Prostaglandina vaginal (PGE2 y PGF2a) para la inducción del trabajo de parto a término
Resumen
Antecedentes
Las prostaglandinas se han utilizado para la inducción del trabajo de parto desde los años sesenta. Los trabajos iniciales se centraron en la prostaglandina F2a ya que la prostaglandina E2 se consideró inadecuada por varias razones. Con el desarrollo de vías alternativas de administración, se llevaron a cabo comparaciones entre varias formulaciones de prostaglandinas vaginales. La presente pertenece a una serie de revisiones de métodos de dilatación cervical e inducción del trabajo de parto mediante el uso de metodología estandarizada.
Objetivos
Determinar los efectos de las prostaglandinas vaginales E2 y F2a para la dilatación cervical o la inducción del trabajo de parto durante el tercer trimestre en comparación con placebo/ no tratamiento u otras prostaglandinas vaginales (excepto misoprostol) .
Métodos de búsqueda
El registro de ensayos del Grupo Cochrane de Embarazo y Parto (Cochrane Pregnancy and Childbirth Group) (mayo de 2003) y las referencias bibliográficas de artículos relevantes.
Criterios de selección
Ensayos clínicos que comparen prostaglandinas vaginales utilizadas para la dilatación cervical o la inducción del trabajo de parto durante el tercer trimestre con placebo/no tratamiento u otros métodos enumerados más adelante en una lista predefinida de métodos de inducción del trabajo de parto.
Obtención y análisis de los datos
Se desarrolló una estrategia para poder trabajar con el gran volumen y complejidad de los datos de los ensayos relacionados con la inducción del trabajo de parto. Esto incluyó un método de obtención de datos de dos etapas.
Resultados principales
En total, se consideraron 101 estudios: Se excluyeron 43 y se incluyeron 57 (10 039 mujeres) . Un estudio está a la espera de evaluación.
La prostaglandina vaginal E2 comparada con placebo o ningún tratamiento redujo la probabilidad de no lograr el parto vaginal a las 24 horas (18% versus 99%, riesgo relativo (RR) 0,19, intervalo de confianza (IC) del 95%: 0,14 a 0,25, 2 ensayos, 384 mujeres) , no hubo pruebas de que existieran diferencias entre las tasas de operación cesárea, aunque aumentó el riesgo de hiperestimulación uterina con cambios en la frecuencia cardiaca fetal (4,6% versus RR 4,14, IC del 95%: 1,93 a 8,90, 13 ensayos, 1203 mujeres) .
La comparación de prostaglandina F2a vaginal con placebo mostró tasas similares de operación cesárea, pero fue más probable que mejorara la puntuación cervical (15% versus 60%, RR 0,25, IC del 95%: 0,13 a 0,49, 5 ensayos, 467 mujeres) y se redujo el riesgo de estimulación con oxitocina (53,9% versus 89,1%, RR 0,60, IC del 95%: 0,43 a 0,84, 11 ensayos, 1265 mujeres) con el uso de PGF2a vaginal.
No hubo datos suficientes para llegar a concusiones válidas con respecto a la comparación de PGE2 y PGF2a por vía vaginal.
El comprimido, el gel y el pesario de PGE2 parecen ser igualmente eficaces. Los regímenes de dosis menores, tal como se definen en esta revisión, parecen ser tan eficaces como los regímenes de dosis más altas.
Conclusiones de los autores
El principal objetivo de esta revisión fue examinar la eficacia de las prostaglandinas vaginales E2 y F2a. Esto se refleja en el aumento de las tasas de parto vaginal exitoso a las 24 horas, en que no hubo un aumento en las tasas de parto operatorio y en una mejoría significativa en el cambio favorable del cuello uterino a las 24 a 48 horas.
Se necesitan investigaciones adicionales que cuantifiquen los análisis del costo de la inducción del trabajo de parto con prostaglandinas, con especial interés en los diferentes métodos de administración.
PICOs
Resumen en términos sencillos
No existen pruebas suficientes para medir la efectividad y seguridad de las prostaglandinas para modificar el cuello uterino y desencadenar el trabajo de parto.
Las prostaglandinas se producen de forma natural en el organismo, modifican el cuello uterino y desencadenan el trabajo de parto. De ser necesario, se pueden utilizar prostaglandinas sintéticas por vía vaginal en forma de comprimidos, gel, supositorios o pesarios. Existe una amplia variación en las dosis y el costo de las variadas formas de tratamiento. La revisión de los ensayos encontró que el uso de las prostaglandinas no aumentó la necesidad de cesáreas y provocó complicaciones mínimas, además de que las dosis bajas fueron tan efectivas como las dosis más altas. No hubo pruebas suficientes para comparar los diferentes tipos y se necesitan más investigaciones con respecto a la seguridad y efectividad de las prostaglandinas.
Conclusiones de los autores
Antecedentes
En ocasiones es necesario iniciar el trabajo de parto de forma artificial debido a las precauciones con respecto a la seguridad de la madre o el niño. Esta revisión pertenece a una serie de revisiones de los métodos de inducción del trabajo de parto utilizando un protocolo estandarizado. Para una información más detallada sobre la justificación de este enfoque metodológico, véase al protocolo "genérico" publicado recientemente (Hofmeyr 2003). El protocolo genérico describe cómo se combinará un número de revisiones estandarizadas para comparar varios métodos de preparación del cuello del útero e inducción del trabajo de parto.
Las prostaglandinas se han utilizado para la inducción del trabajo de parto desde los años sesenta. Los trabajos iniciales se centraron en la prostaglandina F2a porque la prostaglandina E2 se consideró inadecuada por varias razones. Con el desarrollo de vías alternativas de administración, se llevaron a cabo comparaciones entre varias formulaciones de prostaglandina vaginal. En el Reino Unido, las prostaglandinas vaginales son uno de los agentes más frecuentemente utilizados para la inducción.
Existen varias preparaciones vaginales de prostaglandinas diferentes usadas para la inducción del trabajo de parto, que incluye geles, comprimidos, supositorios y pesarios. Los regímenes de inducción usados varían considerablemente en cuanto al número de aplicaciones que se utilizan con cada aplicación, las dosis utilizadas y los intervalos de tiempo entre las dosis. Recientemente se han desarrollado pesarios de liberación gradual para reducir el número de aplicaciones necesarias durante la inducción del trabajo de parto. Existe una variación considerable en los costos de estos agentes y esto ha provocado que aumente el interés en los costos relativos versus efectividad con respecto a las prostaglandinas vaginales.
Objetivos
Determinar, a partir de las mejores pruebas disponibles, la efectividad y seguridad de las prostaglandinas vaginales E2 y F2a para la dilatación cervical y la inducción del trabajo de parto en comparación con placebo, ningún tratamiento u otras prostaglandinas vaginales (excepto misoprostol) .
Métodos
Criterios de inclusión de estudios para esta revisión
Tipos de estudios
Ensayos clínicos que comparen prostaglandinas vaginales utilizadas para la maduración cervical o la inducción del trabajo de parto con placebo/no tratamiento u otros métodos enumerados más adelante en una lista predefinida de métodos de inducción del trabajo de parto (ver "Métodos de la revisión") ; los ensayos incluyeron alguna forma de asignación aleatoria a alguno de los grupos; e informaron de uno o más de los resultados especificados previamente.
Tipos de participantes
Mujeres embarazadas con indicación de inducción del trabajo de parto, con feto viable.
Tipos de intervenciones
Prostaglandinas vaginales E2 y F2a comparadas con placebo/no tratamiento u otras prostaglandinas (excepto misoprostol) .
Comparaciones primarias:
1. prostaglandina E2 versus placebo (dividida en tres subgrupos: dosis única, dosis repetida y liberación gradual versus placebo) ;
2. prostaglandina F2a versus placebo;
3. prostaglandina F2a versus prostaglandina E2.
En la comparación PGE2 versus placebo, los ensayos se subdividieron en tres categorías. Esta división se hizo antes del examen de los datos de los ensayos y fue considerada pertinente desde el punto de vista clínico por los revisores. Los revisores consideraron que Las comparaciones principales eran importantes para los revisores, debido a que pensaban que no sería correcto asumir el mismo efecto independientemente del método de aplicación.
4. gel de prostaglandina E2 versus comprimido de prostaglandina E2;
5. gel de prostaglandina E2 versus pesario/supositorio de prostaglandina E2;
6. comprimido de prostaglandina E2 versus pesario/supositorio de prostaglandina E2;
7. prostaglandina E2 (liberación gradual) versus prostaglandina E2 (cualquier vehículo) ;
8. prostaglandina E2 (dosis baja) versus prostaglandina E2 (dosis alta) .
La división de las comparaciones de dosis de PGE2 en las categorías "dosis baja" y "dosis alta" se hizo para comparar dos prácticas clínicas frecuentes. La división arbitraria de PGE2 menor o igual a 3 mg se hizo por dos razones. Primero, se consideró que esta división separaría los ensayos que usaran, en general, protocolos de dosis única o repetida. En segundo lugar, la división a este nivel permitió que se comparara un mayor número de ensayos. Los ensayos que resultaron excluidos comparaban dosis dentro de cada brazo que se incluyeron tanto en la categoría de dosis alta como de dosis baja. Además, todos estos ensayos excluidos compararon dosis de PGE2 muy similares, p.ej. 2 mg con 3 mg, y además los ensayos fueron todos pequeños y no hubieran detectado diferencias significativas en los resultados examinados.
"Dosis baja": donde la dosis máxima posible en un brazo del protocolo del ensayo fue menor o igual a 3 mg de PGE2.
"Dosis alta": donde la dosis máxima posible en un brazo del protocolo del ensayo fue mayor de 3 mg de PGE2.
9. Maduración cervical ambulatoria. Para esta actualización de la revisión se pretendió examinar el contexto donde se llevó a cabo la inducción del trabajo de parto y el uso de PGE2 en un ámbito ambulatorio.
Tipos de medida de resultado
Dos autores de las revisiones de inducción del trabajo de parto (Justus Hofmeyr y Zarko Alfirevic) especificaron previamente los resultados pertinentes desde le punto de vista clínico de los ensayos de métodos de maduración cervical/inducción del trabajo de parto. Las diferencias se resolvieron por discusión.
Se seleccionaron cinco resultados primarios como los más representativos de medidas importantes desde el punto de vista clínico, en cuanto a efectividad y complicaciones:
(1) no lograr el parto vaginal a las 24 horas;
(2) hiperestimulación uterina con cambios en la frecuencia cardiaca fetal (FCF) :
(3) cesárea;
(4) morbilidad neonatal grave o muerte perinatal (p.ej. convulsiones, asfixia al nacer definida por los autores de los ensayos, encefalopatía neonatal, discapacidad en la infancia) ;
(5) morbilidad materna grave o muerte (p.ej. rotura uterina, ingreso en la unidad de cuidados intensivos, septicemia).
La morbilidad perinatal y materna y la mortalidad son resultados compuestos. Ésta no es una solución ideal porque algunos componentes son claramente menos graves que otros. Es posible que una intervención cause más muertes pero menos morbilidad grave. Sin embargo, esto no es probable en el contexto de la inducción del trabajo de parto a término. Todos estos eventos son infrecuentes y un modesto cambio en su incidencia será más fácil de detectar en caso de que aparezcan los resultados compuestos. Se explorará la incidencia de los componentes individuales como resultados secundarios (ver más adelante) .
Resultados secundarios relacionados con medidas de efectividad, complicaciones y satisfacción:
Medidas de efectividad:
(6) cuello uterino desfavorable/sin cambio después de 12 a 24 horas;
(7) estimulación con oxitocina.
Complicaciones:
(8) hiperestimulación uterina sin cambios en la FCF;
(9) ruptura uterina;
(10) anestesia epidural
(11) parto vaginal instrumental;
(12) líquido teñido con meconio;
(13) Puntuación de Apgar menor a siete a los cinco minutos;
(14) ingreso en la unidad de cuidados intensivos neonatales;
(15) encefalopatía neonatal;
(16) muerte perinatal;
(17) discapacidad en la infancia;
(18) efectos secundarios maternos (todos)
(19) náuseas (maternas)
(20) vómitos (maternos)
(21) diarrea (materna)
(22) otro (p.ej. fiebre)
(23) hemorragia postparto (tal como la definen los autores de los ensayos) ;
(24) complicaciones maternas graves (p.ej. ingreso en la unidad de cuidados intensivos o septicemia, pero se excluye la rotura uterina)
(25) muerte materna
Medidas de satisfacción:
(26) mujer no satisfecha;
(27) personal a cargo no satisfecho
"Rotura uterina" incluye todas las roturas significativas desde el punto de vista clínico en un útero con cicatriz o sin ella. Se excluye la dehiscencia trivial de la herida descubierta incidentalmente en el momento de la cirugía.
En las revisiones primarias individuales pueden aparecer resultados adicionales, pero no aportarán a las revisiones secundarias.
Aunque se buscarán todos los resultados mencionados anteriormente, solamente aparecerán en las tablas de análisis los que presenten datos.
El término hiperestimulación uterina es problemático (Curtis 1987). En las revisiones, el término "hiperestimulación sin cambios en la FCF" se define como taquisistolia uterina (más de cinco contracciones en 10 minutos durante al menos 20 minutos) e hipersistolia/hipertonía (una contracción que dure al menos dos minutos) .
"Hiperestimulación uterina con cambios en la FCF" se define como el síndrome de hiperestimulación uterina (taquisistolia o hipersistolia con cambios en la frecuencia cardiaca fetal con desaceleraciones persistentes, taquicardia o disminución de la variabilidad a corto plazo). Sin embargo, debido a la variabilidad de los informes existe la posibilidad de sesgo subjetivo al interpretar estos resultados. Tampoco está siempre claro en los ensayos si estos resultados se informan de forma mutuamente excluyente.
Los resultados se incluyeron en el análisis si se tomaron medidas razonables para disminuir el sesgo del observador y si los datos estuvieron disponibles de acuerdo con la asignación original al tratamiento.
Métodos de búsqueda para la identificación de los estudios
Se hicieron búsquedas en el Grupo Cochrane de Embarazo y Parto (Cochrane Pregnancy and Childbirth Group trials register) (mayo 2003).
El Coordinador de Búsqueda de Ensayos mantiene el registro de ensayos del Grupo Cochrane de Embarazo y Parto, que contiene ensayos identificados desde:
1. Búsquedas trimestrales en el Registro Cochrane Central de Ensayos Controlados (CENTRAL) Cochrane Central Register of Controlled Trials (CENTRAL);
2. búsquedas mensuales en MEDLINE;
3. búsquedas manuales en 30 revistas y en los resúmenes de las principales conferencias;
4. búsqueda semanal de información actualizada en 37 revistas adicionales.
Los detalles sobre las estrategias de búsqueda en CENTRAL y MEDLINE, la lista de revistas consultadas manualmente y los resúmenes de las conferencias, así como la lista de revistas revisadas por medio del servicio de información actualizada se pueden encontrar en la sección "Estrategias de búsqueda para la identificación de estudios" dentro de la información editorial sobre el Grupo Cochrane de Embarazo y Parto.
A los ensayos identificados a través de las actividades de búsqueda descritas más arriba se les asigna un código (o códigos) que depende del tema. Los códigos están relacionados con los temas de la revisión. El Coordinador de Búsqueda de Ensayos busca el registro para cada revisión utilizando estos códigos en lugar de palabras clave.
La búsqueda se llevó a cabo de forma simultánea para todas las revisiones de métodos de inducción del trabajo de parto, tal como se señala en el protocolo genérico para estas revisiones. (Hofmeyr 2003).
Los ensayos relevantes se identificaron en el Registro Especializado de Ensayos Controlados del grupo (Group's Specialised Register of Controlled Trials). Ver los detalles del Grupo de Revisión para obtener información adicional.
Se realizaron búsquedas manuales en las listas de referencias de los ensayos y las revisiones.
Obtención y análisis de los datos
Se desarrolló una estrategia para poder trabajar con el gran volumen y complejidad de los datos de los ensayos relacionados con la inducción del trabajo de parto. Se han estudiado muchos métodos, que examinan los efectos de los mismos cuando se realiza una inducción del trabajo de parto en una variedad de grupos clínicos, p.ej. limitados a mujeres primíparas o a aquellas con rotura de membranas. La mayoría de los ensayos son de intervención dirigida, que compara dos o más métodos en varias categorías de mujeres. Los médicos y los familiares necesitan los datos ordenados de acuerdo con las características clínicas de las mujeres que se someten a inducción del trabajo de parto, para poder seleccionar el mejor método para una situación clínica particular. Sería muy difícil obtener estos datos en un paso único a partir de la gran cantidad de informes de ensayos. Se desarrolló un método de obtención de datos en dos etapas. La obtención inicial de los datos se hizo en una serie de revisiones primarias ordenadas según el método de inducción del trabajo de parto, con una metodología estandarizada. Los datos se obtuvieron a partir de revisiones primarias y se transfirieron hacia una serie de revisiones secundarias, ordenadas según las características clínicas de las mujeres sometidas a inducción del trabajo de parto.
Para evitar la duplicación de los datos en las revisiones primarias, los métodos de inducción del trabajo de parto se enumeraron en un orden específico, desde el uno hasta el 23. Cada revisión primaria incluyó comparaciones entre uno de los métodos (desde el dos hasta el 23) y solamente los métodos mencionados por encima de éste en la lista. Por lo tanto, la revisión de oxitocina intravenosa (4) incluyó solamente las comparaciones con prostaglandinas intracervicales (3) , prostaglandinas vaginales (2) o placebo (1) . Los métodos identificados en el futuro se agregarán al final de la lista. La lista actual está conformada como sigue:
(1) placebo/ningún tratamiento;
(2) prostaglandinas vaginales;
(3) prostaglandinas intracervicales;
(4) oxitocina intravenosa;
(5) amniotomía;
(6) oxitocina intravenosa con amniotomía;
(7) misoprostol vaginal;
(8) misoprostol oral;
(9) métodos mecánicos con inclusión del catéter de Foley intraamniótico;
(10) separación de las membranas;
(11) prostaglandinas extraamnióticas;
(12) prostaglandinas intravenosas;
(13) prostaglandinas orales;
(14) mifepristona;
(15) estrógenos con o sin amniotomía;
(16) corticosteroides;
(17) relaxina;
(18) hialuronidasa;
(19) aceite de castor, baño o enema
(20) acupuntura;
(21) estimulación de la mama;
(22) coito;
(23) métodos homeopáticos
(24) óxido nítrico;
(25) misoprostol oral o sublingual
(26) otros métodos para la inducción del trabajo de parto.
Las revisiones primarias se analizaron según los siguientes subgrupos:
(1) operación cesárea previa o no;
(2) nuliparidad o multiparidad;
(3) membranas íntegras o rotas;
(4) cuello uterino favorable, desfavorable o no definido.
Las revisiones secundarias incluirán todos los métodos de inducción del trabajo de parto para cada una de las categorías de mujeres para las que se hizo el análisis de subgrupos en las revisiones primarias e incluirán solamente las medidas de resultado primarias. Por lo tanto, habrá seis revisiones secundarias de métodos de inducción del trabajo de parto en los siguientes grupos de mujeres:
(1) nulíparas, membranas íntegras (cuello uterino desfavorable, favorable, no definido) ;
(2) nulíparas, membranas rotas (cuello uterino desfavorable, favorable, no definido) ;
(3) multíparas, membranas íntegras (cuello uterino desfavorable, favorable, no definido) ;
(4) multíparas, membranas rotas (cuello uterino desfavorable, favorable, no definido) ;
(5) cesárea previa, membranas íntegras (cuello uterino desfavorable, favorable o no definido) ;
(6) cesárea previa, membranas rotas (cuello uterino desfavorable, favorable o no definido) ;
Cada vez que se actualiza una revisión primaria con nuevos datos, también se actualizan las revisiones secundarias que incluyen datos que han cambiado.
Los ensayos incluidos en las revisiones primarias se obtuvieron de un grupo inicial de ensayos que cubren todas las intervenciones utilizadas en la inducción del trabajo de parto (ver arriba los detalles de la estrategia de búsqueda) . El proceso de obtención de los datos se llevó a cabo de forma centralizada. Se coordinó desde la Unidad de Apoyo a la Efectividad Clínica (del inglés Clinical Effectiveness Support Unit, CESU) en el Royal College of Obstetricians and Gynaecologists, Reino Unido, en cooperación con el Grupo de Embarazo y Parto de la Colaboración Cochrane. Esto permitió que el proceso de obtención de datos se estandarizara para todas las revisiones.
Los ensayos se revisaron inicialmente en base a los criterios de elegibilidad con un formulario estandarizado y a los criterios de selección básicos especificados anteriormente. Después de esto, los datos se transfirieron a un formulario estandarizado piloto de obtención de datos para confirmar si eran consistentes y estaban completos. El proceso piloto incluyó a los investigadores en el CESU y a revisores previos en el área de inducción del trabajo de parto.
Se obtuvo la información con respecto a la calidad metodológica de los ensayos en varios niveles. Este proceso se completó sin tomar en consideración los resultados del ensayo. La evaluación del sesgo de selección examinó de forma separada el proceso de generación de la secuencia aleatoria y el método de encubrimiento de la asignación. Luego se clasificaron para los propósitos de las revisiones como adecuados o inadecuados mediante el uso de criterios que se describen en la Tabla 01 01.
Se examinó el sesgo de realización con respecto a quién estaba cegado en los ensayos, es decir, la paciente, el personal a cargo, el evaluador de los resultados o el analista. En muchos ensayos el personal a cargo, el evaluador y el analista fueron la misma persona. Se buscaron los detalles acerca de la factibilidad y la idoneidad del cegamiento a todos los niveles.
