83]

12 Vomitting (maternal) Show forest plot	2	2579	Risk Ratio (M‐H, Fixed, 95% CI)	1.16 [0.39, 3.39]

13 Diarrhoea (maternal) Show forest plot	1	2520	Risk Ratio (M‐H, Fixed, 95% CI)	7.01 [0.36, 135.59]

14 Postpartum haemorrhage Show forest plot	5	3099	Risk Ratio (M‐H, Fixed, 95% CI)	1.47 [1.02, 2.13]

15 Woman not satisfied Show forest plot	1	2520	Risk Ratio (M‐H, Fixed, 95% CI)	0.44 [0.33, 0.58]

16 Uterine hyperstimulation with FHR changes Show forest plot	1	155	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

17 Serious maternal morbidity or death Show forest plot	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	4.84 [0.24, 96.66]

18 Oxytocin augmentation Show forest plot	2	375	Risk Ratio (M‐H, Fixed, 95% CI)	0.62 [0.49, 0.79]

19 Other maternal side‐effects Show forest plot	1	155	Risk Ratio (M‐H, Fixed, 95% CI)	0.48 [0.04, 5.20]

Comparison 5. (1.5) PGE2 vs placebo/no treatment ( women with ruptured membranes)

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Comparison 6. (1.6) PGE2 vs placebo/no treatment (women with an 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]

2 Uterine hyperstimulation with FHR changes Show forest plot	12	1143	Risk Ratio (M‐H, Fixed, 95% CI)	4.47 [2.01, 9.93]

3 Caesarean section Show forest plot	22	2173	Risk Ratio (M‐H, Fixed, 95% CI)	0.87 [0.75, 1.02]

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]

5 Serious maternal morbidity or death Show forest plot	2	128	Risk Ratio (M‐H, Fixed, 95% CI)	4.84 [0.24, 96.66]

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]

7 Oxytocin augmentation Show forest plot	8	813	Risk Ratio (M‐H, Random, 95% CI)	0.77 [0.53, 1.10]

8 Uterine hyperstimulation without FHR changes Show forest plot	9	777	Risk Ratio (M‐H, Fixed, 95% CI)	2.63 [0.99, 7.01]

9 Uterine rupture Show forest plot	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, Random, 95% CI)	1.24 [0.63, 2.43]

11 Instrumental vaginal delivery Show forest plot	7	643	Risk Ratio (M‐H, Fixed, 95% CI)	0.88 [0.61, 1.27]

12 Meconium‐stained liquor Show forest plot	5	697	Risk Ratio (M‐H, Fixed, 95% CI)	0.65 [0.47, 0.89]

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]

14 Neonatal intensive care unit admission Show forest plot	7	735	Risk Ratio (M‐H, Fixed, 95% CI)	0.80 [0.51, 1.27]

15 Perinatal death Show forest plot	3	298	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

16 Maternal side‐effects (all) Show forest plot	10	1572	Risk Ratio (M‐H, Fixed, 95% CI)	1.08 [0.73, 1.59]

17 Nausea (maternal) Show forest plot	1	116	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

18 Vomitting (maternal) Show forest plot	2	274	Risk Ratio (M‐H, Fixed, 95% CI)	0.97 [0.15, 6.41]

19 Diarrhoea (maternal) Show forest plot	2	331	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

20 Other maternal side‐effects Show forest plot	7	871	Risk Ratio (M‐H, Fixed, 95% CI)	0.97 [0.62, 1.51]

21 Postpartum haemorrhage Show forest plot	7	917	Risk Ratio (M‐H, Fixed, 95% CI)	0.99 [0.47, 2.05]

22 Serious maternal complication Show forest plot	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	2.90 [0.12, 68.50]

Comparison 6. (1.6) PGE2 vs placebo/no treatment (women with an unfavourable cervix)

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Comparison 7. (1.7) PGE2 vs placebo/no treatment (women with a favourable cervix)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Uterine hyperstimulation without FHR changes Show forest plot	1	56	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

2 Uterine hyperstimulation with FHR changes Show forest plot	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]

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]

5 Oxytocin augmentation Show forest plot	3	443	Risk Ratio (M‐H, Random, 95% CI)	1.00 [0.66, 1.51]

6 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]

7 Instrumental vaginal delivery Show forest plot	1	345	Risk Ratio (M‐H, Fixed, 95% CI)	1.22 [0.28, 5.38]

8 Perinatal death Show forest plot	1	345	Risk Ratio (M‐H, Fixed, 95% CI)	0.31 [0.01, 7.45]

Comparison 7. (1.7) PGE2 vs placebo/no treatment (women with a favourable cervix)

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Comparison 8. (2.1) PGF2a vs placebo (all women)

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

2 Caesarean section Show forest plot	4	467	Risk Ratio (M‐H, Fixed, 95% CI)	0.59 [0.31, 1.14]

3 Cervix unfavourable/unchanged after 12 to 24 hours Show forest plot	2	170	Risk Ratio (M‐H, Fixed, 95% CI)	0.20 [0.11, 0.37]

4 Oxytocin augmentation Show forest plot	3	202	Risk Ratio (M‐H, Random, 95% CI)	0.59 [0.32, 1.07]

5 Epidural analgesia Show forest plot	4	467	Risk Ratio (M‐H, Fixed, 95% CI)	0.74 [0.56, 0.97]

6 Instrumental vaginal delivery Show forest plot	3	435	Risk Ratio (M‐H, Fixed, 95% CI)	0.63 [0.47, 0.84]

Comparison 8. (2.1) PGF2a vs placebo (all women)

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Comparison 9. (2.2) PGF2a vs placebo (primiparae)

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

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

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

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

Comparison 9. (2.2) PGF2a vs placebo (primiparae)

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Comparison 10. (2.3) PGF2a vs placebo (women with an unfavourable cervix)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Cervix unfavourable/unchanged after 12‐24 hours Show forest plot	1	80	Risk Ratio (M‐H, Fixed, 95% CI)	0.15 [0.05, 0.47]

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	2	112	Risk Ratio (M‐H, Fixed, 95% CI)	0.5 [0.13, 1.90]

4 Instrumental Vaginal Delivery Show forest plot	1	80	Risk Ratio (M‐H, Fixed, 95% CI)	0.75 [0.41, 1.38]

5 Oxytocin augmentation Show forest plot	2	112	Risk Ratio (M‐H, Random, 95% CI)	0.59 [0.17, 2.11]

6 Epidural analgesia Show forest plot	2	112	Risk Ratio (M‐H, Fixed, 95% CI)	0.82 [0.56, 1.20]

Comparison 10. (2.3) PGF2a vs placebo (women with an unfavourable cervix)

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Comparison 11. (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]

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

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

6 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 11. (3.1) PGF2a vs PGE2 ( All women)

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Comparison 12. (3.2) PGF2a vs PGE2 (primiparae)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Uterine hyperstimulation with FHR changes Show forest plot	1	32	Risk Ratio (M‐H, Fixed, 95% CI)	1.0 [0.07, 14.64]

2 Caesarean section Show forest plot	1	32	Risk Ratio (M‐H, Fixed, 95% CI)	1.0 [0.07, 14.64]

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

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

Comparison 12. (3.2) PGF2a vs PGE2 (primiparae)

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Comparison 13. (3.3) PGF2a vs PGE2 (women with an 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]

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

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

6 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 13. (3.3) PGF2a vs PGE2 (women with an unfavourable cervix)

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Comparison 14. (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	3	566	Risk Ratio (M‐H, Fixed, 95% CI)	1.03 [0.84, 1.26]

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	6	1046	Risk Ratio (M‐H, Fixed, 95% CI)	0.91 [0.72, 1.17]

4 Serious maternal morbidity or death Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 8.09]

5 Cervix unfavourable/unchanged after 12 to 24 hours Show forest plot	2	365	Risk Ratio (M‐H, Fixed, 95% CI)	0.87 [0.70, 1.07]

6 Oxytocin augmentation Show forest plot	6	742	Risk Ratio (M‐H, Random, 95% CI)	0.85 [0.67, 1.08]

7 Epidural analgesia Show forest plot	3	565	Risk Ratio (M‐H, Fixed, 95% CI)	1.07 [0.95, 1.21]

8 Instrumental vaginal delivery Show forest plot	3	565	Risk Ratio (M‐H, Fixed, 95% CI)	0.77 [0.58, 1.02]

9 Meconium Stained Liquor Show forest plot	1	165	Risk Ratio (M‐H, Fixed, 95% CI)	0.91 [0.39, 2.13]

10 Apgar score < 7 at 5 minutes Show forest plot	4	597	Risk Ratio (M‐H, Fixed, 95% CI)	1.13 [0.35, 3.66]

11 Neonatal Intensive Care Unit Admission Show forest plot	1	165	Risk Ratio (M‐H, Fixed, 95% CI)	0.51 [0.05, 5.47]

12 Postpartum haemorrhage Show forest plot	3	445	Risk Ratio (M‐H, Fixed, 95% CI)	0.89 [0.71, 1.11]

Comparison 14. (4.1) PGE2 gel vs PGE2 tablet ( all women)