Los análisis de subgrupos predefinidos son: operación cesárea previa o no; nuliparidad o multiparidad; membranas íntegras o rotas y cuello uterino desfavorable, favorable o no definido. Solamente los resultados con datos aparecen en tablas de análisis.
Los datos de resultados individuales se incluyeron en el análisis si cumplían con los criterios preestablecidos en "Tipos de medidas de resultado". Los datos incluidos se procesaron tal como se describe en el Manual Cochrane del Revisor (Clarke 2002). Los datos obtenidos de los ensayos se analizaron por intención de tratar (intention to treat) (cuando no se hizo en el informe original se llevó a cabo el reanálisis, si fue posible) . Cuando faltaban datos, se solicitó aclaración a los autores originales. Si la deserción fue tal que pudiera afectar significativamente los resultados, los datos se excluyeron del metanálisis. Los revisores de las revisiones primarias tomaron esta decisión y se documentó con claridad. En caso de estar disponibles, los datos adicionales se incluirán en los análisis.
Se obtuvieron los datos de todos los ensayos elegibles para examinar, mediante un análisis de sensibilidad, cómo influyó cada aspecto de la calidad en el tamaño del efecto. En los ensayos donde el informe fue deficiente, los aspectos metodológicos se clasificaron como dudosos o se solicitó aclaración.
Debido a la gran cantidad de ensayos, no fue factible obtener los datos por duplicado, por lo que el acuerdo entre los tres investigadores que obtuvieron los datos se evaluó entonces mediante una muestra aleatoria de ensayos.
Una vez que se obtuvieron los datos, se distribuyeron entre revisores individuales para su registro en el programa informático Review Manager (RevMan 1999) , se verificaron con respecto a la exactitud y se analizaron tal como se señala anteriormente mediante el programa informático RevMan. Para los datos dicotómicos, se calcularon los riesgos relativos y los intervalos de confianza del 95% y en caso de no existir heterogeneidad, los resultados se agruparon mediante un modelo de efectos fijos.
Los criterios predefinidos para los análisis de sensibilidad incluyeron todos los aspectos de la evaluación de la calidad que se mencionan anteriormente, además de los aspectos de sesgo de selección, realización y desgaste.
El análisis primario se limitó a los resultados preespecificados y al análisis de subgrupos. En caso de encontrar diferencias en resultados o subgrupos no especificados, se hicieron análisis post hoc, pero éstos se identificaron con claridad para evitar llegar a conclusiones injustificadas.
Resultados
Descripción de los estudios
En total, se consideraron 101 estudios: Se excluyeron 43 y se incluyeron 57, los cuales examinaron un total de 10 039 mujeres. Un estudio está a la espera de evaluación. Para detalles adicionales de las características de los estudios ver "Características de los estudios incluidos/excluidos".
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Estudios excluidos
En 23 estudios no se facilitaba el resultado primario o no fue posible obtenerlo. (MacKenzie 1977; Gordon‐Wright 1979; Dommisse 1981; Castle 1983; Lindblad 1985; Sellers 1985; Greer 1986; Greer 1988; Knogler 1988; MacKenzie 1988; Fusi 1989; Bex 1990; Parker 1990; De Laat 1991; Spitzberg 1991; Bamford 1992; Sorokin 1992; Toppozada 1992; Lass 1994; Tan 1994; Danna 1995; Krammer 1995; MacKenzie 1997b).
Se excluyeron seis ensayos en base a la elegibilidad. Cuatro ensayos incluyeron solamente mujeres sometidas a inducción del trabajo de parto a causa de una muerte fetal (Lorenz 1984; Gauger 1991; Hill 1991; Odum 1993). Un estudio examinó la inducción en embarazos prematuros (Loria‐Casanova 1989). Un estudio comparó tres dosis diferentes de PGF2a, lo que no fue una comparación preespecificada de intervención (Tang 1997).
Se excluyeron 14 ensayos que compararon prostaglandina E2 con prostaglandina E2 en diferentes dosis. Estos ensayos se excluyeron porque las dosis utilizadas no fueron comparables según la división hecha en la revisión, en categorías de "dosis alta" y "dosis baja" (Toplis 1979; Hunter 1982; Walker 1983; Hunter 1984; Varma 1984; Grunstein 1990; Zanini 1991; Norchi 1993; Carlan 1995; Granstrom 1995; Seeras 1995; Smith 1996; Hunter 1998; Tan 1999).
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Estudios incluidos
Prostaglandina E2
Treinta y cinco estudios compararon PGE2 con placebo. En 16 ensayos se empleó una dosis única de prostaglandina (MacKenzie 1979; MacKenzie 1981; Hayashi 1983; Prins 1983; Buchanan 1984; Thiery 1984; Graves 1985; Ulmsten 1985; Cardozo 1986; Rayburn 1988; Curet 1989; Chatergee 1990; Chung 1992; Al Malt 1995; Chua 1995; Doany 1997), Catorce ensayos emplearon dosis repetidas (Liggins 1979; Campbell 1984; Egarter 1989; Sawai 1991; Mahmood 1992; Hage 1993; Sawai 1994; Shoaib 1994; O'Brian 1995; Hannah 1996; Ohel 1996; McCaul 1997; Newman 1997; Roach 1997) y cinco ensayos utilizaron un pesario de liberación controlada (Prasad 1989; Dunston‐Boone 1991; Rayburn 1992; Witter 1992; Witter 1996).
Cinco ensayos compararon gel de prostaglandina E2 con comprimidos (Mahmood 1989; Greer 1990; Al‐Sebai 1993; Payne 1993; Murray 1995), dos ensayos compararon gel con pesario o supositorio (Smith 1990; Perryman 1992) y tres ensayos compararon el comprimido con pesario o supositorio (McLaren 1987; El‐Mardi 1991; Stampe Sorensen 1992). En siete ensayos se compararon los pesarios de liberación controlada con otras preparaciones (Miller 1991; Smith 1994; Duhl 1997; Green 1998; Tomlinson 2001; Mukhopadhyay 2002; Rabl 2002). Seis ensayos que compararon estos agentes compararon pesarios de gel de PGE2 y en un ensayo la comparación fue con comprimido de PGE2 (Rabl 2002). Seis ensayos compararon el pesario de liberación lenta con aplicaciones repetidas de gel/comprimido (Prins 1983; Smith 1994; Duhl 1997; Green 1998; Tomlinson 2001; Mukhopadhyay 2002) y uno comparó el pesario de liberación lenta con una dosis única de gel de PGE2 (Miller 1991).
En siete ensayos se compararon "dosis baja" y "dosis alta" (McLaren 1987; Smith 1990; Miller 1991; Payne 1993; Nuutila 1996; MacKenzie 1997; Green 1998).
Prostaglandina F2a
Tres ensayos compararon prostaglandina F2a con placebo (MacKenzie 1979; MacLennan 1979; Murphy 1980) y dos compararon PGF2a con PGE2 (MacKenzie 1979; Neilson 1983).
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Ámbito del ensayo
La mayoría de los ensayos examinaron los resultados de la inducción del trabajo de parto en un medio intrahospitalario. Once ensayos evaluaron la asignación aleatoria a una inducción inmediata comparada con un manejo expectante (Cardozo 1986; Egarter 1989; Sawai 1991; Sawai 1994; Shoaib 1994; Hannah 1996; Ohel 1996; Doany 1997; McCaul 1997; Newman 1997; Roach 1997) y tres ensayos examinaron políticas de inducción en pacientes ambulatorias (Hage 1993; O'Brian 1995; Ohel 1996).
Riesgo de sesgo de los estudios incluidos
Asignación aleatoria y ocultamiento
Catorce ensayos emplearon una preparación de los fármacos de forma central o en una farmacia, en cajas o jeringuillas codificadas (Liggins 1979; Neilson 1983; Prins 1983; Curet 1989; Smith 1990; Chung 1992; Perryman 1992; Rayburn 1992; Smith 1994; Chua 1995; O'Brian 1995; Hannah 1996; Witter 1996; McCaul 1997). Las secuencias de asignación aleatoria se generaron mediante listas creadas por ordenador o mediante tablas de números aleatorios.
Siete ensayos que usaron listas creadas por ordenador o tablas de números aleatorios, asignaron a las mujeres mediante el método de sobre opaco sellado (MacLennan 1979; Mahmood 1989; Mahmood 1992; Murray 1995; Nuutila 1996; MacKenzie 1997; Roach 1997).
En 32 ensayos hubo incertidumbre con respecto al método de generación de la secuencia de asignación aleatoria, el método de encubrimiento o ambos (MacKenzie 1979; Murphy 1980; MacKenzie 1981; Hayashi 1983; Buchanan 1984; Thiery 1984; Graves 1985; Ulmsten 1985; McLaren 1987; Rayburn 1988; Egarter 1989; Prasad 1989; Chatergee 1990; Greer 1990; Dunston‐Boone 1991; El‐Mardi 1991; Miller 1991; Sawai 1991; Stampe Sorensen 1992; Witter 1992; Al‐Sebai 1993; Hage 1993; Sawai 1994; Shoaib 1994; Al Malt 1995; Doany 1997; Duhl 1997; Newman 1997; Green 1998; Tomlinson 2001; Mukhopadhyay 2002; Rabl 2002).
Se usó asignación alterna en un ensayo (Campbell 1984), dos ensayos asignaron mediante el ultimo dígito del número de historia clínica (Cardozo 1986; Ohel 1996) y un ensayo asignó según el mes de ingreso en el ensayo (Payne 1993).
Cegamiento
Se usó un enfoque doble ciego en 29 ensayos (Liggins 1979; MacKenzie 1979; Murphy 1980; MacKenzie 1981; Hayashi 1983; Neilson 1983; Prins 1983; Buchanan 1984; Campbell 1984; Thiery 1984; Graves 1985; Ulmsten 1985; Rayburn 1988; Curet 1989; Prasad 1989; Chatergee 1990; Smith 1990; Dunston‐Boone 1991; Sawai 1991; Chung 1992; Rayburn 1992; Witter 1992; Sawai 1994; Al Malt 1995; Chua 1995; Murray 1995; O'Brian 1995; Witter 1996; Doany 1997).
Efectos de las intervenciones
Se buscaron todos los resultados enumerados en "Tipo de medidas de resultado" y todos los subgrupos definidos en "Tipo de participantes". Solamente aquellos que presentaron datos aparecen en las tablas de análisis.
Los datos discutidos se aplican al grupo de "todas las mujeres" y, a menos que se señale lo contrario, no hubo diferencias entre los subgrupos especificados.
1. Prostaglandina E2 vaginal versus placebo/ningún tratamiento (35 ensayos)
Resultados primarios
Dos estudios informaron del resultado "no lograr el parto vaginal a las 24 horas" (Ulmsten 1985; Egarter 1989). En general hubo una reducción en la imposibilidad de lograr el parto vaginal a las 24 horas (18,1% versus 98,9%, riesgo relativo (RR) 0,19, intervalo de confianza (IC) del 95%: 0,14 a 0,25, dos ensayos, 384 mujeres) para la PGE2 vaginal comparada con placebo o ningún tratamiento. Ambos ensayos informaron resultados diferentes, el pequeño ensayo controlado con placebo de Ulmsten no encontró pruebas de diferencias, mientras que el estudio más grande de Egarter encontró una reducción con el uso de prostaglandinas comparadas con placebo. Este estudio (Egarter 1989) comparó prostaglandinas vaginales con tratamiento conservador. Además, el ensayo Ulmsten 1985 incluyó mujeres todas primíparas con cuello uterino desfavorable y el ensayo Egarter 1989 consiste en mujeres con paridad mixta con cuello uterino favorable e incluye dosis repetidas de prostaglandinas. Estos factores pueden explicar la heterogeneidad observada.
En 13 estudios se informó "Hiperestimulación uterina con cambios en la FCF" . Se observó un aumento en la hiperestimulación uterina con cambios en la FCF asociada a la prostaglandina E2 vaginal (4,6% versus 0,51%, RR 4,14, IC del 95%: 1,93 a 8,90, 13 ensayos, 1203 mujeres) comparada con placebo. Este aumento se debió, en su mayor parte, a un significativo aumento en el grupo de liberación gradual (7,5% versus 0,0%, RR 10,87, IC del 95%: 2,69 a 43,92) . Dentro del subgrupo de liberación gradual los resultados estuvieron marcadamente influidos por un estudio (Rayburn 1992) , el cual encontró un aumento de 30 veces en las tasas de hiperestimulación asociada con cambios de la FCF (12,9% versus 0,0%, RR 30,44, IC del 95%: 1,83 a 505,65) . En este estudio se comparó un pesario vaginal de 10 mg de liberación gradual con placebo. La definición de hiperestimulación utilizada en esta revisión fue precisa, pero el informe en los ensayos fue variable y estos resultados, aunque ampliamente significativos, se deben interpretar con precaución. Además, no se observaron aumentos en las tasas de hiperestimulación asociadas con cambios en la FCF en los subgrupos de dosis única o repetidas comparados con placebo o ningún tratamiento.
La tasa de operación cesárea fue similar cuando se comparó la prostaglandina E2 con placebo (13,6% versus 15,2%, RR 0,89, IC del 95%: 0,79 a 1,00, 31 ensayos, 6243 mujeres) . Este hallazgo se repitió cuando los datos se analizaron según la paridad, el estado de las membranas o las características del cuello uterino. No hubo heterogeneidad estadística y los resultados fueron similares cuando se tomaron en cuenta solamente los estudios de mayor calidad (12,7% versus 14,6%, RR 0,87, IC del 95%: 0,75 a 1,02) .
No hubo datos suficientes para llegar a conclusiones con respecto a morbilidad materna o neonatal grave o muerte.
Resultados secundarios
El riesgo de que el cuello uterino permaneciera en cambio/desfavorable después de 12 a 24 horas se redujo en cinco ensayos (21,6% versus 40,3%, RR 0,46, IC del 95%: 0,35 a 0,62, cinco ensayos, 467 mujeres) (Hayashi 1983; Campbell 1984; Rayburn 1988; Curet 1989; Hage 1993) con el uso de prostaglandina vaginal, cuando se comparó con placebo.
En general aumentó la hiperestimulación sin cambios en la FCF (1,4% versus 0,4%, RR 2,48, IC del 95%: 1,17 a 5,26, 12 ensayos, 3580 mujeres) , nuevamente como resultado del aumento en el subgrupo de liberación gradual (6,6% versus 0,0%, RR 7,85, IC del 95%: 1,05 a 58,82) .
El uso de estimulación con oxitocina se redujo al utilizar las prostaglandinas vaginales (35,1% versus 43,8%, RR 0,80, IC del 95%: 0,69 a 0,91, 11 ensayos, 1265 mujeres) . Hubo una marcada heterogeneidad entre estos ensayos, principalmente entre los seis ensayos donde se administró prostaglandina solamente en dosis única (MacKenzie 1979; MacKenzie 1981; Buchanan 1984; Rayburn 1988; Chua 1995; Doany 1997). Esta heterogeneidad se evidenció cuando se incluyeron solamente ensayos con una asignación aleatoria o un encubrimiento adecuados, pero se mantuvo la reducción general (35,4% versus 52,8%, RR 0,67, IC del 95%: 0,54 a 0,83) . Este efecto no fue significativo cuando se tomaron cuenta solamente los ensayos que examinaron mujeres con un cuello uterino favorable (MacKenzie 1981; Egarter 1989) (36,3% versus 37,6%, RR 0,97, IC del 95%: 0,74 a 1,26) .
Hubo un aumento en el uso de anestesia epidural cuando se utilizaron prostaglandinas (49,6% versus 45,5%, RR 1,09, IC del 95%: 1,01 a 1,16, 7 ensayos, 3555 mujeres) . Esto no se hizo evidente hasta que no se agregó un estudio donde se encontró un aumento de cinco veces en las tasas de anestesia epidural (Shoaib 1994). El ensayo comparó manejo activo versus conservador para la rotura de membranas a término. No se observaron diferencias entre el uso de anestesia epidural o la necesidad de parto instrumental entre los grupos. Los resultados de este estudio contrastan marcadamente con los otros ensayos y existe una heterogeneidad significativa cuando este estudio se incluye.
La aparición de líquido con meconio fue menos probable cuando se realizó una inducción con prostaglandinas vaginales (8,6% versus 10,7%, RR 0,82, IC del 95%: 0,68 a 0,98, 11 ensayos, 4145 mujeres) .
No hubo pruebas de diferencias entre los dos grupos con respecto a la puntuación de Apgar menor de siete a los cinco minutos (2,2% versus 1,6%, RR 1,30, IC del 95%: 0,86 a 1,96, 15 ensayos, 4381 mujeres) y en el ingreso en la unidad de cuidados intensivos neonatales (8,9% versus RR 0,95, IC del 95%: 0,78 a 1,15, 11 ensayos, 3922 mujeres) La puntuación de Apgar menor de siete a los cinco minutos no fue un evento frecuente y solamente se informaron 84 casos en las 4381 pacientes.
Los efectos secundarios maternos no aumentaron con el uso de prostaglandinas vaginales. Por el contrario, la tasa de hemorragia postparto aumentó con el uso de prostaglandinas (4% versus 2,8%, RR 1,44, IC del 95%: 1,01 a 2,05, 8 ensayos, 3437 mujeres) , en su mayoría como resultado del aumento observado en un estudio, que comparó manejo activo versus conservador de la rotura de las membranas (Hannah 1996).
Dos estudios examinaron la satisfacción materna con la forma de inducción (Cardozo 1986; Hannah 1996). En ambos ensayos se comparó una política de inducción activa con la inducción con PGE2 vaginal. En general las mujeres estuvieron menos satisfechas con una política de manejo expectante (6,4% versus 11,5%, RR 0,56, IC del 95%: 0,44 a 0,71) . Sin embargo, los resultados de los dos ensayos fueron diferentes solamente con el ensayo más grande (Hannah 1996), que mostró esta diferencia significativa.
No hubo datos suficientes para establecer conclusiones importantes con respecto a los otros resultados (rotura uterina, encefalopatía neonatal, discapacidad durante la infancia, muerte perinatal, hemorragia postparto, complicaciones maternas importantes o personal a cargo no satisfecho) .
2. Prostaglandina F2a vaginal versus placebo (tres ensayos)
No hubo diferencias en cuanto a tasa de operación cesárea con el uso de PGF2a (5,8% versus 10,2%, RR 0,58, IC del 95%: 0,29 a 1,18, tres ensayos, 387 mujeres) . En el único estudio que informó sobre este resultado fue menos probable que las puntuaciones del cuello uterino permanecieran sin cambio (MacLennan 1979) (15% versus 60%, RR 0,25, IC del 95%: 0,13 a 0,49, 90 mujeres) . Se redujo la estimulación con oxitocina (53,9% versus 89,1%, RR 0,65, IC del 95%: 0,53 a 0,80, dos ensayos, 122 mujeres) con el uso de PGF2a. Ningún otro resultado informado mostró pruebas de diferencias entre los grupos.
3. Prostaglandina F2a versus prostaglandina E2 (dos ensayos)
En general no hubo datos suficientes para llegar a conclusiones importantes. Un ensayo (MacKenzie 1979) mostró un aumento significativo en la necesidad de estimulación con oxitocina con el uso de PGF2a (87,5% versus 37,5%, RR 2,33, IC del 95%: 1,21 a 4,51, un ensayo, 32 mujeres) , pero las cifras en este ensayo fueron pequeñas (16 en cada brazo) , por lo que los resultados se deben interpretar con precaución. No hubo pruebas de diferencias entre los otros resultados informados.
4. Gel de prostaglandina E2 versus comprimido de prostaglandina E2 (cinco ensayos)
Resultados primarios
No hubo pruebas de diferencias en las tasas de parto vaginal no logrado a las 24 horas. No hubo diferencia entre el gel o el comprimido con respecto a la hiperestimulación uterina con cambios en la FCF (0,5% versus 1,0%, RR 2,00, IC del 95%: 0,18 a 21,71, un ensayo, 577 mujeres), o la tasas de operación cesárea (18,1% versus 19,8%, RR 0,91, IC del 95%: 0,64 a 1,28, cuatro ensayos, 553 mujeres) . No hubo datos suficientes para llegar a conclusiones con respecto a morbilidad materna grave o muerte.
Resultados secundarios
No hubo pruebas suficientes de diferencias en las tasas de cuello uterino sin cambios/desfavorable a las 24 o 48 horas en el único ensayo que informó este resultado (Murray 1995). La estimulación con oxitocina se redujo cuando se utilizó el gel de PGE2, comparado con los comprimidos (49,5% versus 59,2%, RR 0,84, IC del 95%: 0,72 a 0,97, 200 mujeres) . Hubo una heterogeneidad significativa entre los ensayos, principalmente entre dos de ellos (Mahmood 1989; Murray 1995). Sin embargo, ambos ensayos fueron muy similares en cuanto a diseño. No hubo pruebas de diferencias entre las tasas de uso de anestesia epidural, parto vaginal instrumental o hemorragia postparto entre los dos grupos.
No hubo datos suficientes para llegar a conclusiones con respecto a los resultados neonatales.
5. Gel de prostaglandina E2 versus pesario/supositorio de prostaglandina E2 (dos ensayos)
Resultados primarios
No hubo datos disponibles con respecto a parto vaginal no logrado a las 24 horas. Se observó una reducción de la hiperestimulación con cambios en la FCF en asociación con el uso de gel de PGE2 en comparación con los pesarios de PGE2 (1,3% versus 11,2%, RR 0,16, IC del 95%: 0,03 a 0,87, dos ensayos, 159 mujeres) (Smith 1990; Perryman 1992). La dosis usada en los dos brazos de un ensayo (Perryman 1992) fue 5 mg de PGE2, que es mucho mayor que la que normalmente se usa como dosis única. El otro ensayo (Smith 1990) comparó 2,5 mg de gel de PGE2 con un "chip" vaginal que contenía de 3 a 3,5 mg de PGE2. Por estas razones, estos resultados deben interpretarse con precaución. No hubo pruebas de que las tasas de operación cesárea fueran diferentes entre los dos sistemas de administración (20,3% versus 31,3%, RR 0,65, IC del 95%: 0,38 a 1,11, dos ensayos, 159 mujeres) .