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Comparison 15. (4.1) PGE2 gel vs PGE2 tablet (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	174	Risk Ratio (M‐H, Random, 95% CI)	1.04 [0.72, 1.51]

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	4	454	Risk Ratio (M‐H, Fixed, 95% CI)	1.01 [0.76, 1.34]

4 Serious maternal morbidity or death Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 8.09]

5 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]

6 Oxytocin augmentation Show forest plot	3	353	Risk Ratio (M‐H, Random, 95% CI)	0.67 [0.34, 1.29]

7 Epidural analgesia Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.96 [0.85, 1.10]

8 Instrumental vaginal delivery Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.88 [0.61, 1.25]

9 Apgar score < 7 at 5 minutes Show forest plot	1	80	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 7.95]

10 Postpartum haemorrhage Show forest plot	1	80	Risk Ratio (M‐H, Fixed, 95% CI)	0.5 [0.05, 5.30]

Comparison 15. (4.1) PGE2 gel vs PGE2 tablet (primiparae)

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Comparison 16. (4.2) PGE2 gel vs PGE2 tablet (multiparae)

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	64	Risk Ratio (M‐H, Fixed, 95% CI)	1.03 [0.57, 1.87]

2 Caesarean section Show forest plot	1	64	Risk Ratio (M‐H, Fixed, 95% CI)	0.88 [0.24, 3.22]

Comparison 16. (4.2) PGE2 gel vs PGE2 tablet (multiparae)

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Comparison 17. (4.3) PGE2 gel vs PGE2 tablet (women with intact membranes)

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	473	Risk Ratio (M‐H, Fixed, 95% CI)	1.02 [0.70, 1.49]

4 Serious maternal morbidity or death Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 8.09]

5 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]

6 Oxytocin augmentation Show forest plot	3	473	Risk Ratio (M‐H, Fixed, 95% CI)	0.91 [0.78, 1.06]

7 Epidural analgesia Show forest plot	2	400	Risk Ratio (M‐H, Fixed, 95% CI)	1.02 [0.89, 1.19]

8 Instrumental vaginal delivery Show forest plot	2	400	Risk Ratio (M‐H, Fixed, 95% CI)	0.81 [0.59, 1.10]

9 Postpartum haemorrhage Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.75 [0.13, 4.40]

Comparison 17. (4.3) PGE2 gel vs PGE2 tablet (women with intact membranes)

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Comparison 18. (4.4) PGE2 gel vs PGE2 tablet (women with an 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	2	191	Risk Ratio (M‐H, Random, 95% CI)	0.99 [0.62, 1.59]

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, Random, 95% CI)	0.94 [0.48, 1.86]

4 Serious maternal morbidity or death Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 8.09]

5 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]

6 Oxytocin augmentation Show forest plot	4	377	Risk Ratio (M‐H, Random, 95% CI)	0.73 [0.43, 1.25]

7 Epidural analgesia Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.96 [0.85, 1.10]

8 Instrumental vaginal delivery Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.88 [0.61, 1.25]

9 Apgar score < 7 at 5 minutes Show forest plot	2	104	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 7.95]

10 Postpartum haemorrhage Show forest plot	1	80	Risk Ratio (M‐H, Fixed, 95% CI)	0.5 [0.05, 5.30]

Comparison 18. (4.4) PGE2 gel vs PGE2 tablet (women with an unfavourable cervix)

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Comparison 19. (4.5) PGE2 gel vs PGE2 tablet (women with a 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	2	373	Risk Ratio (M‐H, Fixed, 95% CI)	1.11 [0.79, 1.56]

2 Caesarean section Show forest plot	1	328	Risk Ratio (M‐H, Fixed, 95% CI)	0.75 [0.40, 1.41]

3 Oxytocin augmentation Show forest plot	1	24	Risk Ratio (M‐H, Fixed, 95% CI)	1.0 [0.39, 2.58]

4 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 19. (4.5) PGE2 gel vs PGE2 tablet (women with a favourable cervix)

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Comparison 20. (5.1) PGE2 gel vs PGE2 suppository/pessary (all women)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Uterine hyperstimulation with FHR changes Show forest plot	2	159	Risk Ratio (M‐H, Fixed, 95% CI)	0.16 [0.03, 0.87]

2 Caesarean section Show forest plot	2	159	Risk Ratio (M‐H, Fixed, 95% CI)	0.65 [0.38, 1.11]

3 Uterine hyperstimulation without FHR changes Show forest plot	1	90	Risk Ratio (M‐H, Fixed, 95% CI)	0.2 [0.01, 4.05]

4 Apgar score < 7 at 5 minutes Show forest plot	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.21 [0.01, 4.13]

5 Maternal side‐effects (all) Show forest plot	2	460	Risk Ratio (M‐H, Fixed, 95% CI)	0.2 [0.02, 1.70]

6 Nausea (maternal) Show forest plot	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.34 [0.01, 8.13]

7 Vomitting (maternal) Show forest plot	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.34 [0.01, 8.13]

8 Diarrhoea (maternal) Show forest plot	2	159	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 7.97]

9 Other maternal side‐effects Show forest plot	2	159	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 7.97]

Comparison 20. (5.1) PGE2 gel vs PGE2 suppository/pessary (all women)

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Comparison 21. (5.2) PGE2 gel vs PGE2 suppository/pessary (women with an unfavourable cervix)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Uterine hyperstimulation with FHR changes Show forest plot	2	159	Risk Ratio (M‐H, Fixed, 95% CI)	0.16 [0.03, 0.87]

2 Caesarean section Show forest plot	2	159	Risk Ratio (M‐H, Fixed, 95% CI)	0.65 [0.38, 1.11]

3 Uterine hyperstimulation without FHR changes Show forest plot	1	90	Risk Ratio (M‐H, Fixed, 95% CI)	0.2 [0.01, 4.05]

4 Apgar score < 7 at 5 minutes Show forest plot	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.21 [0.01, 4.13]

5 Maternal side‐effects (all) Show forest plot	2	460	Risk Ratio (M‐H, Fixed, 95% CI)	0.2 [0.02, 1.70]

6 Nausea (maternal) Show forest plot	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.34 [0.01, 8.13]

7 Vomitting (maternal) Show forest plot	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.34 [0.01, 8.13]

8 Diarrhoea (maternal) Show forest plot	2	159	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 7.97]

9 Other maternal side‐effects Show forest plot	2	159	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 7.97]

Comparison 21. (5.2) PGE2 gel vs PGE2 suppository/pessary (women with an unfavourable cervix)

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Comparison 22. (6.1) PGE2 tablet vs PGE2 pessary/suppository (all women)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Caesarean section Show forest plot	3	491	Risk Ratio (M‐H, Fixed, 95% CI)	1.13 [0.64, 1.99]

2 Oxytocin augmentation Show forest plot	3	491	Risk Ratio (M‐H, Random, 95% CI)	0.66 [0.31, 1.40]

3 Uterine hyperstimulation without FHR changes Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

4 Epidural analgesia Show forest plot	1	24	Risk Ratio (M‐H, Fixed, 95% CI)	0.67 [0.25, 1.78]

5 Instrumental vaginal delivery Show forest plot	3	491	Risk Ratio (M‐H, Fixed, 95% CI)	1.72 [1.09, 2.70]

6 Apgar score < 7 at 5 minutes Show forest plot	2	467	Risk Ratio (M‐H, Fixed, 95% CI)	1.33 [0.58, 3.05]

7 Maternal side‐effects (all) Show forest plot	1	400	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

8 Vomitting (maternal) Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

9 Diarrhoea (maternal) Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

10 Postpartum haemorrhage Show forest plot	1	267	Risk Ratio (M‐H, Fixed, 95% CI)	1.12 [0.57, 2.20]

Comparison 22. (6.1) PGE2 tablet vs PGE2 pessary/suppository (all women)

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Comparison 23. (6.2) PGE2 tablet vs PGE2 pessary/suppository (primiparae)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Caesarean section Show forest plot	1	141	Risk Ratio (M‐H, Fixed, 95% CI)	1.21 [0.57, 2.58]

2 Oxytocin augmentation Show forest plot	1	141	Risk Ratio (M‐H, Fixed, 95% CI)	1.27 [0.85, 1.88]

Comparison 23. (6.2) PGE2 tablet vs PGE2 pessary/suppository (primiparae)