Resultados secundarios
Las tasas de hiperestimulación uterina sin cambios en la FCF no fueron diferentes entre los grupos de gel y pesario en el único ensayo que informó este resultado (Perryman 1992) (0,0% versus 4,4%, RR 0,20, IC del 95%: 0,01 a 4,05, un ensayo, 90 mujeres). No hubo pruebas de diferencias entre efectos secundarios maternos o puntuación de Apgar menor de siete a los cinco minutos.
6. Comprimido de prostaglandina E2 versus pesario/supositorio de prostaglandina E2 (tres ensayos)
Resultados primarios
No se observaron pruebas de diferencias entre las tasas de operación cesárea entre el comprimido y el pesario (9,3% versus 8,1%, RR 1,13, IC del 95%: 0,64 a 1,99, tres ensayos, 491 mujeres). No hubo datos disponibles con respecto a parto vaginal no logrado a las 24 horas.
Resultados secundarios
La estimulación con oxitocina se utilizó con menos frecuencia con los comprimidos de PGE2 como agente de inducción (25,9% versus 35,2%, RR 0,73, IC del 95%: 0,56 a 0,96, tres ensayos, 491 mujeres). Se observó una marcada heterogeneidad entre los ensayos (McLaren 1987; El‐Mardi 1991; Stampe Sorensen 1992) pero los tres ensayos utilizaron dosis similares de ambas preparaciones y ambos utilizaron una aplicación única de cada fármaco.
No hubo datos suficientes disponibles para considerar la hiperestimulación uterina sin cambios en la FCF, el uso de epidural o los efectos secundarios maternos. Las tasas de parto vaginal instrumental aumentaron con el uso de comprimidos de PGE2 (17,8% versus 10,2%, RR 1,72, IC del 95%: 1,09 a 2,70, tres ensayos, 491 mujeres). La hemorragia postparto y las puntuaciones de Apgar menor de siete a los cinco minutos no mostraron diferencias.
7. Prostaglandina E2 (liberación lenta) versus prostaglandina E2 (cualquier vehículo) (siete ensayos)
Resultados primarios
No se observaron diferencias entre parto vaginal no logrado a las 24 horas o tasas de hiperestimulación uterina con cambios en la frecuencia cardíaca fetal (7,2% versus 2,6%, RR 2,76, IC del 95%: 0,89 a 8,56, dos ensayos, 321 mujeres) . Las tasas de operación cesárea no fueron diferentes entre los dos grupos (15,0% versus 16,6%, RR 0,92, IC del 95%: 0,63 a 1,36, cinco ensayos, 537 mujeres) .
Resultados secundarios
El uso de oxitocina y las tasas de hiperestimulación uterina sin cambios en la FCF fueron similares entre los dos grupos. No hubo datos suficientes sobre los resultados neonatales para establecer conclusiones.
8. Prostaglandina E2 (dosis baja) versus prostaglandina E2 a dosis alta (siete ensayos)
Resultados primarios
Se observó una reducción en la hiperestimulación con cambios en la FCF en asociación con regímenes de dosis baja (1,4% versus 11,3%, RR 0,18, IC del 95%: 0,03 a 0,99, dos ensayos, 140 mujeres) . Este resultado se debió principalmente a los resultados de un ensayo (Smith 1990) que, como se mencionó anteriormente, usó un pesario de 3 a 3,5 mg en el brazo de dosis alta. Al retirar este ensayo desapareció la significación del resultado. No hubo pruebas de diferencias entre los dos grupos con respecto a las tasas de operación cesárea (11,2% versus 10,6%, RR 1,07, IC del 95%: 0,80 a 1,42, siete ensayos, 1466 mujeres) . No hubo muertes neonatales ni casos de morbilidad neonatal grave en el único ensayo que informó de este resultado (MacKenzie 1997). No hubo datos disponibles con respecto al parto vaginal no logrado a las 24 horas.
Resultados secundarios
No se observaron diferencias entre los dos grupos con respecto al uso de estimulación con oxitocina (43,8% versus 40,7%, RR 1,09, IC del 95%: 0,95 a 1,24, cuatro ensayos, 1219 mujeres). El uso de estimulación con oxitocina aumentó en las mujeres multíparas cuando se usó el régimen de dosis baja (30,5% versus 15,7%, RR 1,94, IC del 95%: 1,35 a 2,80) en el único ensayo que informó este subgrupo (MacKenzie 1997). Este ensayo comparó una dosis única de 2 mg de gel de PGE2 con dos dosis de la misma formulación.
No aumentó la hiperestimulación sin cambios en la FCF, ni el uso de analgesia epidural, el líquido tenido con meconio, la puntuación de Apgar menor de siete a los cinco minutos, el ingreso en la unidad de cuidados intensivos neonatales, los efectos secundarios maternos o la hemorragia postparto. En general las tasas de parto vaginal instrumental no aumentaron (17,3% versus 19,5%, RR 0,89, IC del 95%: 0,70 a 1,13, tres ensayos, 1179 mujeres), aunque las tasas de parto vaginal instrumental en multíparas sí lo hicieron (5,7% versus 1,0%, RR 5,98, IC del 95%: 1,37 a 25,99).
9. Maduración cervical en pacientes ambulatorias
Tres ensayos examinaron el uso de PGE2 vaginal en un medio extrahospitalario. Los ensayos incluyeron 336 mujeres y los datos acerca de la los aspectos de la seguridad de la inducción del trabajo de parto con este procedimiento no fueron suficientes para hacer planteamiento alguno. Los resultados fueron similares en su naturaleza a otros estudios que compararon la inducción del trabajo de parto con PGE2 con placebo/manejo expectante.
Discusión
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PGE2 versus placebo
Los datos disponibles indican que las tasas de operación cesárea no aumentaron y que el uso de oxitocina se redujo con el uso de prostaglandinas vaginales en comparación con placebo. Hubo un aumento en la tasa de parto vaginal exitoso y cambios favorables en el cuello uterino. Sin embargo, los datos informados para estos resultados fueron limitados y es probable que esto refleje la forma en la que se describen los ensayos incluidos.
Es preocupante el aumento en las tasas de hiperestimulación con cambios en la FCF observado con el uso de pesarios de liberación gradual. La descripción de estos resultados es variable, aunque la mayoría de los ensayos que compararon pesarios de liberación gradual con placebo son estudios recientes y los informes son consistentemente buenos entre ellos, con respecto a las definiciones de hiperestimulación. En la comparación de los pesarios de liberación controlada con gel o comprimido vaginal, el informe de aumento en las tasas de hiperestimulación asociado fue limitado, pero en los tres hubo una tendencia hacia el aumento en la hiperestimulación con y sin cambios en la FCF cuando se utilizaron los pesarios de liberación lenta. Esta revisión se limitó a las comparaciones con otras prostaglandinas vaginales y se deberían comparar las tasas relativas de hiperestimulación con PGE2 intracervical o misoprostol para brindar una descripción completa.
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Comparaciones de los vehículos
Las pruebas actuales sugieren que el gel de PGE2 es tan eficaz como los comprimidos de PGE2. El gel de PGE2 reduce la necesidad de estimulación con oxitocina, aunque la significación de una reducción en el uso de oxitocina es dudosa. Debe ser considerada a la luz de la falta de pruebas con respecto a la diferencias entre las tasas de operación cesárea y de la heterogeneidad observada en los resultados. Los pesarios de liberación lenta comparados con el gel no han mostrado que reduzcan significativamente las tasas de operación cesárea o que mejoren los resultados neonatales o maternos adversos.
El costo es un aspecto importante cuando se analizan los métodos de inducción del trabajo de parto. Dosis equivalentes de comprimidos y gel de dinoprostona cuestan £2,98 y £14,50 respectivamente y un pesario de liberación gradual de dinoprostona cuesta £43,00. Según las pruebas actuales, se debería examinar con más detenimiento el uso de estos tratamientos más costosos. Es evidente que los costos de la inducción son más complicados que el precio de los fármacos utilizados. Es necesario tener en cuenta el hallazgo de que se redujo la necesidad de estimulación con oxitocina cuando se compara el gel con el comprimido, debido al aumento en la necesidad de estimulación con oxitocina y los partos instrumentales en mujeres multíparas que recibieron regímenes de inducción de "dosis baja".
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Comparaciones de dosis
La única diferencia demostrable entre los regímenes de dosis baja y alta fue una mayor tasa de estimulación con oxitocina y de partos instrumentales en mujeres que recibieron el régimen de dosis baja. Si se consideran los problemas de la división arbitraria realizada en esta revisión, no hay pruebas de que los regímenes de dosis alta tengan alguna ventaja.
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Analisis de sensibilidad
Se intentó cuantificar el impacto de una asignación aleatoria o un encubrimiento inadecuados o dudosos en el contexto de la revisión. Fue llamativo el efecto sobre los resultados de incluir solamente los ensayos que presentaron una metodología adecuada. Los factores de menor calidad parecieron ser responsables de la significación de la heterogeneidad en las dos áreas principales de la revisión (tasas de operación cesárea y estimulación con oxitocina con respecto a PGE2 versus placebo) pero en ningún caso se alteró el resultado general.
Debido al número de comparaciones de agentes de esta revisión y al pequeño número de ensayos en cada grupo, no se pudo realizar un análisis más detallado del impacto de la calidad de los ensayos sobre los resultados en otras secciones de la revisión.
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Sesgo de publicación
Se ha intentado examinar el efecto de posibles sesgos de publicación en esta revisión y su impacto en los cinco resultados primarios. Debido a las limitaciones en cuanto a los datos sobre tasas de parto vaginal no logrado a las 24 horas, y a la pequeña cantidad de datos disponibles acerca de morbilidad materna y neonatal grave y mortalidad, los cálculos se limitaron a las tasas de hiperestimulación con cambios en la FCF y de operación cesárea. La distribución en embudo (funnel plot) estándar no muestra pruebas gráficas de sesgo de publicación en esta revisión para los dos resultados examinados, aunque los puntos se hacen asimétricos cuando se incluyen solamente estudios de calidad adecuada al examinar la operación cesárea.
Comparison 1 (1.1) PGE2 (all regimens) vs placebo/no treatment (all women), Outcome 1 Vaginal delivery not achieved within 24 hours.
Comparison 1 (1.1) PGE2 (all regimens) vs placebo/no treatment (all women), Outcome 2 Uterine hyperstimulation with FHR changes.
Comparison 1 (1.1) PGE2 (all regimens) vs placebo/no treatment (all women), Outcome 3 Caesarean section.
Comparison 1 (1.1) PGE2 (all regimens) vs placebo/no treatment (all women), Outcome 4 Serious neonatal morbidity or perinatal death.
Comparison 1 (1.1) PGE2 (all regimens) vs placebo/no treatment (all women), Outcome 5 Serious maternal morbidity or death.
Comparison 1 (1.1) PGE2 (all regimens) vs placebo/no treatment (all women), Outcome 6 Cervix unfavourable/unchanged after 12 to 24 hours.
Comparison 1 (1.1) PGE2 (all regimens) vs placebo/no treatment (all women), Outcome 7 Oxytocin augmentation.
Comparison 1 (1.1) PGE2 (all regimens) vs placebo/no treatment (all women), Outcome 8 Uterine hyperstimulation without FHR changes.
Comparison 1 (1.1) PGE2 (all regimens) vs placebo/no treatment (all women), Outcome 9 Uterine rupture.
Comparison 1 (1.1) PGE2 (all regimens) vs placebo/no treatment (all women), Outcome 10 Epidural analgesia.
Comparison 1 (1.1) PGE2 (all regimens) vs placebo/no treatment (all women), Outcome 11 Instrumental vaginal delivery.
Comparison 1 (1.1) PGE2 (all regimens) vs placebo/no treatment (all women), Outcome 12 Meconium stained liquor.
Comparison 1 (1.1) PGE2 (all regimens) vs placebo/no treatment (all women), Outcome 13 Apgar score <7 at 5 minutes.
Comparison 1 (1.1) PGE2 (all regimens) vs placebo/no treatment (all women), Outcome 14 Neonatal intensive care unit admission.
Comparison 1 (1.1) PGE2 (all regimens) vs placebo/no treatment (all women), Outcome 16 Perinatal death.
Comparison 1 (1.1) PGE2 (all regimens) vs placebo/no treatment (all women), Outcome 18 Maternal side‐effects (all).
Comparison 1 (1.1) PGE2 (all regimens) vs placebo/no treatment (all women), Outcome 19 Nausea (maternal).
Comparison 1 (1.1) PGE2 (all regimens) vs placebo/no treatment (all women), Outcome 20 Vomitting (maternal).
Comparison 1 (1.1) PGE2 (all regimens) vs placebo/no treatment (all women), Outcome 21 Diarrhoea (maternal).
Comparison 1 (1.1) PGE2 (all regimens) vs placebo/no treatment (all women), Outcome 22 Other maternal side effects.
Comparison 1 (1.1) PGE2 (all regimens) vs placebo/no treatment (all women), Outcome 23 Postpartum haemorrhage.
Comparison 1 (1.1) PGE2 (all regimens) vs placebo/no treatment (all women), Outcome 24 Serious maternal complication.
Comparison 1 (1.1) PGE2 (all regimens) vs placebo/no treatment (all women), Outcome 26 Woman not satisfied.
Comparison 2 (1.2) PGE2 (all regimens) vs placebo/no treatment (all women, unfavourable cervix), Outcome 1 Vaginal delivery not achieved within 24 hours.
Comparison 2 (1.2) PGE2 (all regimens) vs placebo/no treatment (all women, unfavourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.
Comparison 2 (1.2) PGE2 (all regimens) vs placebo/no treatment (all women, unfavourable cervix), Outcome 3 Caesarean section.
Comparison 2 (1.2) PGE2 (all regimens) vs placebo/no treatment (all women, unfavourable cervix), Outcome 4 Serious neonatal morbidity or perinatal death.
Comparison 2 (1.2) PGE2 (all regimens) vs placebo/no treatment (all women, unfavourable cervix), Outcome 5 Serious maternal morbidity or death.
Comparison 2 (1.2) PGE2 (all regimens) vs placebo/no treatment (all women, unfavourable cervix), Outcome 6 Cervix unfavourable/unchanged after 12 to 24 hours.
Comparison 2 (1.2) PGE2 (all regimens) vs placebo/no treatment (all women, unfavourable cervix), Outcome 7 Oxytocin augmentation.
Comparison 2 (1.2) PGE2 (all regimens) vs placebo/no treatment (all women, unfavourable cervix), Outcome 8 Uterine hyperstimulation without FHR changes.
Comparison 2 (1.2) PGE2 (all regimens) vs placebo/no treatment (all women, unfavourable cervix), Outcome 9 Uterine rupture.
Comparison 2 (1.2) PGE2 (all regimens) vs placebo/no treatment (all women, unfavourable cervix), Outcome 10 Epidural analgesia.
Comparison 2 (1.2) PGE2 (all regimens) vs placebo/no treatment (all women, unfavourable cervix), Outcome 11 Instrumental vaginal delivery.
Comparison 2 (1.2) PGE2 (all regimens) vs placebo/no treatment (all women, unfavourable cervix), Outcome 12 Meconium stained liquor.
Comparison 2 (1.2) PGE2 (all regimens) vs placebo/no treatment (all women, unfavourable cervix), Outcome 13 Apgar score <7 at 5 minutes.
Comparison 2 (1.2) PGE2 (all regimens) vs placebo/no treatment (all women, unfavourable cervix), Outcome 14 Neonatal intensive care unit admission.
Comparison 2 (1.2) PGE2 (all regimens) vs placebo/no treatment (all women, unfavourable cervix), Outcome 16 Perinatal death.
Comparison 2 (1.2) PGE2 (all regimens) vs placebo/no treatment (all women, unfavourable cervix), Outcome 18 Maternal side‐effects (all).
Comparison 2 (1.2) PGE2 (all regimens) vs placebo/no treatment (all women, unfavourable cervix), Outcome 19 Nausea (maternal).
Comparison 2 (1.2) PGE2 (all regimens) vs placebo/no treatment (all women, unfavourable cervix), Outcome 20 Vomitting (maternal).
Comparison 2 (1.2) PGE2 (all regimens) vs placebo/no treatment (all women, unfavourable cervix), Outcome 21 Diarrhoea (maternal).
Comparison 2 (1.2) PGE2 (all regimens) vs placebo/no treatment (all women, unfavourable cervix), Outcome 22 Other maternal side effects.
Comparison 2 (1.2) PGE2 (all regimens) vs placebo/no treatment (all women, unfavourable cervix), Outcome 23 Postpartum haemorrhage.
Comparison 2 (1.2) PGE2 (all regimens) vs placebo/no treatment (all women, unfavourable cervix), Outcome 24 Serious maternal complication.
Comparison 3 (1.3) PGE2 (all regimens) vs placebo/no treatment (all women, favourable cervix), Outcome 1 Vaginal delivery not achieved within 24 hours.
Comparison 3 (1.3) PGE2 (all regimens) vs placebo/no treatment (all women, favourable cervix), Outcome 3 Caesarean section.
Comparison 3 (1.3) PGE2 (all regimens) vs placebo/no treatment (all women, favourable cervix), Outcome 4 Serious neonatal morbidity or perinatal death.
Comparison 3 (1.3) PGE2 (all regimens) vs placebo/no treatment (all women, favourable cervix), Outcome 7 Oxytocin augmentation.
Comparison 3 (1.3) PGE2 (all regimens) vs placebo/no treatment (all women, favourable cervix), Outcome 11 Instrumental vaginal delivery.
Comparison 3 (1.3) PGE2 (all regimens) vs placebo/no treatment (all women, favourable cervix), Outcome 16 Perinatal death.
Comparison 4 (1.5) PGE2 (all regimens) vs placebo/no treatment (all women, intact membranes, unfavourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.
Comparison 4 (1.5) PGE2 (all regimens) vs placebo/no treatment (all women, intact membranes, unfavourable cervix), Outcome 3 Caesarean section.
Comparison 4 (1.5) PGE2 (all regimens) vs placebo/no treatment (all women, intact membranes, unfavourable cervix), Outcome 6 Cervix unfavourable/unchanged after 12 to 24 hours.
Comparison 4 (1.5) PGE2 (all regimens) vs placebo/no treatment (all women, intact membranes, unfavourable cervix), Outcome 7 Oxytocin augmentation.
Comparison 4 (1.5) PGE2 (all regimens) vs placebo/no treatment (all women, intact membranes, unfavourable cervix), Outcome 8 Uterine hyperstimulation without FHR changes.
Comparison 4 (1.5) PGE2 (all regimens) vs placebo/no treatment (all women, intact membranes, unfavourable cervix), Outcome 13 Apgar score <7 at 5 minutes.
Comparison 4 (1.5) PGE2 (all regimens) vs placebo/no treatment (all women, intact membranes, unfavourable cervix), Outcome 14 Neonatal intensive care unit admission.
Comparison 4 (1.5) PGE2 (all regimens) vs placebo/no treatment (all women, intact membranes, unfavourable cervix), Outcome 18 Maternal side‐effects (all).
Comparison 4 (1.5) PGE2 (all regimens) vs placebo/no treatment (all women, intact membranes, unfavourable cervix), Outcome 23 Postpartum haemorrhage.
Comparison 5 (1.6) PGE2 (all regimens) vs placebo/no treatment (all women, intact membranes, favourable cervix), Outcome 1 Vaginal delivery not achieved within 24 hours.
Comparison 5 (1.6) PGE2 (all regimens) vs placebo/no treatment (all women, intact membranes, favourable cervix), Outcome 3 Caesarean section.
Comparison 5 (1.6) PGE2 (all regimens) vs placebo/no treatment (all women, intact membranes, favourable cervix), Outcome 4 Serious neonatal morbidity or perinatal death.
Comparison 5 (1.6) PGE2 (all regimens) vs placebo/no treatment (all women, intact membranes, favourable cervix), Outcome 7 Oxytocin augmentation.
Comparison 5 (1.6) PGE2 (all regimens) vs placebo/no treatment (all women, intact membranes, favourable cervix), Outcome 11 Instrumental vaginal delivery.
Comparison 5 (1.6) PGE2 (all regimens) vs placebo/no treatment (all women, intact membranes, favourable cervix), Outcome 16 Perinatal death.
Comparison 6 (1.7) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, variable/undefined cervix), Outcome 3 Caesarean section.
Comparison 6 (1.7) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, variable/undefined cervix), Outcome 4 Serious neonatal morbidity or perinatal death.
Comparison 6 (1.7) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, variable/undefined cervix), Outcome 8 Uterine hyperstimulation without FHR changes.
Comparison 6 (1.7) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, variable/undefined cervix), Outcome 9 Uterine rupture.
Comparison 6 (1.7) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, variable/undefined cervix), Outcome 10 Epidural analgesia.
Comparison 6 (1.7) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, variable/undefined cervix), Outcome 11 Instrumental vaginal delivery.
Comparison 6 (1.7) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, variable/undefined cervix), Outcome 12 Meconium stained liquor.
Comparison 6 (1.7) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, variable/undefined cervix), Outcome 13 Apgar score <7 at 5 minutes.
Comparison 6 (1.7) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, variable/undefined cervix), Outcome 14 Neonatal intensive care unit admission.