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Comparison 24. (6.3) PGE2 tablet vs PGE2 pessary/suppository (multiparae)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Caesarean section Show forest plot	1	126	Risk Ratio (M‐H, Fixed, 95% CI)	0.83 [0.23, 2.93]

2 Oxytocin augmentation Show forest plot	1	126	Risk Ratio (M‐H, Fixed, 95% CI)	0.66 [0.37, 1.16]

Comparison 24. (6.3) PGE2 tablet vs PGE2 pessary/suppository (multiparae)

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Comparison 25. (6.4) PGE2 tablet vs PGE2 pessary/suppository (women with an unfavourable cervix)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Caesarean section Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	1.0 [0.26, 3.89]

2 Oxytocin augmentation Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.35 [0.19, 0.64]

3 Uterine hyperstimulation without FHR changes Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

4 Instrumental vaginal delivery Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	1.11 [0.47, 2.62]

5 Apgar score < 7 at 5 minutes Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	1.25 [0.51, 3.04]

6 Maternal side‐effects (all) Show forest plot	1	400	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

7 Vomitting (maternal) Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

8 Diarrhoea (maternal) Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 25. (6.4) PGE2 tablet vs PGE2 pessary/suppository (women with an unfavourable cervix)

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Comparison 26. (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	3	450	Risk Ratio (M‐H, Fixed, 95% CI)	1.15 [0.92, 1.45]

2 Uterine hyperstimulation with FHR changes Show forest plot	5	643	Risk Ratio (M‐H, Fixed, 95% CI)	2.15 [0.89, 5.21]

3 Caesarean section Show forest plot	11	1262	Risk Ratio (M‐H, Fixed, 95% CI)	1.02 [0.82, 1.26]

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]

6 Cervix unfavourable/unchanged after 12 ‐24 hours (BS < 3) Show forest plot	2	271	Risk Ratio (M‐H, Fixed, 95% CI)	0.61 [0.46, 0.80]

7 Oxytocin augmentation Show forest plot	7	884	Risk Ratio (M‐H, Random, 95% CI)	0.88 [0.69, 1.13]

8 Uterine hyperstimulation without FHR changes Show forest plot	8	908	Risk Ratio (M‐H, Fixed, 95% CI)	1.59 [0.81, 3.14]

9 Uterine rupture Show forest plot	2	330	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 8.09]

10 Epidural analgesia Show forest plot	3	315	Risk Ratio (M‐H, Fixed, 95% CI)	1.14 [0.95, 1.36]

11 Instrumental vaginal delivery Show forest plot	6	791	Risk Ratio (M‐H, Fixed, 95% CI)	0.47 [0.32, 0.68]

12 Postpartum haemorrhage Show forest plot	1	130	Risk Ratio (M‐H, Fixed, 95% CI)	1.33 [0.31, 5.72]

13 Apgar score < 7 at 5 minutes Show forest plot	3	370	Risk Ratio (M‐H, Fixed, 95% CI)	3.0 [0.12, 72.77]

14 Vomitting (maternal) Show forest plot	1	120	Risk Ratio (M‐H, Fixed, 95% CI)	5.0 [0.25, 102.00]

15 Diarrhoea (maternal) Show forest plot	1	120	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 8.02]

Comparison 26. (7.1) PGE2 (controlled release) vs all PGE2 delivery systems (all women)

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Comparison 27. (7.2) PGE2 (controlled release) vs all PGE2 delivery systems (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	98	Risk Ratio (M‐H, Fixed, 95% CI)	1.27 [0.77, 2.10]

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	5	399	Risk Ratio (M‐H, Fixed, 95% CI)	0.88 [0.63, 1.23]

4 Cervix unfavourable/unchanged after 12‐24 hours Show forest plot	1	151	Risk Ratio (M‐H, Fixed, 95% CI)	0.60 [0.45, 0.80]

5 Oxytocin augmentation Show forest plot	3	258	Risk Ratio (M‐H, Random, 95% CI)	0.74 [0.43, 1.29]

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

7 Epidural analgesia Show forest plot	2	246	Risk Ratio (M‐H, Random, 95% CI)	1.15 [0.83, 1.58]

8 Instrumental vaginal delivery Show forest plot	1	43	Risk Ratio (M‐H, Fixed, 95% CI)	0.70 [0.23, 2.13]

Comparison 27. (7.2) PGE2 (controlled release) vs all PGE2 delivery systems (primiparae)

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Comparison 28. (7.3) PGE2 (controlled release) vs all PGE2 delivery systems (multiparae)

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	32	Risk Ratio (M‐H, Fixed, 95% CI)	1.46 [0.35, 6.15]

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	3	127	Risk Ratio (M‐H, Fixed, 95% CI)	1.30 [0.53, 3.23]

4 Oxytocin augmentation Show forest plot	1	66	Risk Ratio (M‐H, Fixed, 95% CI)	0.41 [0.20, 0.86]

5 Instrumental vaginal delivery Show forest plot	1	29	Risk Ratio (M‐H, Fixed, 95% CI)	0.62 [0.13, 2.85]

Comparison 28. (7.3) PGE2 (controlled release) vs all PGE2 delivery systems (multiparae)

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Comparison 29. (7.4) PGE2 (controlled release) vs all PGE2 delivery systems (women with an 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	130	Risk Ratio (M‐H, Fixed, 95% CI)	1.37 [0.85, 2.21]

2 Uterine hyperstimulation with FHR changes Show forest plot	3	323	Risk Ratio (M‐H, Fixed, 95% CI)	6.67 [0.86, 51.67]

3 Caesarean section Show forest plot	8	873	Risk Ratio (M‐H, Fixed, 95% CI)	1.00 [0.77, 1.28]

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]

6 Cervix unfavourable/unchanged after 12‐24 hours Show forest plot	1	151	Risk Ratio (M‐H, Fixed, 95% CI)	0.60 [0.45, 0.80]

7 Oxytocin augmentation Show forest plot	5	564	Risk Ratio (M‐H, Random, 95% CI)	0.81 [0.54, 1.21]

8 Uterine hyperstimulation without FHR changes Show forest plot	5	537	Risk Ratio (M‐H, Fixed, 95% CI)	5.81 [0.71, 47.25]

9 Uterine rupture Show forest plot	1	130	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

10 Epidural analgesia Show forest plot	3	286	Risk Ratio (M‐H, Random, 95% CI)	1.17 [0.84, 1.63]

11 Instrumental vaginal delivery Show forest plot	3	402	Risk Ratio (M‐H, Fixed, 95% CI)	0.34 [0.20, 0.59]

12 Apgar score < 7 at 5 minutes Show forest plot	2	170	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

13 Postpartum haemorrhage Show forest plot	1	130	Risk Ratio (M‐H, Fixed, 95% CI)	1.33 [0.31, 5.72]

Comparison 29. (7.4) PGE2 (controlled release) vs all PGE2 delivery systems (women with an unfavourable cervix)

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Comparison 30. (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
1 Uterine hyperstimulation with FHR changes Show forest plot	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.15 [0.02, 1.13]

2 Caesarean section Show forest plot	7	1546	Risk Ratio (M‐H, Fixed, 95% CI)	1.02 [0.78, 1.33]

3 Serious neonatal morbidity or perinatal death Show forest plot	1	955	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