Comparison 6 (1.7) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, variable/undefined cervix), Outcome 16 Perinatal death.
Comparison 6 (1.7) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, variable/undefined cervix), Outcome 18 Maternal side‐effects (all).
Comparison 6 (1.7) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, variable/undefined cervix), Outcome 20 Vomitting (maternal).
Comparison 6 (1.7) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, variable/undefined cervix), Outcome 21 Diarrhoea (maternal).
Comparison 6 (1.7) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, variable/undefined cervix), Outcome 23 Postpartum haemorrhage.
Comparison 6 (1.7) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, variable/undefined cervix), Outcome 26 Woman not satisfied.
Comparison 7 (1.8) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, unfavourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.
Comparison 7 (1.8) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, unfavourable cervix), Outcome 3 Caesarean section.
Comparison 7 (1.8) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, unfavourable cervix), Outcome 4 Serious neonatal morbidity or perinatal death.
Comparison 7 (1.8) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, unfavourable cervix), Outcome 5 Serious maternal morbidity or death.
Comparison 7 (1.8) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, unfavourable cervix), Outcome 7 Oxytocin augmentation.
Comparison 7 (1.8) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, unfavourable cervix), Outcome 8 Uterine hyperstimulation without FHR changes.
Comparison 7 (1.8) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, unfavourable cervix), Outcome 9 Uterine rupture.
Comparison 7 (1.8) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, unfavourable cervix), Outcome 10 Epidural analgesia.
Comparison 7 (1.8) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, unfavourable cervix), Outcome 11 Instrumental vaginal delivery.
Comparison 7 (1.8) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, unfavourable cervix), Outcome 12 Meconium stained liquor.
Comparison 7 (1.8) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, unfavourable cervix), Outcome 13 Apgar score <7 at 5 minutes.
Comparison 7 (1.8) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, unfavourable cervix), Outcome 14 Neonatal intensive care unit admission.
Comparison 7 (1.8) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, unfavourable cervix), Outcome 16 Perinatal death.
Comparison 7 (1.8) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, unfavourable cervix), Outcome 18 Maternal side‐effects (all).
Comparison 7 (1.8) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, unfavourable cervix), Outcome 20 Vomitting (maternal).
Comparison 7 (1.8) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, unfavourable cervix), Outcome 22 Other maternal side effects.
Comparison 7 (1.8) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, unfavourable cervix), Outcome 23 Postpartum haemorrhage.
Comparison 7 (1.8) PGE2 (all regimens) vs placebo/no treatment (all women, ruptured membranes, unfavourable cervix), Outcome 24 Serious maternal complication.
Comparison 8 (1.10) PGE2 (all regimens) vs placebo/no treatment (all primiparae), Outcome 1 Vaginal delivery not achieved within 24 hours.
Comparison 8 (1.10) PGE2 (all regimens) vs placebo/no treatment (all primiparae), Outcome 2 Uterine hyperstimulation with FHR changes.
Comparison 8 (1.10) PGE2 (all regimens) vs placebo/no treatment (all primiparae), Outcome 3 Caesarean section.
Comparison 8 (1.10) PGE2 (all regimens) vs placebo/no treatment (all primiparae), Outcome 4 Serious neonatal morbidity or perinatal death.
Comparison 8 (1.10) PGE2 (all regimens) vs placebo/no treatment (all primiparae), Outcome 5 Serious maternal morbidity or death.
Comparison 8 (1.10) PGE2 (all regimens) vs placebo/no treatment (all primiparae), Outcome 6 Cervix unfavourable/unchanged after 12 to 24 hours.
Comparison 8 (1.10) PGE2 (all regimens) vs placebo/no treatment (all primiparae), Outcome 7 Oxytocin augmentation.
Comparison 8 (1.10) PGE2 (all regimens) vs placebo/no treatment (all primiparae), Outcome 8 Uterine hyperstimulation without FHR changes.
Comparison 8 (1.10) PGE2 (all regimens) vs placebo/no treatment (all primiparae), Outcome 9 Uterine rupture.
Comparison 8 (1.10) PGE2 (all regimens) vs placebo/no treatment (all primiparae), Outcome 10 Epidural analgesia.
Comparison 8 (1.10) PGE2 (all regimens) vs placebo/no treatment (all primiparae), Outcome 11 Instrumental vaginal delivery.
Comparison 8 (1.10) PGE2 (all regimens) vs placebo/no treatment (all primiparae), Outcome 12 Meconium stained liquor.
Comparison 8 (1.10) PGE2 (all regimens) vs placebo/no treatment (all primiparae), Outcome 13 Apgar score <7 at 5 minutes.
Comparison 8 (1.10) PGE2 (all regimens) vs placebo/no treatment (all primiparae), Outcome 14 Neonatal intensive care unit admission.
Comparison 8 (1.10) PGE2 (all regimens) vs placebo/no treatment (all primiparae), Outcome 16 Perinatal death.
Comparison 8 (1.10) PGE2 (all regimens) vs placebo/no treatment (all primiparae), Outcome 18 Maternal side‐effects (all).
Comparison 8 (1.10) PGE2 (all regimens) vs placebo/no treatment (all primiparae), Outcome 20 Vomitting (maternal).
Comparison 8 (1.10) PGE2 (all regimens) vs placebo/no treatment (all primiparae), Outcome 21 Diarrhoea (maternal).
Comparison 8 (1.10) PGE2 (all regimens) vs placebo/no treatment (all primiparae), Outcome 22 Other maternal side effects.
Comparison 8 (1.10) PGE2 (all regimens) vs placebo/no treatment (all primiparae), Outcome 23 Postpartum haemorrhage.
Comparison 9 (1.11) PGE2 (all regimens) vs placebo/no treatment (all primiparae, unfavourable cervix), Outcome 1 Vaginal delivery not achieved within 24 hours.
Comparison 9 (1.11) PGE2 (all regimens) vs placebo/no treatment (all primiparae, unfavourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.
Comparison 9 (1.11) PGE2 (all regimens) vs placebo/no treatment (all primiparae, unfavourable cervix), Outcome 3 Caesarean section.
Comparison 9 (1.11) PGE2 (all regimens) vs placebo/no treatment (all primiparae, unfavourable cervix), Outcome 4 Serious neonatal morbidity or perinatal death.
Comparison 9 (1.11) PGE2 (all regimens) vs placebo/no treatment (all primiparae, unfavourable cervix), Outcome 5 Serious maternal morbidity or death.
Comparison 9 (1.11) PGE2 (all regimens) vs placebo/no treatment (all primiparae, unfavourable cervix), Outcome 7 Oxytocin augmentation.
Comparison 9 (1.11) PGE2 (all regimens) vs placebo/no treatment (all primiparae, unfavourable cervix), Outcome 8 Uterine hyperstimulation without FHR changes.
Comparison 9 (1.11) PGE2 (all regimens) vs placebo/no treatment (all primiparae, unfavourable cervix), Outcome 10 Epidural analgesia.
Comparison 9 (1.11) PGE2 (all regimens) vs placebo/no treatment (all primiparae, unfavourable cervix), Outcome 11 Instrumental vaginal delivery.
Comparison 9 (1.11) PGE2 (all regimens) vs placebo/no treatment (all primiparae, unfavourable cervix), Outcome 12 Meconium stained liquor.
Comparison 9 (1.11) PGE2 (all regimens) vs placebo/no treatment (all primiparae, unfavourable cervix), Outcome 13 Apgar score <7 at 5 minutes.
Comparison 9 (1.11) PGE2 (all regimens) vs placebo/no treatment (all primiparae, unfavourable cervix), Outcome 14 Neonatal intensive care unit admission.
Comparison 9 (1.11) PGE2 (all regimens) vs placebo/no treatment (all primiparae, unfavourable cervix), Outcome 16 Perinatal death.
Comparison 9 (1.11) PGE2 (all regimens) vs placebo/no treatment (all primiparae, unfavourable cervix), Outcome 18 Maternal side‐effects (all).
Comparison 9 (1.11) PGE2 (all regimens) vs placebo/no treatment (all primiparae, unfavourable cervix), Outcome 22 Other maternal side effects.
Comparison 9 (1.11) PGE2 (all regimens) vs placebo/no treatment (all primiparae, unfavourable cervix), Outcome 23 Postpartum haemorrhage.
Comparison 10 (1.12) PGE2 (all regimens) vs placebo/no treatment (all primiparae, favourable cervix), Outcome 1 Vaginal delivery not achieved within 24 hours.
Comparison 10 (1.12) PGE2 (all regimens) vs placebo/no treatment (all primiparae, favourable cervix), Outcome 3 Caesarean section.
Comparison 11 (1.14) PGE2 (all regimens) vs placebo/no treatment (all primiparae, intact membranes, unfavourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.
Comparison 11 (1.14) PGE2 (all regimens) vs placebo/no treatment (all primiparae, intact membranes, unfavourable cervix), Outcome 3 Caesarean section.
Comparison 12 (1.15) PGE2 (all regimens) vs placebo/no treatment (all primiparae, intact membranes, favourable cervix), Outcome 1 Vaginal delivery not achieved within 24 hours.
Comparison 12 (1.15) PGE2 (all regimens) vs placebo/no treatment (all primiparae, intact membranes, favourable cervix), Outcome 3 Caesarean section.
Comparison 13 (1.16) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured memb., variable/undefined cervix), Outcome 3 Caesarean section.
Comparison 13 (1.16) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured memb., variable/undefined cervix), Outcome 4 Serious neonatal morbidity or perinatal death.
Comparison 13 (1.16) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured memb., variable/undefined cervix), Outcome 8 Uterine hyperstimulation without FHR changes.
Comparison 13 (1.16) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured memb., variable/undefined cervix), Outcome 9 Uterine rupture.
Comparison 13 (1.16) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured memb., variable/undefined cervix), Outcome 10 Epidural analgesia.
Comparison 13 (1.16) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured memb., variable/undefined cervix), Outcome 11 Instrumental vaginal delivery.
Comparison 13 (1.16) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured memb., variable/undefined cervix), Outcome 16 Perinatal death.
Comparison 13 (1.16) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured memb., variable/undefined cervix), Outcome 18 Maternal side‐effects (all).
Comparison 13 (1.16) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured memb., variable/undefined cervix), Outcome 20 Vomitting (maternal).
Comparison 13 (1.16) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured memb., variable/undefined cervix), Outcome 21 Diarrhoea (maternal).
Comparison 13 (1.16) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured memb., variable/undefined cervix), Outcome 23 Postpartum haemorrhage.
Comparison 14 (1.17) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured membranes, unfavourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.
Comparison 14 (1.17) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured membranes, unfavourable cervix), Outcome 3 Caesarean section.
Comparison 14 (1.17) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured membranes, unfavourable cervix), Outcome 4 Serious neonatal morbidity or perinatal death.
Comparison 14 (1.17) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured membranes, unfavourable cervix), Outcome 7 Oxytocin augmentation.
Comparison 14 (1.17) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured membranes, unfavourable cervix), Outcome 8 Uterine hyperstimulation without FHR changes.
Comparison 14 (1.17) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured membranes, unfavourable cervix), Outcome 10 Epidural analgesia.
Comparison 14 (1.17) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured membranes, unfavourable cervix), Outcome 11 Instrumental vaginal delivery.
Comparison 14 (1.17) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured membranes, unfavourable cervix), Outcome 12 Meconium stained liquor.
Comparison 14 (1.17) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured membranes, unfavourable cervix), Outcome 13 Apgar score <7 at 5 minutes.
Comparison 14 (1.17) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured membranes, unfavourable cervix), Outcome 14 Neonatal intensive care unit admission.
Comparison 14 (1.17) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured membranes, unfavourable cervix), Outcome 16 Perinatal death.
Comparison 14 (1.17) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured membranes, unfavourable cervix), Outcome 18 Maternal side‐effects (all).
Comparison 14 (1.17) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured membranes, unfavourable cervix), Outcome 22 Other maternal side effects.
Comparison 14 (1.17) PGE2 (all regimens) vs placebo/no treatment (all primiparae, ruptured membranes, unfavourable cervix), Outcome 23 Postpartum haemorrhage.
Comparison 15 (1.19) PGE2 (all regimens) vs placebo/no treatment (all multiparae, without previous caesarean section), Outcome 1 Vaginal delivery not achieved within 24 hours.
Comparison 15 (1.19) PGE2 (all regimens) vs placebo/no treatment (all multiparae, without previous caesarean section), Outcome 2 Uterine hyperstimulation with FHR changes.
Comparison 15 (1.19) PGE2 (all regimens) vs placebo/no treatment (all multiparae, without previous caesarean section), Outcome 3 Caesarean section.
Comparison 15 (1.19) PGE2 (all regimens) vs placebo/no treatment (all multiparae, without previous caesarean section), Outcome 4 Serious neonatal morbidity or perinatal death.
Comparison 15 (1.19) PGE2 (all regimens) vs placebo/no treatment (all multiparae, without previous caesarean section), Outcome 5 Uterine rupture.
Comparison 15 (1.19) PGE2 (all regimens) vs placebo/no treatment (all multiparae, without previous caesarean section), Outcome 6 Epidural analgesia.
Comparison 15 (1.19) PGE2 (all regimens) vs placebo/no treatment (all multiparae, without previous caesarean section), Outcome 7 Oxytocin augmentation.
Comparison 15 (1.19) PGE2 (all regimens) vs placebo/no treatment (all multiparae, without previous caesarean section), Outcome 8 Uterine hyperstimulation without FHR changes.
Comparison 15 (1.19) PGE2 (all regimens) vs placebo/no treatment (all multiparae, without previous caesarean section), Outcome 11 Instrumental vaginal delivery.
Comparison 15 (1.19) PGE2 (all regimens) vs placebo/no treatment (all multiparae, without previous caesarean section), Outcome 16 Perinatal death.
Comparison 15 (1.19) PGE2 (all regimens) vs placebo/no treatment (all multiparae, without previous caesarean section), Outcome 18 Maternal side‐effects (all).
Comparison 15 (1.19) PGE2 (all regimens) vs placebo/no treatment (all multiparae, without previous caesarean section), Outcome 20 Vomitting (maternal).
Comparison 15 (1.19) PGE2 (all regimens) vs placebo/no treatment (all multiparae, without previous caesarean section), Outcome 21 Diarrhoea (maternal).
Comparison 15 (1.19) PGE2 (all regimens) vs placebo/no treatment (all multiparae, without previous caesarean section), Outcome 23 Postpartum haemorrhage.
Comparison 16 (1.20) PGE2 (all regimens) vs placebo/no treatment (all multiparae, unfavourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.
Comparison 16 (1.20) PGE2 (all regimens) vs placebo/no treatment (all multiparae, unfavourable cervix), Outcome 3 Caesarean section.
Comparison 17 (1.21) PGE2 (all regimens) vs placebo/no treatment (all multiparae, favourable cervix), Outcome 1 Vaginal delivery not achieved within 24 hours.
Comparison 17 (1.21) PGE2 (all regimens) vs placebo/no treatment (all multiparae, favourable cervix), Outcome 3 Caesarean section.
Comparison 17 (1.21) PGE2 (all regimens) vs placebo/no treatment (all multiparae, favourable cervix), Outcome 7 Oxytocin augmentation.
Comparison 18 (1.23) PGE2 (all regimens) vs placebo/no treatment (all multiparae, intact membranes, unfavourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.
Comparison 18 (1.23) PGE2 (all regimens) vs placebo/no treatment (all multiparae, intact membranes, unfavourable cervix), Outcome 3 Caesarean section.
Comparison 19 (1.24) PGE2 (all regimens) vs placebo/no treatment (all multiparae, intact membranes, favourable cervix), Outcome 1 Vaginal delivery not achieved within 24 hours.
Comparison 19 (1.24) PGE2 (all regimens) vs placebo/no treatment (all multiparae, intact membranes, favourable cervix), Outcome 3 Caesarean section.
Comparison 20 (1.25) PGE2 (all regimens) vs placebo/no treatment (all multi., ruptured membranes, variable/undefined cervix), Outcome 3 Caesarean section.
Comparison 20 (1.25) PGE2 (all regimens) vs placebo/no treatment (all multi., ruptured membranes, variable/undefined cervix), Outcome 4 Serious neonatal morbidity or perinatal death.
Comparison 20 (1.25) PGE2 (all regimens) vs placebo/no treatment (all multi., ruptured membranes, variable/undefined cervix), Outcome 8 Uterine hyperstimulation without FHR changes.
Comparison 20 (1.25) PGE2 (all regimens) vs placebo/no treatment (all multi., ruptured membranes, variable/undefined cervix), Outcome 9 Uterine rupture.
Comparison 20 (1.25) PGE2 (all regimens) vs placebo/no treatment (all multi., ruptured membranes, variable/undefined cervix), Outcome 10 Epidural analgesia.
Comparison 20 (1.25) PGE2 (all regimens) vs placebo/no treatment (all multi., ruptured membranes, variable/undefined cervix), Outcome 11 Instrumental vaginal delivery.
Comparison 20 (1.25) PGE2 (all regimens) vs placebo/no treatment (all multi., ruptured membranes, variable/undefined cervix), Outcome 16 Perinatal death.
Comparison 20 (1.25) PGE2 (all regimens) vs placebo/no treatment (all multi., ruptured membranes, variable/undefined cervix), Outcome 18 Maternal side‐effects (all).
Comparison 20 (1.25) PGE2 (all regimens) vs placebo/no treatment (all multi., ruptured membranes, variable/undefined cervix), Outcome 20 Vomitting (maternal).
Comparison 20 (1.25) PGE2 (all regimens) vs placebo/no treatment (all multi., ruptured membranes, variable/undefined cervix), Outcome 21 Diarrhoea (maternal).
Comparison 20 (1.25) PGE2 (all regimens) vs placebo/no treatment (all multi., ruptured membranes, variable/undefined cervix), Outcome 23 Postpartum haemorrhage.
Comparison 22 (2.1) PGF2a vs placebo (all women), Outcome 2 Uterine hyperstimulation with FHR changes.
Comparison 22 (2.1) PGF2a vs placebo (all women), Outcome 3 Caesarean section.
Comparison 22 (2.1) PGF2a vs placebo (all women), Outcome 6 Cervix unfavourable/unchanged after 12 to 24 hours.
Comparison 22 (2.1) PGF2a vs placebo (all women), Outcome 7 Oxytocin augmentation.
Comparison 22 (2.1) PGF2a vs placebo (all women), Outcome 10 Epidural analgesia.
Comparison 22 (2.1) PGF2a vs placebo (all women), Outcome 11 Instrumental vaginal delivery.
Comparison 23 (2.2) PGF2a vs placebo (all women, unfavourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.
Comparison 23 (2.2) PGF2a vs placebo (all women, unfavourable cervix), Outcome 3 Caesarean section.
Comparison 23 (2.2) PGF2a vs placebo (all women, unfavourable cervix), Outcome 7 Oxytocin augmentation.
Comparison 23 (2.2) PGF2a vs placebo (all women, unfavourable cervix), Outcome 10 Epidural analgesia.
Comparison 24 (2.10) PGF2a vs placebo (all primiparae), Outcome 2 Uterine hyperstimulation with FHR changes.
Comparison 24 (2.10) PGF2a vs placebo (all primiparae), Outcome 3 Caesarean section.
Comparison 24 (2.10) PGF2a vs placebo (all primiparae), Outcome 7 Oxytocin augmentation.
Comparison 24 (2.10) PGF2a vs placebo (all primiparae), Outcome 10 Epidural analgesia.
Comparison 25 (2.11) PGF2a vs placebo (all primiparae, unfavourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.
Comparison 25 (2.11) PGF2a vs placebo (all primiparae, unfavourable cervix), Outcome 3 Caesarean section.
Comparison 25 (2.11) PGF2a vs placebo (all primiparae, unfavourable cervix), Outcome 7 Oxytocin augmentation.
Comparison 25 (2.11) PGF2a vs placebo (all primiparae, unfavourable cervix), Outcome 10 Epidural analgesia.
Comparison 26 (3.1) PGF2a vs PGE2 (all women), Outcome 1 Vaginal delivery not achieved within 24 hours.
Comparison 26 (3.1) PGF2a vs PGE2 (all women), Outcome 2 Uterine hyperstimulation with FHR changes.
Comparison 26 (3.1) PGF2a vs PGE2 (all women), Outcome 3 Caesarean section.
Comparison 26 (3.1) PGF2a vs PGE2 (all women), Outcome 7 Oxytocin augmentation.
Comparison 26 (3.1) PGF2a vs PGE2 (all women), Outcome 10 Epidural analgesia.
Comparison 26 (3.1) PGF2a vs PGE2 (all women), Outcome 13 Apgar score <7 at 5 minutes.
Comparison 27 (3.2) PGF2a vs PGE2 (all women, unfavourable cervix), Outcome 1 Vaginal delivery not achieved within 24 hours.
Comparison 27 (3.2) PGF2a vs PGE2 (all women, unfavourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.
Comparison 27 (3.2) PGF2a vs PGE2 (all women, unfavourable cervix), Outcome 3 Caesarean section.
Comparison 27 (3.2) PGF2a vs PGE2 (all women, unfavourable cervix), Outcome 7 Oxytocin augmentation.
Comparison 27 (3.2) PGF2a vs PGE2 (all women, unfavourable cervix), Outcome 10 Epidural analgesia.
Comparison 27 (3.2) PGF2a vs PGE2 (all women, unfavourable cervix), Outcome 13 Apgar score <7 at 5 minutes.
Comparison 28 (3.10) PGF2a vs PGE2 (all primiparae), Outcome 2 Uterine hyperstimulation with FHR changes.
Comparison 28 (3.10) PGF2a vs PGE2 (all primiparae), Outcome 3 Caesarean section.