4 Cervix unfavourable/unchanged after 12‐24hrs Show forest plot	1	151	Risk Ratio (M‐H, Fixed, 95% CI)	1.66 [1.25, 2.21]

5 Oxytocin augmentation Show forest plot	5	1370	Risk Ratio (M‐H, Random, 95% CI)	0.96 [0.77, 1.20]

6 Uterine hyperstimulation without FHR changes Show forest plot	1	40	Risk Ratio (M‐H, Fixed, 95% CI)	0.2 [0.01, 3.92]

7 Epidural analgesia Show forest plot	4	1330	Risk Ratio (M‐H, Random, 95% CI)	0.96 [0.74, 1.26]

8 Instrumental vaginal delivery Show forest plot	3	1179	Risk Ratio (M‐H, Fixed, 95% CI)	0.89 [0.70, 1.13]

9 Meconium‐stained liquor Show forest plot	1	955	Risk Ratio (M‐H, Fixed, 95% CI)	0.86 [0.67, 1.10]

10 Apgar score < 7 at 5 minutes Show forest plot	3	1064	Risk Ratio (M‐H, Fixed, 95% CI)	0.51 [0.20, 1.31]

11 Neonatal intensive care unit admission Show forest plot	1	955	Risk Ratio (M‐H, Fixed, 95% CI)	0.51 [0.24, 1.09]

12 Perinatal death Show forest plot	1	955	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

13 Maternal side‐effects (all) Show forest plot	1	280	Risk Ratio (M‐H, Fixed, 95% CI)	0.2 [0.01, 4.13]

14 Nausea (maternal) Show forest plot	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.34 [0.01, 8.13]

15 Vomitting (maternal) Show forest plot	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.34 [0.01, 8.13]

16 Diarrhoea (maternal) Show forest plot	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

17 Other maternal side‐effects Show forest plot	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

18 Postpartum haemorrhage Show forest plot	2	1155	Risk Ratio (M‐H, Fixed, 95% CI)	1.28 [0.79, 2.09]

Comparison 30. (8.1) PGE2 low dose vs PGE2 high dose (all women)

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Comparison 31. (8.2) PGE2 low dose vs PGE2 high dose (primiparae)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Caesarean section Show forest plot	2	650	Risk Ratio (M‐H, Fixed, 95% CI)	1.16 [0.83, 1.63]

2 Serious neonatal morbidity or perinatal death Show forest plot	1	499	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

3 Cervix unfavourable/unchanged after 12‐24hrs Show forest plot	1	151	Risk Ratio (M‐H, Fixed, 95% CI)	1.66 [1.25, 2.21]

4 Oxytocin augmentation Show forest plot	2	650	Risk Ratio (M‐H, Fixed, 95% CI)	1.05 [0.93, 1.18]

5 Epidural analgesia Show forest plot	2	650	Risk Ratio (M‐H, Fixed, 95% CI)	1.07 [0.93, 1.22]

6 Instrumental vaginal delivery Show forest plot	1	499	Risk Ratio (M‐H, Fixed, 95% CI)	0.92 [0.71, 1.18]

7 Meconium‐stained liquor Show forest plot	1	499	Risk Ratio (M‐H, Fixed, 95% CI)	0.95 [0.72, 1.27]

8 Apgar score < 7 at 5 minutes Show forest plot	1	499	Risk Ratio (M‐H, Fixed, 95% CI)	0.16 [0.02, 1.27]

9 Neonatal intensive care unit admission Show forest plot	1	499	Risk Ratio (M‐H, Fixed, 95% CI)	0.34 [0.11, 1.03]

10 Perinatal death Show forest plot	1	499	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

11 Postpartum haemorrhage Show forest plot	1	499	Risk Ratio (M‐H, Fixed, 95% CI)	1.62 [0.86, 3.05]

Comparison 31. (8.2) PGE2 low dose vs PGE2 high dose (primiparae)

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Comparison 32. (8.3) PGE2 low dose vs PGE2 high dose (multiparae)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Caesarean section Show forest plot	1	456	Risk Ratio (M‐H, Fixed, 95% CI)	0.68 [0.19, 2.51]

2 Serious neonatal morbidity or perinatal death Show forest plot	1	456	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

3 Oxytocin augmentation Show forest plot	1	456	Risk Ratio (M‐H, Fixed, 95% CI)	1.94 [1.35, 2.80]

4 Epidural analgesia Show forest plot	1	456	Risk Ratio (M‐H, Fixed, 95% CI)	1.15 [0.77, 1.70]

5 Instrumental vaginal delivery Show forest plot	1	456	Risk Ratio (M‐H, Fixed, 95% CI)	5.98 [1.37, 25.99]

6 Meconium‐stained liquor Show forest plot	1	456	Risk Ratio (M‐H, Fixed, 95% CI)	0.77 [0.48, 1.24]

7 Apgar score < 7 at 5 minutes Show forest plot	1	456	Risk Ratio (M‐H, Fixed, 95% CI)	1.42 [0.34, 5.88]

8 Neonatal intensive care unit admission Show forest plot	1	492	Risk Ratio (M‐H, Fixed, 95% CI)	1.0 [0.33, 3.06]

9 Perinatal death Show forest plot	1	465	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

10 Postpartum haemorrhage Show forest plot	1	456	Risk Ratio (M‐H, Fixed, 95% CI)	1.04 [0.44, 2.47]

Comparison 32. (8.3) PGE2 low dose vs PGE2 high dose (multiparae)

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Comparison 33. (8.4) PGE2 low dose vs PGE2 high dose (all women with intact membranes)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Caesarean section Show forest plot	2	269	Risk Ratio (M‐H, Fixed, 95% CI)	0.78 [0.44, 1.38]