Comparison 28 (3.10) PGF2a vs PGE2 (all primiparae), Outcome 7 Oxytocin augmentation.
Comparison 28 (3.10) PGF2a vs PGE2 (all primiparae), Outcome 10 Epidural analgesia.
Comparison 29 (3.11) PGF2a vs PGE2 (all primiparae, unfavourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.
Comparison 29 (3.11) PGF2a vs PGE2 (all primiparae, unfavourable cervix), Outcome 3 Caesarean section.
Comparison 29 (3.11) PGF2a vs PGE2 (all primiparae, unfavourable cervix), Outcome 7 Oxytocin augmentation.
Comparison 29 (3.11) PGF2a vs PGE2 (all primiparae, unfavourable cervix), Outcome 10 Epidural analgesia.
Comparison 31 (4.1) PGE2 gel vs PGE2 tablet (all women), Outcome 1 Vaginal delivery not achieved within 24 hours.
Comparison 31 (4.1) PGE2 gel vs PGE2 tablet (all women), Outcome 2 Uterine hyperstimulation with FHR changes.
Comparison 31 (4.1) PGE2 gel vs PGE2 tablet (all women), Outcome 3 Caesarean section.
Comparison 31 (4.1) PGE2 gel vs PGE2 tablet (all women), Outcome 5 Serious maternal morbidity or death.
Comparison 31 (4.1) PGE2 gel vs PGE2 tablet (all women), Outcome 6 Cervix unfavourable/unchanged after 12 to 24 hours.
Comparison 31 (4.1) PGE2 gel vs PGE2 tablet (all women), Outcome 7 Oxytocin augmentation.
Comparison 31 (4.1) PGE2 gel vs PGE2 tablet (all women), Outcome 10 Epidural analgesia.
Comparison 31 (4.1) PGE2 gel vs PGE2 tablet (all women), Outcome 11 Instrumental vaginal delivery.
Comparison 31 (4.1) PGE2 gel vs PGE2 tablet (all women), Outcome 13 Apgar score <7 at 5 minutes.
Comparison 31 (4.1) PGE2 gel vs PGE2 tablet (all women), Outcome 23 Postpartum haemorrhage.
Comparison 33 (4.2) PGE2 gel vs PGE2 tablet (all women, unfavourable cervix), Outcome 1 Vaginal delivery not achieved within 24 hours.
Comparison 33 (4.2) PGE2 gel vs PGE2 tablet (all women, unfavourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.
Comparison 33 (4.2) PGE2 gel vs PGE2 tablet (all women, unfavourable cervix), Outcome 3 Caesarean section.
Comparison 33 (4.2) PGE2 gel vs PGE2 tablet (all women, unfavourable cervix), Outcome 5 Serious maternal morbidity or death.
Comparison 33 (4.2) PGE2 gel vs PGE2 tablet (all women, unfavourable cervix), Outcome 6 Cervix unfavourable/unchanged after 12 to 24 hours.
Comparison 33 (4.2) PGE2 gel vs PGE2 tablet (all women, unfavourable cervix), Outcome 7 Oxytocin augmentation.
Comparison 33 (4.2) PGE2 gel vs PGE2 tablet (all women, unfavourable cervix), Outcome 10 Epidural analgesia.
Comparison 33 (4.2) PGE2 gel vs PGE2 tablet (all women, unfavourable cervix), Outcome 11 Instrumental vaginal delivery.
Comparison 33 (4.2) PGE2 gel vs PGE2 tablet (all women, unfavourable cervix), Outcome 13 Apgar score <7 at 5 minutes.
Comparison 33 (4.2) PGE2 gel vs PGE2 tablet (all women, unfavourable cervix), Outcome 23 Postpartum haemorrhage.
Comparison 34 (4.3) PGE2 gel vs PGE2 tablet (all women, favourable cervix), Outcome 7 Oxytocin augmentation.
Comparison 34 (4.3) PGE2 gel vs PGE2 tablet (all women, favourable cervix), Outcome 13 Apgar score <7 at 5 minutes.
Comparison 35 (4.4) PGE2 gel vs PGE2 tablet (all women, intact membranes, variable or undefined cervix), Outcome 3 Caesarean section.
Comparison 35 (4.4) PGE2 gel vs PGE2 tablet (all women, intact membranes, variable or undefined cervix), Outcome 7 Oxytocin augmentation.
Comparison 35 (4.4) PGE2 gel vs PGE2 tablet (all women, intact membranes, variable or undefined cervix), Outcome 10 Epidural analgesia.
Comparison 35 (4.4) PGE2 gel vs PGE2 tablet (all women, intact membranes, variable or undefined cervix), Outcome 11 Instrumental vaginal delivery.
Comparison 35 (4.4) PGE2 gel vs PGE2 tablet (all women, intact membranes, variable or undefined cervix), Outcome 23 Postpartum haemorrhage.
Comparison 36 (4.5) PGE2 gel vs PGE2 tablet (all women, intact membranes, unfavourable cervix), Outcome 1 Vaginal delivery not achieved within 24 hours.
Comparison 36 (4.5) PGE2 gel vs PGE2 tablet (all women, intact membranes, unfavourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.
Comparison 36 (4.5) PGE2 gel vs PGE2 tablet (all women, intact membranes, unfavourable cervix), Outcome 3 Caesarean section.
Comparison 36 (4.5) PGE2 gel vs PGE2 tablet (all women, intact membranes, unfavourable cervix), Outcome 5 Serious maternal morbidity or death.
Comparison 36 (4.5) PGE2 gel vs PGE2 tablet (all women, intact membranes, unfavourable cervix), Outcome 6 Cervix unfavourable/unchanged after 12 to 24 hours.
Comparison 36 (4.5) PGE2 gel vs PGE2 tablet (all women, intact membranes, unfavourable cervix), Outcome 7 Oxytocin augmentation.
Comparison 36 (4.5) PGE2 gel vs PGE2 tablet (all women, intact membranes, unfavourable cervix), Outcome 10 Epidural analgesia.
Comparison 36 (4.5) PGE2 gel vs PGE2 tablet (all women, intact membranes, unfavourable cervix), Outcome 11 Instrumental vaginal delivery.
Comparison 37 (4.10) PGE2 gel vs PGE2 tablet (all primiparae), Outcome 1 Vaginal delivery not achieved within 24 hours.
Comparison 37 (4.10) PGE2 gel vs PGE2 tablet (all primiparae), Outcome 2 Uterine hyperstimulation with FHR changes.
Comparison 37 (4.10) PGE2 gel vs PGE2 tablet (all primiparae), Outcome 3 Caesarean section.
Comparison 37 (4.10) PGE2 gel vs PGE2 tablet (all primiparae), Outcome 5 Serious maternal morbidity or death.
Comparison 37 (4.10) PGE2 gel vs PGE2 tablet (all primiparae), Outcome 6 Cervix unfavourable/unchanged after 12 to 24 hours.
Comparison 37 (4.10) PGE2 gel vs PGE2 tablet (all primiparae), Outcome 7 Oxytocin augmentation.
Comparison 37 (4.10) PGE2 gel vs PGE2 tablet (all primiparae), Outcome 10 Epidural analgesia.
Comparison 37 (4.10) PGE2 gel vs PGE2 tablet (all primiparae), Outcome 11 Instrumental vaginal delivery.
Comparison 37 (4.10) PGE2 gel vs PGE2 tablet (all primiparae), Outcome 13 Apgar score <7 at 5 minutes.
Comparison 37 (4.10) PGE2 gel vs PGE2 tablet (all primiparae), Outcome 23 Postpartum haemorrhage.
Comparison 38 (4.11) PGE2 gel vs PGE2 tablet (all primiparae, unfavourable cervix), Outcome 1 Vaginal delivery not achieved within 24 hours.
Comparison 38 (4.11) PGE2 gel vs PGE2 tablet (all primiparae, unfavourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.
Comparison 38 (4.11) PGE2 gel vs PGE2 tablet (all primiparae, unfavourable cervix), Outcome 3 Caesarean section.
Comparison 38 (4.11) PGE2 gel vs PGE2 tablet (all primiparae, unfavourable cervix), Outcome 5 Serious maternal morbidity or death.
Comparison 38 (4.11) PGE2 gel vs PGE2 tablet (all primiparae, unfavourable cervix), Outcome 6 Cervix unfavourable/unchanged after 12 to 24 hours.
Comparison 38 (4.11) PGE2 gel vs PGE2 tablet (all primiparae, unfavourable cervix), Outcome 7 Oxytocin augmentation.
Comparison 38 (4.11) PGE2 gel vs PGE2 tablet (all primiparae, unfavourable cervix), Outcome 10 Epidural analgesia.
Comparison 38 (4.11) PGE2 gel vs PGE2 tablet (all primiparae, unfavourable cervix), Outcome 11 Instrumental vaginal delivery.
Comparison 38 (4.11) PGE2 gel vs PGE2 tablet (all primiparae, unfavourable cervix), Outcome 13 Apgar score <7 at 5 minutes.
Comparison 38 (4.11) PGE2 gel vs PGE2 tablet (all primiparae, unfavourable cervix), Outcome 23 Postpartum haemorrhage.
Comparison 39 (4.14) PGE2 gel vs PGE2 tablet (all primiparae, intact membranes, unfavourable cervix), Outcome 1 Vaginal delivery not achieved within 24 hours.
Comparison 39 (4.14) PGE2 gel vs PGE2 tablet (all primiparae, intact membranes, unfavourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.
Comparison 39 (4.14) PGE2 gel vs PGE2 tablet (all primiparae, intact membranes, unfavourable cervix), Outcome 3 Caesarean section.
Comparison 39 (4.14) PGE2 gel vs PGE2 tablet (all primiparae, intact membranes, unfavourable cervix), Outcome 5 Serious maternal morbidity or death.
Comparison 39 (4.14) PGE2 gel vs PGE2 tablet (all primiparae, intact membranes, unfavourable cervix), Outcome 6 Cervix unfavourable/unchanged after 12 to 24 hours.
Comparison 39 (4.14) PGE2 gel vs PGE2 tablet (all primiparae, intact membranes, unfavourable cervix), Outcome 7 Oxytocin augmentation.
Comparison 39 (4.14) PGE2 gel vs PGE2 tablet (all primiparae, intact membranes, unfavourable cervix), Outcome 10 Epidural analgesia.
Comparison 39 (4.14) PGE2 gel vs PGE2 tablet (all primiparae, intact membranes, unfavourable cervix), Outcome 11 Instrumental vaginal delivery.
Comparison 40 (5.1) PGE2 gel vs PGE2 suppository/pessary (all women), Outcome 2 Uterine hyperstimulation with FHR changes.
Comparison 40 (5.1) PGE2 gel vs PGE2 suppository/pessary (all women), Outcome 3 Caesarean section.
Comparison 40 (5.1) PGE2 gel vs PGE2 suppository/pessary (all women), Outcome 8 Uterine hyperstimulation without FHR changes.
Comparison 40 (5.1) PGE2 gel vs PGE2 suppository/pessary (all women), Outcome 13 Apgar score <7 at 5 minutes.
Comparison 40 (5.1) PGE2 gel vs PGE2 suppository/pessary (all women), Outcome 18 Maternal side‐effects (all).
Comparison 40 (5.1) PGE2 gel vs PGE2 suppository/pessary (all women), Outcome 19 Nausea (maternal).
Comparison 40 (5.1) PGE2 gel vs PGE2 suppository/pessary (all women), Outcome 20 Vomitting (maternal).
Comparison 40 (5.1) PGE2 gel vs PGE2 suppository/pessary (all women), Outcome 21 Diarrhoea (maternal).
Comparison 40 (5.1) PGE2 gel vs PGE2 suppository/pessary (all women), Outcome 22 Other maternal side effects.
Comparison 41 (5.2) PGE2 gel vs PGE2 suppository/pessary (all women, unfavourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.
Comparison 41 (5.2) PGE2 gel vs PGE2 suppository/pessary (all women, unfavourable cervix), Outcome 3 Caesarean section.
Comparison 41 (5.2) PGE2 gel vs PGE2 suppository/pessary (all women, unfavourable cervix), Outcome 8 Uterine hyperstimulation without FHR changes.
Comparison 41 (5.2) PGE2 gel vs PGE2 suppository/pessary (all women, unfavourable cervix), Outcome 13 Apgar score <7 at 5 minutes.
Comparison 41 (5.2) PGE2 gel vs PGE2 suppository/pessary (all women, unfavourable cervix), Outcome 18 Maternal side‐effects (all).
Comparison 41 (5.2) PGE2 gel vs PGE2 suppository/pessary (all women, unfavourable cervix), Outcome 19 Nausea (maternal).
Comparison 41 (5.2) PGE2 gel vs PGE2 suppository/pessary (all women, unfavourable cervix), Outcome 20 Vomitting (maternal).
Comparison 41 (5.2) PGE2 gel vs PGE2 suppository/pessary (all women, unfavourable cervix), Outcome 21 Diarrhoea (maternal).
Comparison 41 (5.2) PGE2 gel vs PGE2 suppository/pessary (all women, unfavourable cervix), Outcome 22 Other maternal side‐effects.
Comparison 42 (5.5) PGE2 gel vs PGE2 suppository/pessary (all women, intact membranes, unfavourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.
Comparison 42 (5.5) PGE2 gel vs PGE2 suppository/pessary (all women, intact membranes, unfavourable cervix), Outcome 3 Caesarean section.
Comparison 42 (5.5) PGE2 gel vs PGE2 suppository/pessary (all women, intact membranes, unfavourable cervix), Outcome 8 Uterine hyperstimulation without FHR changes.
Comparison 42 (5.5) PGE2 gel vs PGE2 suppository/pessary (all women, intact membranes, unfavourable cervix), Outcome 13 Apgar score <7 at 5 minutes.
Comparison 42 (5.5) PGE2 gel vs PGE2 suppository/pessary (all women, intact membranes, unfavourable cervix), Outcome 18 Maternal side‐effects (all).
Comparison 42 (5.5) PGE2 gel vs PGE2 suppository/pessary (all women, intact membranes, unfavourable cervix), Outcome 19 Nausea (maternal).
Comparison 42 (5.5) PGE2 gel vs PGE2 suppository/pessary (all women, intact membranes, unfavourable cervix), Outcome 20 Vomitting (maternal).
Comparison 42 (5.5) PGE2 gel vs PGE2 suppository/pessary (all women, intact membranes, unfavourable cervix), Outcome 21 Diarrhoea (maternal).
Comparison 42 (5.5) PGE2 gel vs PGE2 suppository/pessary (all women, intact membranes, unfavourable cervix), Outcome 22 Other maternal side‐effects.
Comparison 43 (6.1) PGE2 tablet vs PGE2 pessary/suppository (all women), Outcome 3 Caesarean section.
Comparison 43 (6.1) PGE2 tablet vs PGE2 pessary/suppository (all women), Outcome 7 Oxytocin augmentation.
Comparison 43 (6.1) PGE2 tablet vs PGE2 pessary/suppository (all women), Outcome 8 Uterine hyperstimulation without FHR changes.
Comparison 43 (6.1) PGE2 tablet vs PGE2 pessary/suppository (all women), Outcome 10 Epidural analgesia.
Comparison 43 (6.1) PGE2 tablet vs PGE2 pessary/suppository (all women), Outcome 11 Instrumental vaginal delivery.
Comparison 43 (6.1) PGE2 tablet vs PGE2 pessary/suppository (all women), Outcome 13 Apgar score <7 at 5 minutes.
Comparison 43 (6.1) PGE2 tablet vs PGE2 pessary/suppository (all women), Outcome 18 Maternal side‐effects (all).
Comparison 43 (6.1) PGE2 tablet vs PGE2 pessary/suppository (all women), Outcome 20 Vomitting (maternal).
Comparison 43 (6.1) PGE2 tablet vs PGE2 pessary/suppository (all women), Outcome 21 Diarrhoea (maternal).
Comparison 43 (6.1) PGE2 tablet vs PGE2 pessary/suppository (all women), Outcome 23 Postpartum haemorrhage.
Comparison 44 (6.2) PGE2 tablet vs PGE2 pessary/suppository (all women, unfavourable cervix), Outcome 3 Caesarean section.
Comparison 44 (6.2) PGE2 tablet vs PGE2 pessary/suppository (all women, unfavourable cervix), Outcome 7 Oxytocin augmentation.
Comparison 44 (6.2) PGE2 tablet vs PGE2 pessary/suppository (all women, unfavourable cervix), Outcome 8 Uterine hyperstimulation without FHR changes.
Comparison 44 (6.2) PGE2 tablet vs PGE2 pessary/suppository (all women, unfavourable cervix), Outcome 11 Instrumental vaginal delivery.
Comparison 44 (6.2) PGE2 tablet vs PGE2 pessary/suppository (all women, unfavourable cervix), Outcome 13 Apgar score <7 at 5 minutes.
Comparison 44 (6.2) PGE2 tablet vs PGE2 pessary/suppository (all women, unfavourable cervix), Outcome 18 Maternal side‐effects (all).
Comparison 44 (6.2) PGE2 tablet vs PGE2 pessary/suppository (all women, unfavourable cervix), Outcome 20 Vomitting (maternal).
Comparison 44 (6.2) PGE2 tablet vs PGE2 pessary/suppository (all women, unfavourable cervix), Outcome 21 Diarrhoea (maternal).
Comparison 45 (6.10) PGE2 tablet vs PGE2 pessary/suppository (all primiparae), Outcome 3 Caesarean section.
Comparison 45 (6.10) PGE2 tablet vs PGE2 pessary/suppository (all primiparae), Outcome 7 Oxytocin augmentation.
Comparison 46 (6.19) PGE2 tablet vs PGE2 pessary/suppository (all multiparae), Outcome 3 Caesarean section.
Comparison 46 (6.19) PGE2 tablet vs PGE2 pessary/suppository (all multiparae), Outcome 7 Oxytocin augmentation.
Comparison 47 (7.1) PGE2 (controlled release) vs all PGE2 delivery systems (all women), Outcome 1 Vaginal delivery not achieved within 24 hours.
Comparison 47 (7.1) PGE2 (controlled release) vs all PGE2 delivery systems (all women), Outcome 2 Uterine hyperstimulation with FHR changes.
Comparison 47 (7.1) PGE2 (controlled release) vs all PGE2 delivery systems (all women), Outcome 3 Caesarean section.
Comparison 47 (7.1) PGE2 (controlled release) vs all PGE2 delivery systems (all women), Outcome 7 Oxytocin augmentation.
Comparison 47 (7.1) PGE2 (controlled release) vs all PGE2 delivery systems (all women), Outcome 8 Uterine hyperstimulation without FHR changes.
Comparison 47 (7.1) PGE2 (controlled release) vs all PGE2 delivery systems (all women), Outcome 9 Uterine rupture.
Comparison 47 (7.1) PGE2 (controlled release) vs all PGE2 delivery systems (all women), Outcome 10 Epidural analgesia.
Comparison 47 (7.1) PGE2 (controlled release) vs all PGE2 delivery systems (all women), Outcome 11 Instrumental vaginal delivery.
Comparison 47 (7.1) PGE2 (controlled release) vs all PGE2 delivery systems (all women), Outcome 13 Apgar score <7 at 5 minutes.
Comparison 48 (7.2) PGE2 (controlled release) vs all PGE2 delivery systems (all women, unfavourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.
Comparison 48 (7.2) PGE2 (controlled release) vs all PGE2 delivery systems (all women, unfavourable cervix), Outcome 3 Caesarean section.
Comparison 48 (7.2) PGE2 (controlled release) vs all PGE2 delivery systems (all women, unfavourable cervix), Outcome 7 Oxytocin augmentation.
Comparison 48 (7.2) PGE2 (controlled release) vs all PGE2 delivery systems (all women, unfavourable cervix), Outcome 8 Uterine hyperstimulation without FHR changes.
Comparison 48 (7.2) PGE2 (controlled release) vs all PGE2 delivery systems (all women, unfavourable cervix), Outcome 10 Epidural analgesia.
Comparison 48 (7.2) PGE2 (controlled release) vs all PGE2 delivery systems (all women, unfavourable cervix), Outcome 13 Apgar score <7 at 5 minutes.
Comparison 49 (7.1) PGE2 (controlled release) vs all PGE2 delivery systems (all women, intact, variable cervix), Outcome 3 Caesarean section.
Comparison 49 (7.1) PGE2 (controlled release) vs all PGE2 delivery systems (all women, intact, variable cervix), Outcome 10 Epidural analgesia.
Comparison 49 (7.1) PGE2 (controlled release) vs all PGE2 delivery systems (all women, intact, variable cervix), Outcome 11 Instrumental vaginal delivery.
Comparison 50 (7.5) PGE2 (controlled release) vs all PGE2 delivery systems (all women, intact membranes, unfav. cervix), Outcome 2 Uterine hyperstimulation with FHR changes.
Comparison 50 (7.5) PGE2 (controlled release) vs all PGE2 delivery systems (all women, intact membranes, unfav. cervix), Outcome 3 Caesarean section.
Comparison 50 (7.5) PGE2 (controlled release) vs all PGE2 delivery systems (all women, intact membranes, unfav. cervix), Outcome 7 Oxytocin augmentation.
Comparison 51 (7.10) PGE2 (controlled release) vs all PGE2 delivery systems (all primiparae), Outcome 2 Uterine hyperstimulation with FHR changes.
Comparison 51 (7.10) PGE2 (controlled release) vs all PGE2 delivery systems (all primiparae), Outcome 3 Caesarean section.
Comparison 51 (7.10) PGE2 (controlled release) vs all PGE2 delivery systems (all primiparae), Outcome 7 Oxytocin augmentation.
Comparison 51 (7.10) PGE2 (controlled release) vs all PGE2 delivery systems (all primiparae), Outcome 8 Uterine hyperstimulation without FHR changes.
Comparison 51 (7.10) PGE2 (controlled release) vs all PGE2 delivery systems (all primiparae), Outcome 10 Epidural analgesia.
Comparison 52 (7.11) PGE2 (controlled release) vs all PGE2 delivery systems (all primiparae, unfavourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.
Comparison 52 (7.11) PGE2 (controlled release) vs all PGE2 delivery systems (all primiparae, unfavourable cervix), Outcome 3 Caesarean section.
Comparison 52 (7.11) PGE2 (controlled release) vs all PGE2 delivery systems (all primiparae, unfavourable cervix), Outcome 7 Oxytocin augmentation.
Comparison 52 (7.11) PGE2 (controlled release) vs all PGE2 delivery systems (all primiparae, unfavourable cervix), Outcome 8 Uterine hyperstimulation without FHR changes.
Comparison 52 (7.11) PGE2 (controlled release) vs all PGE2 delivery systems (all primiparae, unfavourable cervix), Outcome 10 Epidural analgesia.
Comparison 53 (7.14) PGE2 (controlled release) vs all PGE2 delivery systems (all prim., intact membranes, unfav. cervix), Outcome 2 Uterine hyperstimulation with FHR changes.
Comparison 53 (7.14) PGE2 (controlled release) vs all PGE2 delivery systems (all prim., intact membranes, unfav. cervix), Outcome 3 Caesarean section.
Comparison 53 (7.14) PGE2 (controlled release) vs all PGE2 delivery systems (all prim., intact membranes, unfav. cervix), Outcome 7 Oxytocin augmentation.
Comparison 54 (7.19) PGE2 (controlled release) vs all PGE2 delivery systems (all multiparae), Outcome 2 Uterine hyperstimulation with FHR changes.
Comparison 54 (7.19) PGE2 (controlled release) vs all PGE2 delivery systems (all multiparae), Outcome 3 Caesarean section.
Comparison 54 (7.19) PGE2 (controlled release) vs all PGE2 delivery systems (all multiparae), Outcome 7 Oxytocin augmentation.
Comparison 55 (7.20) PGE2 (controlled release) vs all PGE2 delivery systems (all multiparae, unfavourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.
Comparison 55 (7.20) PGE2 (controlled release) vs all PGE2 delivery systems (all multiparae, unfavourable cervix), Outcome 3 Caesarean section.
Comparison 55 (7.20) PGE2 (controlled release) vs all PGE2 delivery systems (all multiparae, unfavourable cervix), Outcome 7 Oxytocin augmentation.
Comparison 56 (7.23) PGE2 (controlled release) vs all PGE2 delivery systems (all multi., intact membranes, unfav. cervix), Outcome 2 Uterine hyperstimulation with FHR changes.
Comparison 56 (7.23) PGE2 (controlled release) vs all PGE2 delivery systems (all multi., intact membranes, unfav. cervix), Outcome 3 Caesarean section.
Comparison 56 (7.23) PGE2 (controlled release) vs all PGE2 delivery systems (all multi., intact membranes, unfav. cervix), Outcome 7 Oxytocin augmentation.
Comparison 57 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 2 Uterine hyperstimulation with FHR changes.
Comparison 57 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 3 Caesarean section.
Comparison 57 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 4 Serious neonatal morbidity or perinatal death.
Comparison 57 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 7 Oxytocin augmentation.
Comparison 57 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 8 Uterine hyperstimulation without FHR changes.
Comparison 57 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 10 Epidural analgesia.
Comparison 57 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 11 Instrumental vaginal delivery.
Comparison 57 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 12 Meconium stained liquor.
Comparison 57 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 13 Apgar score <7 at 5 minutes.
Comparison 57 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 14 Neonatal intensive care unit admission.
Comparison 57 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 16 Perinatal death.
Comparison 57 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 18 Maternal side‐effects (all).
Comparison 57 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 19 Nausea (maternal).
Comparison 57 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 20 Vomitting (maternal).
Comparison 57 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 21 Diarrhoea (maternal).
Comparison 57 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 22 Other maternal side‐effects.
Comparison 57 (8.1) PGE2 low dose vs PGE2 high dose (all women), Outcome 23 Postpartum haemorrhage.
Comparison 58 (8.2) PGE2 low dose vs PGE2 high dose (all women, unfavourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.
Comparison 58 (8.2) PGE2 low dose vs PGE2 high dose (all women, unfavourable cervix), Outcome 3 Caesarean section.
Comparison 58 (8.2) PGE2 low dose vs PGE2 high dose (all women, unfavourable cervix), Outcome 7 Oxytocin augmentation.
Comparison 58 (8.2) PGE2 low dose vs PGE2 high dose (all women, unfavourable cervix), Outcome 8 Uterine hyperstimulation without FHR changes.
Comparison 58 (8.2) PGE2 low dose vs PGE2 high dose (all women, unfavourable cervix), Outcome 13 Apgar score <7 at 5 minutes.
Comparison 58 (8.2) PGE2 low dose vs PGE2 high dose (all women, unfavourable cervix), Outcome 18 Maternal side‐effects (all).
Comparison 58 (8.2) PGE2 low dose vs PGE2 high dose (all women, unfavourable cervix), Outcome 19 Nausea (maternal).
Comparison 58 (8.2) PGE2 low dose vs PGE2 high dose (all women, unfavourable cervix), Outcome 20 Vomitting (maternal).
Comparison 58 (8.2) PGE2 low dose vs PGE2 high dose (all women, unfavourable cervix), Outcome 21 Diarrhoea (maternal).
Comparison 58 (8.2) PGE2 low dose vs PGE2 high dose (all women, unfavourable cervix), Outcome 22 Other maternal side‐effects.
Comparison 59 (8.4) PGE2 low dose vs PGE2 high dose (all women, intact membranes, variable or undefined cervix), Outcome 3 Caesarean section.
Comparison 59 (8.4) PGE2 low dose vs PGE2 high dose (all women, intact membranes, variable or undefined cervix), Outcome 7 Oxytocin augmentation.
Comparison 59 (8.4) PGE2 low dose vs PGE2 high dose (all women, intact membranes, variable or undefined cervix), Outcome 10 Epidural analgesia.
Comparison 59 (8.4) PGE2 low dose vs PGE2 high dose (all women, intact membranes, variable or undefined cervix), Outcome 11 Instrumental vaginal delivery.
Comparison 59 (8.4) PGE2 low dose vs PGE2 high dose (all women, intact membranes, variable or undefined cervix), Outcome 23 Postpartum haemorrhage.
Comparison 60 (8.5) PGE2 low dose vs PGE2 high dose (all women, intact membranes, unfavourable cervix), Outcome 2 Uterine hyperstimulation with FHR changes.
Comparison 60 (8.5) PGE2 low dose vs PGE2 high dose (all women, intact membranes, unfavourable cervix), Outcome 3 Caesarean section.
Comparison 60 (8.5) PGE2 low dose vs PGE2 high dose (all women, intact membranes, unfavourable cervix), Outcome 13 Apgar score <7 at 5 minutes.
Comparison 60 (8.5) PGE2 low dose vs PGE2 high dose (all women, intact membranes, unfavourable cervix), Outcome 18 Maternal side‐effects (all).
Comparison 60 (8.5) PGE2 low dose vs PGE2 high dose (all women, intact membranes, unfavourable cervix), Outcome 19 Nausea (maternal).
Comparison 60 (8.5) PGE2 low dose vs PGE2 high dose (all women, intact membranes, unfavourable cervix), Outcome 20 Vomitting (maternal).
Comparison 60 (8.5) PGE2 low dose vs PGE2 high dose (all women, intact membranes, unfavourable cervix), Outcome 21 Diarrhoea (maternal).
Comparison 60 (8.5) PGE2 low dose vs PGE2 high dose (all women, intact membranes, unfavourable cervix), Outcome 22 Other maternal side‐effects.
Comparison 61 (8.10) PGE2 low dose vs PGE2 high dose (all primiparae), Outcome 3 Caesarean section.
Comparison 61 (8.10) PGE2 low dose vs PGE2 high dose (all primiparae), Outcome 4 Serious neonatal morbidity or perinatal death.
Comparison 61 (8.10) PGE2 low dose vs PGE2 high dose (all primiparae), Outcome 7 Oxytocin augmentation.
Comparison 61 (8.10) PGE2 low dose vs PGE2 high dose (all primiparae), Outcome 10 Epidural analgesia.
Comparison 61 (8.10) PGE2 low dose vs PGE2 high dose (all primiparae), Outcome 11 Instrumental vaginal delivery.
Comparison 61 (8.10) PGE2 low dose vs PGE2 high dose (all primiparae), Outcome 12 Meconium stained liquor.
Comparison 61 (8.10) PGE2 low dose vs PGE2 high dose (all primiparae), Outcome 13 Apgar score <7 at 5 minutes.
Comparison 61 (8.10) PGE2 low dose vs PGE2 high dose (all primiparae), Outcome 14 Neonatal intensive care unit admission.
Comparison 61 (8.10) PGE2 low dose vs PGE2 high dose (all primiparae), Outcome 16 Perinatal death.
Comparison 61 (8.10) PGE2 low dose vs PGE2 high dose (all primiparae), Outcome 23 Postpartum haemorrhage.
Comparison 62 (8.19) PGE2 low dose vs PGE2 high dose (all multiparae), Outcome 3 Caesarean section.
Comparison 62 (8.19) PGE2 low dose vs PGE2 high dose (all multiparae), Outcome 4 Serious neonatal morbidity or perinatal death.
Comparison 62 (8.19) PGE2 low dose vs PGE2 high dose (all multiparae), Outcome 7 Oxytocin augmentation.
Comparison 62 (8.19) PGE2 low dose vs PGE2 high dose (all multiparae), Outcome 10 Epidural analgesia.
Comparison 62 (8.19) PGE2 low dose vs PGE2 high dose (all multiparae), Outcome 11 Instrumental vaginal delivery.
Comparison 62 (8.19) PGE2 low dose vs PGE2 high dose (all multiparae), Outcome 12 Meconium stained liquor.
Comparison 62 (8.19) PGE2 low dose vs PGE2 high dose (all multiparae), Outcome 13 Apgar score <7 at 5 minutes.
Comparison 62 (8.19) PGE2 low dose vs PGE2 high dose (all multiparae), Outcome 14 Neonatal intensive care unit admission.
Comparison 62 (8.19) PGE2 low dose vs PGE2 high dose (all multiparae), Outcome 16 Perinatal death.
Comparison 62 (8.19) PGE2 low dose vs PGE2 high dose (all multiparae), Outcome 23 Postpartum haemorrhage.
Comparison 63 PGE2 (all regimens) vs placebo/no treatment (all women, outpatient ripening), Outcome 2 Uterine hyperstimulation with FHR changes.
Comparison 63 PGE2 (all regimens) vs placebo/no treatment (all women, outpatient ripening), Outcome 3 Caesarean section.
Comparison 63 PGE2 (all regimens) vs placebo/no treatment (all women, outpatient ripening), Outcome 6 Cervix unfavourable/unchanged after 12 to 24 hours.
Comparison 63 PGE2 (all regimens) vs placebo/no treatment (all women, outpatient ripening), Outcome 8 Uterine hyperstimulation without FHR changes.
Comparison 63 PGE2 (all regimens) vs placebo/no treatment (all women, outpatient ripening), Outcome 10 Epidural analgesia.
Comparison 63 PGE2 (all regimens) vs placebo/no treatment (all women, outpatient ripening), Outcome 12 Meconium stained liquor.
Comparison 63 PGE2 (all regimens) vs placebo/no treatment (all women, outpatient ripening), Outcome 13 Apgar score <7 at 5 minutes.
Comparison 63 PGE2 (all regimens) vs placebo/no treatment (all women, outpatient ripening), Outcome 14 Neonatal intensive care unit admission.
| 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. |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Vaginal delivery not achieved within 24 hours Show forest plot | 2 | 384 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.19 [0.14, 0.25] |
| 1.1 PGE2 (once only) vs placebo/no treatment | 1 | 39 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.88 [0.67, 1.15] |
| 1.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 345 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.12 [0.08, 0.18] |
| 2 Uterine hyperstimulation with FHR changes Show forest plot | 13 | 1203 | Risk Ratio (M‐H, Fixed, 95% CI) | 4.14 [1.93, 8.90] |
| 2.1 PGE2 (once only) vs placebo/no treatment | 6 | 459 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.38 [0.46, 4.15] |
| 2.2 PGE2 (repeated doses) vs placebo/no treatment | 3 | 208 | Risk Ratio (M‐H, Fixed, 95% CI) | 5.34 [0.27, 106.70] |
| 2.3 PGE2 (sustained release) vs placebo/no treatment | 4 | 536 | Risk Ratio (M‐H, Fixed, 95% CI) | 10.87 [2.69, 43.92] |
| 3 Caesarean section Show forest plot | 32 | 6243 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.89 [0.79, 1.00] |
| 3.1 PGE2 (once only) vs placebo/no treatment | 15 | 1349 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.01 [0.82, 1.24] |
| 3.2 PGE2 (repeated doses) vs placebo/no treatment | 13 | 4323 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.84 [0.71, 1.00] |
| 3.3 PGE2 (sustained release) vs placebo/no treatment | 4 | 571 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.84 [0.64, 1.10] |
| 4 Serious neonatal morbidity or perinatal death Show forest plot | 7 | 3482 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.46 [0.09, 2.31] |
| 4.1 PGE2 (once only) vs placebo/no treatment | 1 | 29 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 4.2 PGE2 (repeated doses) vs placebo/no treatment | 4 | 3169 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.46 [0.09, 2.31] |
| 4.3 PGE2 (sustained release) vs placebo/no treatment | 2 | 284 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 5 Serious maternal morbidity or death Show forest plot | 3 | 530 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.23 [0.34, 14.76] |
| 5.1 PGE2 (once only) vs placebo | 2 | 461 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.23 [0.34, 14.76] |
| 5.3 PGE2 (sustained release) vs placebo/no treatment | 1 | 69 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 6 Cervix unfavourable/unchanged after 12 to 24 hours Show forest plot | 5 | 467 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.46 [0.35, 0.62] |
| 6.1 PGE2 (once only) vs placebo/no treatment | 3 | 232 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.55 [0.40, 0.75] |
| 6.2 PGE2 (repeated doses) vs placebo/no treatment | 2 | 235 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.34 [0.19, 0.61] |
| 7 Oxytocin augmentation Show forest plot | 11 | 1265 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.80 [0.69, 0.91] |
| 7.1 PGE2 (once only) vs placebo/no treatment | 6 | 489 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.83 [0.67, 1.05] |
| 7.2 PGE2 (repeated doses) vs placebo/no treatment | 4 | 695 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.85 [0.71, 1.02] |
| 7.3 PGE2 (sustained release) vs placebo/no treatment | 1 | 81 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.36 [0.20, 0.64] |
| 8 Uterine hyperstimulation without FHR changes Show forest plot | 12 | 3580 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.48 [1.17, 5.26] |
| 8.1 PGE2 (once only) vs placebo/no treatment | 5 | 387 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.26 [0.33, 4.84] |
| 8.2 PGE2 (repeated doses) vs placebo/no treatment | 5 | 2953 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.34 [0.78, 7.03] |
| 8.3 PGE2 (sustained release) vs placebo/no treatment | 2 | 240 | Risk Ratio (M‐H, Fixed, 95% CI) | 7.85 [1.05, 58.82] |
| 9 Uterine rupture Show forest plot | 2 | 2579 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.90 [0.12, 68.50] |
| 9.1 PGE2 (once only) vs placebo/no treatment | 1 | 59 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.90 [0.12, 68.50] |
| 9.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 2520 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 10 Epidural analgesia Show forest plot | 7 | 3555 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.09 [1.01, 1.16] |
| 10.1 PGE2 (once only) vs placebo/no treatment | 2 | 434 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.98 [0.76, 1.25] |
| 10.2 PGE2 (repeated doses) vs placebo/no treatment | 4 | 3040 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.10 [1.02, 1.18] |
| 10.3 PGE2 (sustained release) vs placebo/no treatment | 1 | 81 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.18 [0.83, 1.68] |
| 11 Instrumental vaginal delivery Show forest plot | 13 | 4219 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.95 [0.82, 1.10] |
| 11.1 PGE2 (once only) vs placebo/no treatment | 6 | 721 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.84 [0.55, 1.28] |
| 11.2 PGE2 (repeated doses) vs placebo/no treatment | 5 | 3348 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.97 [0.83, 1.13] |
| 11.3 PGE2 (sustained release) vs placebo/no treatment | 2 | 150 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.01 [0.55, 1.86] |
| 12 Meconium stained liquor Show forest plot | 11 | 4145 | 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 | 6 | 3441 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.78 [0.64, 0.97] |
| 13 Apgar score <7 at 5 minutes Show forest plot | 15 | 4381 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.30 [0.86, 1.96] |
| 13.1 PGE2 (once only) vs placebo/no treatment | 9 | 1046 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.56 [0.24, 1.30] |
| 13.2 PGE2 (repeated doses) vs placebo/no treatment | 5 | 3120 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.38 [0.80, 2.37] |
| 13.3 PGE2 (sustained release) vs placebo/no treatment | 1 | 215 | Risk Ratio (M‐H, Fixed, 95% CI) | 6.21 [1.41, 27.34] |
| 14 Neonatal intensive care unit admission Show forest plot | 11 | 3922 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.95 [0.78, 1.15] |
| 14.1 PGE2 (once only) vs placebo/no treatment | 4 | 681 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.23 [0.70, 2.15] |
| 14.2 PGE2 (repeated doses) vs placebo/no treatment | 6 | 3172 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.90 [0.73, 1.11] |
| 14.3 PGE2 (sustained release) vs placebo/no treatment | 1 | 69 | Risk Ratio (M‐H, Fixed, 95% CI) | 3.27 [0.36, 29.93] |
| 16 Perinatal death Show forest plot | 7 | 3648 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.56 [0.14, 2.22] |
| 16.1 PGE2 (once only) vs placebo/no treatment | 2 | 431 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.06 [0.07, 16.85] |
| 16.2 PGE2 (repeated doses) vs placebo/no treatment | 4 | 3148 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.46 [0.09, 2.31] |
| 16.3 PGE2 (sustained release) vs placebo/no treatment | 1 | 69 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 18 Maternal side‐effects (all) Show forest plot | 12 | 6780 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.15 [0.80, 1.67] |
| 18.1 PGE2 (once only) vs placebo/no treatment | 6 | 577 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.95 [1.02, 3.74] |
| 18.2 PGE2 (repeated doses) vs placebo/no treatment | 5 | 5558 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.84 [0.53, 1.34] |
| 18.3 PGE2 (sustained release) vs placebo/no treatment | 1 | 645 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 19 Nausea (maternal) Show forest plot | 1 | 84 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 19.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 84 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 20 Vomitting (maternal) Show forest plot | 3 | 2794 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.16 [0.39, 3.39] |
| 20.1 PGE2 (once only) vs placebo/no treatment | 1 | 59 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.97 [0.15, 6.41] |
| 20.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 2520 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.25 [0.34, 4.65] |
| 20.3 PGE2 (sustained release) vs placebo/no treatment | 1 | 215 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 21 Diarrhoea (maternal) Show forest plot | 3 | 2819 | Risk Ratio (M‐H, Fixed, 95% CI) | 7.01 [0.36, 135.59] |
| 21.2 PGE2 (repeated doses) vs placebo/no treatment | 2 | 2604 | Risk Ratio (M‐H, Fixed, 95% CI) | 7.01 [0.36, 135.59] |
| 21.3 PGE2 (sustained release) vs placebo/no treatment | 1 | 215 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 22 Other maternal side effects Show forest plot | 7 | 871 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.97 [0.62, 1.51] |
| 22.1 PGE2 (once only) vs placebo/no treatment | 4 | 356 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.78 [0.97, 8.02] |
| 22.2 PGE2 (repeated doses) vs placebo/no treatment | 2 | 300 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.69 [0.42, 1.15] |
| 22.3 PGE2 (sustained release) vs placebo/no treatment | 1 | 215 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 23 Postpartum haemorrhage Show forest plot | 8 | 3437 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.44 [1.01, 2.05] |
| 23.1 PGE2 (once only) vs placebo/no treatment | 4 | 282 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.14 [0.33, 3.97] |
| 23.2 PGE2 (repeated doses) vs placebo/no treatment | 3 | 2940 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.42 [0.98, 2.07] |
| 23.3 PGE2 (sustained release) vs placebo/no treatment | 1 | 215 | Risk Ratio (M‐H, Fixed, 95% CI) | 5.64 [0.27, 116.05] |
| 24 Serious maternal complication Show forest plot | 1 | 59 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.90 [0.12, 68.50] |
| 24.1 PGE2 (once only) vs placebo/no treatment | 1 | 59 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.90 [0.12, 68.50] |
| 26 Woman not satisfied Show forest plot | 2 | 2922 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.56 [0.44, 0.71] |
| 26.1 PGE2 (once only) vs placebo/no treatment | 1 | 402 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.40 [0.83, 2.35] |
| 26.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 2520 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.44 [0.33, 0.58] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Vaginal delivery not achieved within 24 hours Show forest plot | 1 | 39 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.88 [0.67, 1.15] |
| 1.1 PGE2 (once only) vs placebo/no treatment | 1 | 39 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.88 [0.67, 1.15] |
| 2 Uterine hyperstimulation with FHR changes Show forest plot | 12 | 1143 | Risk Ratio (M‐H, Fixed, 95% CI) | 4.47 [2.01, 9.93] |
| 2.1 PGE2 (once only) vs placebo/no treatment | 5 | 399 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.44 [0.44, 4.65] |
| 2.2 PGE2 (repeated doses) vs placebo/no treatment | 3 | 208 | Risk Ratio (M‐H, Fixed, 95% CI) | 5.34 [0.27, 106.70] |
| 2.3 PGE2 (sustained release) vs placebo/no treatment | 4 | 536 | Risk Ratio (M‐H, Fixed, 95% CI) | 10.87 [2.69, 43.92] |
| 3 Caesarean section Show forest plot | 22 | 2173 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.87 [0.75, 1.02] |
| 3.1 PGE2 (once only) vs placebo/no treatment | 11 | 828 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.92 [0.73, 1.17] |
| 3.2 PGE2 (repeated doses) vs placebo/no treatment | 7 | 774 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.84 [0.61, 1.15] |
| 3.3 PGE2 (sustained release) vs placebo/no treatment | 4 | 571 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.84 [0.64, 1.10] |
| 4 Serious neonatal morbidity or perinatal death Show forest plot | 4 | 533 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 4.1 PGE2 (once only) vs placebo/no treatment | 1 | 29 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 4.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 220 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 4.3 PGE2 (sustained release) vs placebo/no treatment | 2 | 284 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 5 Serious maternal morbidity or death Show forest plot | 2 | 128 | Risk Ratio (M‐H, Fixed, 95% CI) | 4.84 [0.24, 96.66] |
| 5.1 PGE2 (once only) vs placebo | 1 | 59 | Risk Ratio (M‐H, Fixed, 95% CI) | 4.84 [0.24, 96.66] |
| 5.3 PGE2 (sustained release) vs placebo/no treatment | 1 | 69 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 6 Cervix unfavourable/unchanged after 12 to 24 hours Show forest plot | 2 | 172 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.53 [0.35, 0.79] |
| 6.1 PGE2 (once only) vs placebo/no treatment | 2 | 172 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.53 [0.35, 0.79] |
| 7 Oxytocin augmentation Show forest plot | 8 | 813 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.72 [0.61, 0.85] |
| 7.1 PGE2 (once only) vs placebo/no treatment | 4 | 382 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.87 [0.67, 1.13] |
| 7.2 PGE2 (repeated doses) vs placebo/no treatment | 3 | 350 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.70 [0.55, 0.89] |
| 7.3 PGE2 (sustained release) vs placebo/no treatment | 1 | 81 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.36 [0.20, 0.64] |
| 8 Uterine hyperstimulation without FHR changes Show forest plot | 9 | 777 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.63 [0.99, 7.01] |
| 8.1 PGE2 (once only) vs placebo/no treatment | 5 | 387 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.26 [0.33, 4.84] |
| 8.2 PGE2 (repeated doses) vs placebo/no treatment | 2 | 150 | Risk Ratio (M‐H, Fixed, 95% CI) | 3.0 [0.13, 71.92] |
| 8.3 PGE2 (sustained release) vs placebo/no treatment | 2 | 240 | Risk Ratio (M‐H, Fixed, 95% CI) | 7.85 [1.05, 58.82] |
| 9 Uterine rupture Show forest plot | 1 | 59 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.90 [0.12, 68.50] |
| 9.1 PGE2 (once only) vs placebo/no treatment | 1 | 59 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.90 [0.12, 68.50] |
| 10 Epidural analgesia Show forest plot | 5 | 633 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.46 [1.22, 1.75] |
| 10.1 PGE2 (once only) vs placebo/no treatment | 1 | 32 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.54 [0.29, 0.98] |
| 10.2 PGE2 (repeated doses) vs placebo/no treatment | 3 | 520 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.69 [1.36, 2.10] |
| 10.3 PGE2 (sustained release) vs placebo/no treatment | 1 | 81 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.18 [0.83, 1.68] |
| 11 Instrumental vaginal delivery Show forest plot | 7 | 643 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.88 [0.61, 1.27] |
| 11.1 PGE2 (once only) vs placebo/no treatment | 4 | 293 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.87 [0.45, 1.69] |
| 11.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.79 [0.43, 1.46] |
| 11.3 PGE2 (sustained release) vs placebo/no treatment | 2 | 150 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.01 [0.55, 1.86] |
| 12 Meconium stained liquor Show forest plot | 5 | 697 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.65 [0.47, 0.89] |