2 Oxytocin augmentation Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.81 [0.63, 1.05]

3 Epidural analgesia Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	1.20 [0.80, 1.82]

4 Instrumental vaginal delivery Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.69 [0.38, 1.26]

5 Postpartum haemorrhage Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.75 [0.13, 4.40]

6 Uterine hyperstimulation with FHR changes Show forest plot	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.15 [0.02, 1.13]

7 Apgar score < 7 at 5 minutes Show forest plot	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.21 [0.01, 4.13]

8 Maternal side‐effects (all) Show forest plot	1	280	Risk Ratio (M‐H, Fixed, 95% CI)	0.2 [0.01, 4.13]

9 Nausea (maternal) Show forest plot	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.34 [0.01, 8.13]

10 Vomitting (maternal) Show forest plot	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.34 [0.01, 8.13]

11 Diarrhoea (maternal) Show forest plot	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

12 Other maternal side‐effects Show forest plot	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 33. (8.4) PGE2 low dose vs PGE2 high dose (all women with intact membranes)

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Comparison 34. (8.5) 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
1 Uterine hyperstimulation with FHR changes Show forest plot	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.15 [0.02, 1.13]

2 Caesarean section Show forest plot	4	367	Risk Ratio (M‐H, Fixed, 95% CI)	1.00 [0.69, 1.46]

3 Oxytocin augmentation Show forest plot	2	191	Risk Ratio (M‐H, Fixed, 95% CI)	0.88 [0.73, 1.06]

4 Uterine hyperstimulation without FHR changes Show forest plot	1	40	Risk Ratio (M‐H, Fixed, 95% CI)	0.2 [0.01, 3.92]

5 Apgar score < 7 at 5 minutes Show forest plot	2	109	Risk Ratio (M‐H, Fixed, 95% CI)	0.21 [0.01, 4.13]

6 Maternal side‐effects (all) Show forest plot	1	280	Risk Ratio (M‐H, Fixed, 95% CI)	0.2 [0.01, 4.13]

7 Nausea (maternal) Show forest plot	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.34 [0.01, 8.13]

8 Vomitting (maternal) Show forest plot	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.34 [0.01, 8.13]

9 Diarrhoea (maternal) Show forest plot	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

10 Other maternal side‐effects Show forest plot	1	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 34. (8.5) PGE2 low dose vs PGE2 high dose (all women, unfavourable cervix)

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Comparison 35. 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
1 Uterine hyperstimulation with FHR changes Show forest plot	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

1.1 PGE2 (repeated doses) vs placebo/no treatment	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2 Caesarean section Show forest plot	2	300	Risk Ratio (M‐H, Fixed, 95% CI)	0.70 [0.42, 1.18]

2.1 PGE2 (repeated doses) vs placebo/no treatment	2	300	Risk Ratio (M‐H, Fixed, 95% CI)	0.70 [0.42, 1.18]
3 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]

3.1 PGE2 (repeated doses) vs placebo/no treatment	1	36	Risk Ratio (M‐H, Fixed, 95% CI)	0.13 [0.03, 0.47]
4 Uterine hyperstimulation without FHR changes Show forest plot	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	3.0 [0.13, 71.92]

4.1 PGE2 (repeated doses) vs placebo/no treatment	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	3.0 [0.13, 71.92]
5 Epidural analgesia Show forest plot	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	0.83 [0.62, 1.12]

5.1 PGE2 (repeated doses) vs placebo/no treatment	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	0.83 [0.62, 1.12]
6 Meconium‐stained liquor Show forest plot	2	300	Risk Ratio (M‐H, Fixed, 95% CI)	0.43 [0.28, 0.66]

6.1 PGE2 (repeated doses) vs placebo/no treatment	2	300	Risk Ratio (M‐H, Fixed, 95% CI)	0.43 [0.28, 0.66]
7 Apgar score < 7 at 5 minutes Show forest plot	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	0.2 [0.01, 4.06]

7.1 PGE2 (repeated doses) vs placebo/no treatment	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	0.2 [0.01, 4.06]
8 Neonatal intensive care unit admission Show forest plot	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	0.2 [0.02, 1.65]

8.1 PGE2 (repeated doses) vs placebo/no treatment	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	0.2 [0.02, 1.65]

Comparison 35. PGE2 (all regimens) vs placebo/no treatment (all women, outpatient ripening)

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