| 12.1 PGE2 (once only) vs placebo/no treatment | 2 | 177 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.90 [0.51, 1.57] |
| 12.2 PGE2 (repeated doses) vs placebo/no treatment | 3 | 520 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.55 [0.37, 0.81] |
| 13 Apgar score <7 at 5 minutes Show forest plot | 11 | 1194 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.08 [0.59, 1.99] |
| 13.1 PGE2 (once only) vs placebo/no treatment | 7 | 579 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.48 [0.17, 1.36] |
| 13.2 PGE2 (repeated doses) vs placebo/no treatment | 3 | 400 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.55 [0.15, 1.98] |
| 13.3 PGE2 (sustained release) vs placebo/no treatment | 1 | 215 | Risk Ratio (M‐H, Fixed, 95% CI) | 6.21 [1.41, 27.34] |
| 14 Neonatal intensive care unit admission Show forest plot | 7 | 735 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.80 [0.51, 1.27] |
| 14.1 PGE2 (once only) vs placebo/no treatment | 2 | 214 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.96 [0.51, 1.82] |
| 14.2 PGE2 (repeated doses) vs placebo/no treatment | 4 | 452 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.55 [0.27, 1.14] |
| 14.3 PGE2 (sustained release) vs placebo/no treatment | 1 | 69 | Risk Ratio (M‐H, Fixed, 95% CI) | 3.27 [0.36, 29.93] |
| 16 Perinatal death Show forest plot | 3 | 298 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 16.1 PGE2 (once only) vs placebo/no treatment | 1 | 29 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 16.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 16.3 PGE2 (sustained release) vs placebo/no treatment | 1 | 69 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 18 Maternal side‐effects (all) Show forest plot | 10 | 1572 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.08 [0.73, 1.59] |
| 18.1 PGE2 (once only) vs placebo/no treatment | 6 | 577 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.95 [1.02, 3.74] |
| 18.2 PGE2 (repeated doses) vs placebo/no treatment | 3 | 350 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.69 [0.42, 1.15] |
| 18.3 PGE2 (sustained release) vs placebo/no treatment | 1 | 645 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 19 Nausea (maternal) Show forest plot | 1 | 116 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 19.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 116 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 20 Vomitting (maternal) Show forest plot | 2 | 274 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.97 [0.15, 6.41] |
| 20.1 PGE2 (once only) vs placebo/no treatment | 1 | 59 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.97 [0.15, 6.41] |
| 20.3 PGE2 (sustained release) vs placebo/no treatment | 1 | 215 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 21 Diarrhoea (maternal) Show forest plot | 2 | 331 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 21.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 116 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 21.3 PGE2 (sustained release) vs placebo/no treatment | 1 | 215 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 22 Other maternal side effects Show forest plot | 7 | 871 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.97 [0.62, 1.51] |
| 22.1 PGE2 (once only) vs placebo/no treatment | 4 | 356 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.78 [0.97, 8.02] |
| 22.2 PGE2 (repeated doses) vs placebo/no treatment | 2 | 300 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.69 [0.42, 1.15] |
| 22.3 PGE2 (sustained release) vs placebo/no treatment | 1 | 215 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 23 Postpartum haemorrhage Show forest plot | 7 | 917 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.99 [0.47, 2.05] |
| 23.1 PGE2 (once only) vs placebo/no treatment | 4 | 282 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.14 [0.33, 3.97] |
| 23.2 PGE2 (repeated doses) vs placebo/no treatment | 2 | 420 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.67 [0.24, 1.84] |
| 23.3 PGE2 (sustained release) vs placebo/no treatment | 1 | 215 | Risk Ratio (M‐H, Fixed, 95% CI) | 5.64 [0.27, 116.05] |
| 24 Serious maternal complication Show forest plot | 1 | 59 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.90 [0.12, 68.50] |
| 24.1 PGE2 (once only) vs placebo/no treatment | 1 | 59 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.90 [0.12, 68.50] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Vaginal delivery not achieved within 24 hours Show forest plot | 1 | 345 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.12 [0.08, 0.18] |
| 1.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 345 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.12 [0.08, 0.18] |
| 3 Caesarean section Show forest plot | 1 | 345 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.61 [0.10, 3.61] |
| 3.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 345 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.61 [0.10, 3.61] |
| 4 Serious neonatal morbidity or perinatal death Show forest plot | 1 | 345 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.31 [0.01, 7.45] |
| 4.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 345 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.31 [0.01, 7.45] |
| 7 Oxytocin augmentation Show forest plot | 2 | 387 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.97 [0.74, 1.26] |
| 7.1 PGE2 (once only) vs placebo/no treatment | 1 | 42 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.42 [0.18, 0.97] |
| 7.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 345 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.07 [0.81, 1.42] |
| 11 Instrumental vaginal delivery Show forest plot | 1 | 345 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.22 [0.28, 5.38] |
| 11.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 345 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.22 [0.28, 5.38] |
| 16 Perinatal death Show forest plot | 1 | 345 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.31 [0.01, 7.45] |
| 16.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 345 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.31 [0.01, 7.45] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2 Uterine hyperstimulation with FHR changes Show forest plot | 5 | 425 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.16 [0.57, 8.21] |
| 2.1 PGE2 (once only) vs placebo/no treatment | 2 | 135 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.95 [0.14, 6.69] |
| 2.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 50 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 2.3 PGE2 (sustained release) vs placebo/no treatment | 2 | 240 | Risk Ratio (M‐H, Fixed, 95% CI) | 4.44 [0.55, 35.61] |
| 3 Caesarean section Show forest plot | 5 | 471 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.17 [0.84, 1.63] |
| 3.1 PGE2 (once only) vs placebo/no treatment | 3 | 215 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.28 [0.77, 2.11] |
| 3.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 50 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.63 [0.52, 5.07] |
| 3.3 PGE2 (sustained release) vs placebo/no treatment | 1 | 206 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.02 [0.63, 1.65] |
| 6 Cervix unfavourable/unchanged after 12 to 24 hours Show forest plot | 1 | 54 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.40 [0.24, 0.68] |
| 6.1 PGE2 (once only) vs placebo/no treatment | 1 | 54 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.40 [0.24, 0.68] |
| 7 Oxytocin augmentation Show forest plot | 1 | 50 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.01 [0.60, 1.68] |
| 7.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 50 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.01 [0.60, 1.68] |
| 8 Uterine hyperstimulation without FHR changes Show forest plot | 5 | 424 | Risk Ratio (M‐H, Fixed, 95% CI) | 6.76 [1.32, 34.54] |
| 8.1 PGE2 (once only) vs placebo/no treatment | 2 | 134 | Risk Ratio (M‐H, Fixed, 95% CI) | 5.16 [0.31, 86.59] |
| 8.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 50 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 8.3 PGE2 (sustained release) vs placebo/no treatment | 2 | 240 | Risk Ratio (M‐H, Fixed, 95% CI) | 7.85 [1.05, 58.82] |
| 13 Apgar score <7 at 5 minutes Show forest plot | 2 | 161 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.54 [0.14, 2.05] |
| 13.1 PGE2 (once only) vs placebo/no treatment | 2 | 161 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.54 [0.14, 2.05] |
| 14 Neonatal intensive care unit admission Show forest plot | 1 | 50 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.22 [0.01, 4.28] |
| 14.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 50 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.22 [0.01, 4.28] |
| 18 Maternal side‐effects (all) Show forest plot | 3 | 212 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.68 [0.66, 4.31] |
| 18.1 PGE2 (once only) vs placebo/no treatment | 2 | 162 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.68 [0.66, 4.31] |
| 18.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 50 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 23 Postpartum haemorrhage Show forest plot | 1 | 81 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 23.1 PGE2 (once only) vs placebo/no treatment | 1 | 81 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Vaginal delivery not achieved within 24 hours Show forest plot | 1 | 345 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.12 [0.08, 0.18] |
| 1.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 345 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.12 [0.08, 0.18] |
| 3 Caesarean section Show forest plot | 1 | 345 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.61 [0.10, 3.61] |
| 3.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 345 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.61 [0.10, 3.61] |
| 4 Serious neonatal morbidity or perinatal death Show forest plot | 1 | 345 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.31 [0.01, 7.45] |
| 4.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 345 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.31 [0.01, 7.45] |
| 7 Oxytocin augmentation Show forest plot | 1 | 345 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.07 [0.81, 1.42] |
| 7.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 345 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.07 [0.81, 1.42] |
| 11 Instrumental vaginal delivery Show forest plot | 1 | 345 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.22 [0.28, 5.38] |
| 11.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 345 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.22 [0.28, 5.38] |
| 16 Perinatal death Show forest plot | 1 | 345 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.31 [0.01, 7.45] |
| 16.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 345 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.31 [0.01, 7.45] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 3 Caesarean section Show forest plot | 1 | 2520 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.88 [0.70, 1.11] |
| 3.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 2520 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.88 [0.70, 1.11] |
| 4 Serious neonatal morbidity or perinatal death Show forest plot | 1 | 2520 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.20 [0.01, 4.17] |
| 4.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 2520 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.20 [0.01, 4.17] |
| 8 Uterine hyperstimulation without FHR changes Show forest plot | 1 | 2520 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.25 [0.70, 7.30] |
| 8.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 2520 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.25 [0.70, 7.30] |
| 9 Uterine rupture Show forest plot | 1 | 2520 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 9.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 2520 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 10 Epidural analgesia Show forest plot | 1 | 2520 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.02 [0.94, 1.10] |
| 10.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 2520 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.02 [0.94, 1.10] |
| 11 Instrumental vaginal delivery Show forest plot | 1 | 2520 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.96 [0.80, 1.14] |
| 11.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 2520 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.96 [0.80, 1.14] |
| 12 Meconium stained liquor Show forest plot | 1 | 2520 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.04 [0.80, 1.36] |
| 12.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 2520 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.04 [0.80, 1.36] |
| 13 Apgar score <7 at 5 minutes Show forest plot | 1 | 2519 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.67 [0.89, 3.15] |
| 13.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 2519 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.67 [0.89, 3.15] |
| 14 Neonatal intensive care unit admission Show forest plot | 1 | 2519 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.91 [0.72, 1.15] |
| 14.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 2519 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.91 [0.72, 1.15] |
| 16 Perinatal death Show forest plot | 1 | 2519 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.20 [0.01, 4.17] |
| 16.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 2519 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.20 [0.01, 4.17] |
| 18 Maternal side‐effects (all) Show forest plot | 1 | 5040 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.00 [0.60, 6.64] |
| 18.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 5040 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.00 [0.60, 6.64] |
| 20 Vomitting (maternal) Show forest plot | 1 | 2520 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.25 [0.34, 4.65] |
| 20.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 2520 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.25 [0.34, 4.65] |
| 21 Diarrhoea (maternal) Show forest plot | 1 | 2520 | Risk Ratio (M‐H, Fixed, 95% CI) | 7.01 [0.36, 135.59] |
| 21.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 2520 | Risk Ratio (M‐H, Fixed, 95% CI) | 7.01 [0.36, 135.59] |
| 23 Postpartum haemorrhage Show forest plot | 1 | 2520 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.61 [1.07, 2.43] |
| 23.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 2520 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.61 [1.07, 2.43] |
| 26 Woman not satisfied Show forest plot | 1 | 2520 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.44 [0.33, 0.58] |
| 26.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 2520 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.44 [0.33, 0.58] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2 Uterine hyperstimulation with FHR changes Show forest plot | 1 | 155 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 2.1 PGE2 (once only) vs placebo/no treatment | 1 | 155 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 3 Caesarean section Show forest plot | 5 | 700 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.96 [0.66, 1.40] |
| 3.1 PGE2 (once only) vs placebo/no treatment | 2 | 214 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.02 [0.57, 1.82] |
| 3.2 PGE2 (repeated doses) vs placebo/no treatment | 3 | 486 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.92 [0.56, 1.51] |
| 4 Serious neonatal morbidity or perinatal death Show forest plot | 1 | 220 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 4.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 220 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 5 Serious maternal morbidity or death Show forest plot | 1 | 59 | Risk Ratio (M‐H, Fixed, 95% CI) | 4.84 [0.24, 96.66] |
| 5.1 PGE2 (once only) vs placebo | 1 | 59 | Risk Ratio (M‐H, Fixed, 95% CI) | 4.84 [0.24, 96.66] |
| 7 Oxytocin augmentation Show forest plot | 2 | 375 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.62 [0.49, 0.79] |
| 7.1 PGE2 (once only) vs placebo/no treatment | 1 | 155 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.63 [0.45, 0.90] |
| 7.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 220 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.61 [0.43, 0.85] |
| 8 Uterine hyperstimulation without FHR changes Show forest plot | 2 | 214 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.48 [0.05, 5.05] |
| 8.1 PGE2 (once only) vs placebo/no treatment | 2 | 214 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.48 [0.05, 5.05] |
| 9 Uterine rupture Show forest plot | 1 | 59 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.90 [0.12, 68.50] |
| 9.1 PGE2 (once only) vs placebo/no treatment | 1 | 59 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.90 [0.12, 68.50] |
| 10 Epidural analgesia Show forest plot | 2 | 420 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.35 [1.75, 3.16] |
| 10.2 PGE2 (repeated doses) vs placebo/no treatment | 2 | 420 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.35 [1.75, 3.16] |
| 11 Instrumental vaginal delivery Show forest plot | 2 | 259 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.99 [0.57, 1.73] |
| 11.1 PGE2 (once only) vs placebo/no treatment | 1 | 59 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.9 [0.64, 13.22] |
| 11.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.79 [0.43, 1.46] |
| 12 Meconium stained liquor Show forest plot | 3 | 479 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.60 [0.32, 1.10] |
| 12.1 PGE2 (once only) vs placebo/no treatment | 1 | 59 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.73 [0.18, 2.96] |
| 12.2 PGE2 (repeated doses) vs placebo/no treatment | 2 | 420 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.57 [0.29, 1.13] |
| 13 Apgar score <7 at 5 minutes Show forest plot | 2 | 375 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.74 [0.17, 3.27] |
| 13.1 PGE2 (once only) vs placebo/no treatment | 1 | 155 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.96 [0.06, 15.11] |
| 13.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 220 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.67 [0.11, 3.91] |
| 14 Neonatal intensive care unit admission Show forest plot | 3 | 434 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.93 [0.55, 1.59] |
| 14.1 PGE2 (once only) vs placebo/no treatment | 2 | 214 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.96 [0.51, 1.82] |
| 14.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 220 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.88 [0.33, 2.33] |
| 16 Perinatal death Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 16.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 18 Maternal side‐effects (all) Show forest plot | 3 | 493 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.03 [0.63, 1.69] |
| 18.1 PGE2 (once only) vs placebo/no treatment | 2 | 273 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.54 [0.52, 4.57] |
| 18.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 220 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.90 [0.52, 1.59] |
| 20 Vomitting (maternal) Show forest plot | 1 | 59 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.97 [0.15, 6.41] |
| 20.1 PGE2 (once only) vs placebo/no treatment | 1 | 59 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.97 [0.15, 6.41] |
| 22 Other maternal side effects Show forest plot | 1 | 155 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.48 [0.04, 5.20] |
| 22.1 PGE2 (once only) vs placebo/no treatment | 1 | 155 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.48 [0.04, 5.20] |
| 23 Postpartum haemorrhage Show forest plot | 3 | 479 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.79 [0.31, 2.02] |
| 23.1 PGE2 (once only) vs placebo/no treatment | 1 | 59 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.90 [0.12, 68.50] |
| 23.2 PGE2 (repeated doses) vs placebo/no treatment | 2 | 420 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.67 [0.24, 1.84] |
| 24 Serious maternal complication Show forest plot | 1 | 59 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.90 [0.12, 68.50] |
| 24.1 PGE2 (once only) vs placebo/no treatment | 1 | 59 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.90 [0.12, 68.50] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Vaginal delivery not achieved within 24 hours Show forest plot | 2 | 226 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.30 [0.23, 0.40] |
| 1.1 PGE2 (once only) vs placebo/no treatment | 1 | 39 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.88 [0.67, 1.15] |
| 1.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 187 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.20 [0.13, 0.29] |
| 2 Uterine hyperstimulation with FHR changes Show forest plot | 3 | 217 | Risk Ratio (M‐H, Fixed, 95% CI) | 3.0 [0.13, 68.57] |
| 2.1 PGE2 (once only) vs placebo/no treatment | 2 | 187 | Risk Ratio (M‐H, Fixed, 95% CI) | 3.0 [0.13, 68.57] |
| 2.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 30 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 3 Caesarean section Show forest plot | 10 | 2486 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.93 [0.77, 1.12] |
| 3.1 PGE2 (once only) vs placebo/no treatment | 4 | 273 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.98 [0.66, 1.46] |
| 3.2 PGE2 (repeated doses) vs placebo/no treatment | 5 | 2144 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.93 [0.75, 1.16] |
| 3.3 PGE2 (sustained release) vs placebo/no treatment | 1 | 69 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.79 [0.36, 1.73] |
| 4 Serious neonatal morbidity or perinatal death Show forest plot | 3 | 1796 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.34 [0.01, 8.22] |
| 4.2 PGE2 (repeated doses) vs placebo/no treatment | 2 | 1727 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.34 [0.01, 8.22] |
| 4.3 PGE2 (sustained release) vs placebo/no treatment | 1 | 69 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 5 Serious maternal morbidity or death Show forest plot | 1 | 69 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 5.3 PGE2 (sustained release) vs placebo/no treatment | 1 | 69 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 6 Cervix unfavourable/unchanged after 12 to 24 hours Show forest plot | 1 | 36 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.13 [0.03, 0.47] |
| 6.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 36 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.13 [0.03, 0.47] |
| 7 Oxytocin augmentation Show forest plot | 3 | 407 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.59 [0.47, 0.74] |
| 7.1 PGE2 (once only) vs placebo/no treatment | 2 | 187 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.57 [0.42, 0.77] |
| 7.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 220 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.61 [0.43, 0.85] |
| 8 Uterine hyperstimulation without FHR changes Show forest plot | 3 | 1701 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.35 [0.02, 8.10] |
| 8.1 PGE2 (once only) vs placebo/no treatment | 2 | 194 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.35 [0.02, 8.10] |
| 8.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 1507 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 9 Uterine rupture Show forest plot | 1 | 1507 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 9.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 1507 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 10 Epidural analgesia Show forest plot | 4 | 1959 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.12 [1.03, 1.21] |
| 10.1 PGE2 (once only) vs placebo/no treatment | 1 | 32 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.54 [0.29, 0.98] |
| 10.2 PGE2 (repeated doses) vs placebo/no treatment | 3 | 1927 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.13 [1.05, 1.23] |
| 11 Instrumental vaginal delivery Show forest plot | 4 | 1815 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.97 [0.83, 1.14] |
| 11.1 PGE2 (once only) vs placebo/no treatment | 1 | 39 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.70 [0.23, 2.10] |
| 11.2 PGE2 (repeated doses) vs placebo/no treatment | 2 | 1707 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.96 [0.82, 1.14] |
| 11.3 PGE2 (sustained release) vs placebo/no treatment | 1 | 69 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.56 [0.67, 3.62] |
| 12 Meconium stained liquor Show forest plot | 2 | 420 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.57 [0.29, 1.13] |
| 12.2 PGE2 (repeated doses) vs placebo/no treatment | 2 | 420 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.57 [0.29, 1.13] |
| 13 Apgar score <7 at 5 minutes Show forest plot | 3 | 414 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.74 [0.17, 3.27] |
| 13.1 PGE2 (once only) vs placebo/no treatment | 2 | 194 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.96 [0.06, 15.11] |
| 13.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 220 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.67 [0.11, 3.91] |
| 14 Neonatal intensive care unit admission Show forest plot | 3 | 444 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.06 [0.54, 2.09] |
| 14.1 PGE2 (once only) vs placebo/no treatment | 1 | 155 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.96 [0.32, 2.85] |
| 14.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 220 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.88 [0.33, 2.33] |
| 14.3 PGE2 (sustained release) vs placebo/no treatment | 1 | 69 | Risk Ratio (M‐H, Fixed, 95% CI) | 3.27 [0.36, 29.93] |
| 16 Perinatal death Show forest plot | 3 | 1776 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.34 [0.01, 8.22] |
| 16.1 PGE2 (repeated doses) vs placebo/no treatment | 2 | 1707 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.34 [0.01, 8.22] |
| 16.3 PGE2 (sustained release) vs placebo/no treatment | 1 | 69 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 18 Maternal side‐effects (all) Show forest plot | 3 | 1882 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.04 [0.63, 1.71] |
| 18.1 PGE2 (once only) vs placebo/no treatment | 1 | 155 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.48 [0.04, 5.20] |
| 18.2 PGE2 (repeated doses) vs placebo/no treatment | 2 | 1727 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.08 [0.65, 1.81] |
| 20 Vomitting (maternal) Show forest plot | 1 | 1507 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.68 [0.40, 7.00] |
| 20.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 1507 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.68 [0.40, 7.00] |
| 21 Diarrhoea (maternal) Show forest plot | 1 | 1507 | Risk Ratio (M‐H, Fixed, 95% CI) | 5.03 [0.24, 104.66] |
| 21.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 1507 | Risk Ratio (M‐H, Fixed, 95% CI) | 5.03 [0.24, 104.66] |
| 22 Other maternal side effects Show forest plot | 2 | 375 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.87 [0.50, 1.50] |
| 22.1 PGE2 (once only) vs placebo/no treatment | 1 | 155 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.48 [0.04, 5.20] |
| 22.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 220 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.90 [0.52, 1.59] |
| 23 Postpartum haemorrhage Show forest plot | 3 | 1927 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.51 [0.97, 2.34] |
| 23.2 PGE2 (repeated doses) vs placebo/no treatment | 3 | 1927 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.51 [0.97, 2.34] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Vaginal delivery not achieved within 24 hours Show forest plot | 1 | 39 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.88 [0.67, 1.15] |
| 1.1 PGE2 (once only) vs placebo/no treatment | 1 | 39 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.88 [0.67, 1.15] |
| 2 Uterine hyperstimulation with FHR changes Show forest plot | 3 | 217 | Risk Ratio (M‐H, Fixed, 95% CI) | 3.0 [0.13, 68.57] |
| 2.1 PGE2 (once only) vs placebo/no treatment | 2 | 187 | Risk Ratio (M‐H, Fixed, 95% CI) | 3.0 [0.13, 68.57] |
| 2.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 30 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 3 Caesarean section Show forest plot | 8 | 792 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.88 [0.66, 1.17] |
| 3.1 PGE2 (once only) vs placebo/no treatment | 4 | 273 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.98 [0.66, 1.46] |
| 3.2 PGE2 (repeated doses) vs placebo/no treatment | 3 | 450 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.81 [0.51, 1.29] |
| 3.3 PGE2 (sustained release) vs placebo/no treatment | 1 | 69 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.79 [0.36, 1.73] |
| 4 Serious neonatal morbidity or perinatal death Show forest plot | 2 | 289 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 4.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 220 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 4.3 PGE2 (sustained release) vs placebo/no treatment | 1 | 69 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 5 Serious maternal morbidity or death Show forest plot | 1 | 69 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 5.3 PGE2 (sustained release) vs placebo/no treatment | 1 | 69 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 7 Oxytocin augmentation Show forest plot | 3 | 407 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.59 [0.47, 0.74] |
| 7.1 PGE2 (once only) vs placebo/no treatment | 2 | 187 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.57 [0.42, 0.77] |
| 7.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 220 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.61 [0.43, 0.85] |
| 8 Uterine hyperstimulation without FHR changes Show forest plot | 2 | 194 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.35 [0.02, 8.10] |
| 8.1 PGE2 (once only) vs placebo/no treatment | 2 | 194 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.35 [0.02, 8.10] |
| 10 Epidural analgesia Show forest plot | 3 | 452 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.95 [1.50, 2.54] |
| 10.1 PGE2 (once only) vs placebo/no treatment | 1 | 32 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.54 [0.29, 0.98] |
| 10.2 PGE2 (repeated doses) vs placebo/no treatment | 2 | 420 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.35 [1.75, 3.16] |
| 11 Instrumental vaginal delivery Show forest plot | 3 | 308 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.94 [0.60, 1.47] |
| 11.1 PGE2 (once only) vs placebo/no treatment | 1 | 39 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.70 [0.23, 2.10] |
| 11.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.79 [0.43, 1.46] |
| 11.3 PGE2 (sustained release) vs placebo/no treatment | 1 | 69 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.56 [0.67, 3.62] |
| 12 Meconium stained liquor Show forest plot | 2 | 420 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.57 [0.29, 1.13] |
| 12.2 PGE2 (repeated doses) vs placebo/no treatment | 2 | 420 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.57 [0.29, 1.13] |
| 13 Apgar score <7 at 5 minutes Show forest plot | 3 | 414 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.74 [0.17, 3.27] |
| 13.1 PGE2 (once only) vs placebo/no treatment | 2 | 194 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.96 [0.06, 15.11] |
| 13.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 220 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.67 [0.11, 3.91] |
| 14 Neonatal intensive care unit admission Show forest plot | 3 | 444 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.06 [0.54, 2.09] |
| 14.1 PGE2 (once only) vs placebo/no treatment | 1 | 155 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.96 [0.32, 2.85] |
| 14.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 220 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.88 [0.33, 2.33] |
| 14.3 PGE2 (sustained release) vs placebo/no treatment | 1 | 69 | Risk Ratio (M‐H, Fixed, 95% CI) | 3.27 [0.36, 29.93] |
| 16 Perinatal death Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 16.1 PGE2 (repeated doses) vs placebo/no treatment | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 18 Maternal side‐effects (all) Show forest plot | 2 | 375 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.87 [0.50, 1.50] |
| 18.1 PGE2 (once only) vs placebo/no treatment | 1 | 155 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.48 [0.04, 5.20] |
| 18.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 220 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.90 [0.52, 1.59] |
| 22 Other maternal side effects Show forest plot | 2 | 375 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.87 [0.50, 1.50] |
| 22.1 PGE2 (once only) vs placebo/no treatment | 1 | 155 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.48 [0.04, 5.20] |
| 22.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 220 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.90 [0.52, 1.59] |
| 23 Postpartum haemorrhage Show forest plot | 2 | 420 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.67 [0.24, 1.84] |
| 23.2 PGE2 (repeated doses) vs placebo/no treatment | 2 | 420 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.67 [0.24, 1.84] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Vaginal delivery not achieved within 24 hours Show forest plot | 1 | 187 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.20 [0.13, 0.29] |
| 1.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 187 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.20 [0.13, 0.29] |
| 3 Caesarean section Show forest plot | 1 | 187 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.30 [0.03, 2.80] |
| 3.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 187 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.30 [0.03, 2.80] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2 Uterine hyperstimulation with FHR changes Show forest plot | 1 | 30 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 2.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 30 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 3 Caesarean section Show forest plot | 2 | 77 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.84 [0.51, 1.38] |
| 3.1 PGE2 (once only) vs placebo/no treatment | 1 | 47 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.95 [0.56, 1.63] |
| 3.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 30 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.57 [0.17, 1.87] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Vaginal delivery not achieved within 24 hours Show forest plot | 1 | 187 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.20 [0.13, 0.29] |
| 1.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 187 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.20 [0.13, 0.29] |
| 3 Caesarean section Show forest plot | 1 | 187 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.30 [0.03, 2.80] |
| 3.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 187 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.30 [0.03, 2.80] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 3 Caesarean section Show forest plot | 1 | 1507 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.99 [0.77, 1.27] |
| 3.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 1507 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.99 [0.77, 1.27] |
| 4 Serious neonatal morbidity or perinatal death Show forest plot | 1 | 1507 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.34 [0.01, 8.22] |
| 4.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 1507 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.34 [0.01, 8.22] |
| 8 Uterine hyperstimulation without FHR changes Show forest plot | 1 | 1507 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.01 [0.25, 4.01] |
| 8.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 1507 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.01 [0.25, 4.01] |
| 9 Uterine rupture Show forest plot | 1 | 1507 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 9.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 1507 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 10 Epidural analgesia Show forest plot | 1 | 1507 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.01 [0.93, 1.10] |
| 10.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 1507 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.01 [0.93, 1.10] |
| 11 Instrumental vaginal delivery Show forest plot | 1 | 1507 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.98 [0.83, 1.16] |
| 11.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 1507 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.98 [0.83, 1.16] |
| 16 Perinatal death Show forest plot | 1 | 1507 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.34 [0.01, 8.22] |
| 16.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 1507 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.34 [0.01, 8.22] |
| 18 Maternal side‐effects (all) Show forest plot | 1 | 1507 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.35 [0.61, 9.05] |
| 18.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 1507 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.35 [0.61, 9.05] |
| 20 Vomitting (maternal) Show forest plot | 1 | 1507 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.68 [0.40, 7.00] |
| 20.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 1507 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.68 [0.40, 7.00] |
| 21 Diarrhoea (maternal) Show forest plot | 1 | 1507 | Risk Ratio (M‐H, Fixed, 95% CI) | 5.03 [0.24, 104.66] |
| 21.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 1507 | Risk Ratio (M‐H, Fixed, 95% CI) | 5.03 [0.24, 104.66] |
| 23 Postpartum haemorrhage Show forest plot | 1 | 1507 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.84 [1.12, 3.03] |
| 23.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 1507 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.84 [1.12, 3.03] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2 Uterine hyperstimulation with FHR changes Show forest plot | 1 | 155 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 2.1 PGE2 (once only) vs placebo/no treatment | 1 | 155 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 3 Caesarean section Show forest plot | 3 | 575 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.91 [0.60, 1.39] |
| 3.1 PGE2 (once only) vs placebo/no treatment | 1 | 155 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.05 [0.49, 2.23] |
| 3.2 PGE2 (repeated doses) vs placebo/no treatment | 2 | 420 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.86 [0.51, 1.43] |
| 4 Serious neonatal morbidity or perinatal death Show forest plot | 1 | 220 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 4.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 220 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 7 Oxytocin augmentation Show forest plot | 2 | 375 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.62 [0.49, 0.79] |
| 7.1 PGE2 (once only) vs placebo/no treatment | 1 | 155 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.63 [0.45, 0.90] |
| 7.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 220 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.61 [0.43, 0.85] |
| 8 Uterine hyperstimulation without FHR changes Show forest plot | 1 | 155 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 8.1 PGE2 (once only) vs placebo/no treatment | 1 | 155 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 10 Epidural analgesia Show forest plot | 2 | 420 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.35 [1.75, 3.16] |
| 10.2 PGE2 (repeated doses) vs placebo/no treatment | 2 | 420 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.35 [1.75, 3.16] |
| 11 Instrumental vaginal delivery Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.79 [0.43, 1.46] |
| 11.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.79 [0.43, 1.46] |
| 12 Meconium stained liquor Show forest plot | 2 | 420 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.57 [0.29, 1.13] |
| 12.2 PGE2 (repeated doses) vs placebo/no treatment | 2 | 420 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.57 [0.29, 1.13] |
| 13 Apgar score <7 at 5 minutes Show forest plot | 2 | 375 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.74 [0.17, 3.27] |
| 13.1 PGE2 (once only) vs placebo/no treatment | 1 | 155 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.96 [0.06, 15.11] |
| 13.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 220 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.67 [0.11, 3.91] |
| 14 Neonatal intensive care unit admission Show forest plot | 2 | 375 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.91 [0.44, 1.89] |
| 14.1 PGE2 (once only) vs placebo/no treatment | 1 | 155 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.96 [0.32, 2.85] |
| 14.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 220 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.88 [0.33, 2.33] |
| 16 Perinatal death Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 16.1 PGE2 (repeated doses) vs placebo/no treatment | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 18 Maternal side‐effects (all) Show forest plot | 2 | 375 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.87 [0.50, 1.50] |
| 18.1 PGE2 (once only) vs placebo/no treatment | 1 | 155 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.48 [0.04, 5.20] |
| 18.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 220 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.90 [0.52, 1.59] |
| 22 Other maternal side effects Show forest plot | 2 | 375 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.87 [0.50, 1.50] |
| 22.1 PGE2 (once only) vs placebo/no treatment | 1 | 155 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.48 [0.04, 5.20] |
| 22.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 220 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.90 [0.52, 1.59] |
| 23 Postpartum haemorrhage Show forest plot | 2 | 420 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.67 [0.24, 1.84] |
| 23.2 PGE2 (repeated doses) vs placebo/no treatment | 2 | 420 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.67 [0.24, 1.84] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Vaginal delivery not achieved within 24 hours Show forest plot | 1 | 158 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.04 [0.02, 0.12] |
| 1.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 158 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.04 [0.02, 0.12] |
| 2 Uterine hyperstimulation with FHR changes Show forest plot | 1 | 20 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 2.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 20 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 3 Caesarean section Show forest plot | 4 | 1198 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.88 [0.51, 1.55] |
| 3.1 PGE2 (once only) vs placebo/no treatment | 1 | 7 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.33 [0.13, 13.74] |
| 3.2 PGE2 (repeated doses) vs placebo/no treatment | 3 | 1191 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.87 [0.49, 1.54] |
| 4 Serious neonatal morbidity or perinatal death Show forest plot | 1 | 1013 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.33 [0.01, 8.12] |
| 4.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 1013 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.33 [0.01, 8.12] |
| 5 Uterine rupture Show forest plot | 1 | 1013 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 5.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 1013 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 6 Epidural analgesia Show forest plot | 1 | 1013 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.05 [0.88, 1.24] |
| 6.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 1013 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.05 [0.88, 1.24] |
| 7 Oxytocin augmentation Show forest plot | 1 | 42 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.42 [0.18, 0.97] |
| 7.1 PGE2 (once only) vs placebo/no treatment | 1 | 42 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.42 [0.18, 0.97] |
| 8 Uterine hyperstimulation without FHR changes Show forest plot | 1 | 1013 | Risk Ratio (M‐H, Fixed, 95% CI) | 10.94 [0.61, 197.24] |
| 8.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 1013 | Risk Ratio (M‐H, Fixed, 95% CI) | 10.94 [0.61, 197.24] |
| 11 Instrumental vaginal delivery Show forest plot | 1 | 1013 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.23 [0.77, 1.95] |
| 11.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 1013 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.23 [0.77, 1.95] |
| 16 Perinatal death Show forest plot | 1 | 1013 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.33 [0.01, 8.12] |
| 16.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 1013 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.33 [0.01, 8.12] |
| 18 Maternal side‐effects (all) Show forest plot | 1 | 2026 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.99 [0.06, 15.87] |
| 18.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 2026 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.99 [0.06, 15.87] |
| 20 Vomitting (maternal) Show forest plot | 1 | 1013 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.33 [0.01, 8.12] |
| 20.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 1013 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.33 [0.01, 8.12] |
| 21 Diarrhoea (maternal) Show forest plot | 1 | 1013 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.98 [0.12, 73.04] |
| 21.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 1013 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.98 [0.12, 73.04] |
| 23 Postpartum haemorrhage Show forest plot | 1 | 1013 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.22 [0.59, 2.52] |
| 23.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 1013 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.22 [0.59, 2.52] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2 Uterine hyperstimulation with FHR changes Show forest plot | 1 | 20 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 2.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 20 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 3 Caesarean section Show forest plot | 2 | 27 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.95 [0.30, 12.59] |
| 3.1 PGE2 (once only) vs placebo/no treatment | 1 | 7 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.33 [0.13, 13.74] |
| 3.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 20 | Risk Ratio (M‐H, Fixed, 95% CI) | 3.0 [0.14, 65.90] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Vaginal delivery not achieved within 24 hours Show forest plot | 1 | 158 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.04 [0.02, 0.12] |
| 1.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 158 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.04 [0.02, 0.12] |
| 3 Caesarean section Show forest plot | 1 | 158 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.85 [0.12, 69.00] |
| 3.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 158 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.85 [0.12, 69.00] |
| 7 Oxytocin augmentation Show forest plot | 1 | 42 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.42 [0.18, 0.97] |
| 7.1 PGE2 (once only) vs placebo/no treatment | 1 | 42 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.42 [0.18, 0.97] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2 Uterine hyperstimulation with FHR changes Show forest plot | 1 | 20 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 2.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 20 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 3 Caesarean section Show forest plot | 2 | 27 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.95 [0.30, 12.59] |
| 3.1 PGE2 (once only) vs placebo/no treatment | 1 | 7 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.33 [0.13, 13.74] |
| 3.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 20 | Risk Ratio (M‐H, Fixed, 95% CI) | 3.0 [0.14, 65.90] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Vaginal delivery not achieved within 24 hours Show forest plot | 1 | 158 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.04 [0.02, 0.12] |
| 1.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 158 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.04 [0.02, 0.12] |
| 3 Caesarean section Show forest plot | 1 | 158 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.85 [0.12, 69.00] |
| 3.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 158 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.85 [0.12, 69.00] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 3 Caesarean section Show forest plot | 1 | 1013 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.78 [0.43, 1.42] |
| 3.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 1013 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.78 [0.43, 1.42] |
| 4 Serious neonatal morbidity or perinatal death Show forest plot | 1 | 1013 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.33 [0.01, 8.12] |
| 4.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 1013 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.33 [0.01, 8.12] |
| 8 Uterine hyperstimulation without FHR changes Show forest plot | 1 | 1013 | Risk Ratio (M‐H, Fixed, 95% CI) | 10.94 [0.61, 197.24] |
| 8.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 1013 | Risk Ratio (M‐H, Fixed, 95% CI) | 10.94 [0.61, 197.24] |
| 9 Uterine rupture Show forest plot | 1 | 1013 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 9.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 1013 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 10 Epidural analgesia Show forest plot | 1 | 1013 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.05 [0.88, 1.24] |
| 10.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 1013 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.05 [0.88, 1.24] |
| 11 Instrumental vaginal delivery Show forest plot | 1 | 1013 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.23 [0.77, 1.95] |
| 11.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 1013 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.23 [0.77, 1.95] |
| 16 Perinatal death Show forest plot | 1 | 1013 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.33 [0.01, 8.12] |
| 16.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 1013 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.33 [0.01, 8.12] |
| 18 Maternal side‐effects (all) Show forest plot | 1 | 2026 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.99 [0.06, 15.87] |
| 18.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 2026 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.99 [0.06, 15.87] |
| 20 Vomitting (maternal) Show forest plot | 1 | 1013 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.33 [0.01, 8.12] |
| 20.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 1013 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.33 [0.01, 8.12] |
| 21 Diarrhoea (maternal) Show forest plot | 1 | 1013 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.98 [0.12, 73.04] |
| 21.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 1013 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.98 [0.12, 73.04] |
| 23 Postpartum haemorrhage Show forest plot | 1 | 1013 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.22 [0.59, 2.52] |
| 23.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 1013 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.22 [0.59, 2.52] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2 Uterine hyperstimulation with FHR changes Show forest plot | 1 | 32 | Risk Ratio (M‐H, Fixed, 95% CI) | 3.0 [0.13, 68.57] |
| 3 Caesarean section Show forest plot | 3 | 387 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.58 [0.29, 1.18] |
| 6 Cervix unfavourable/unchanged after 12 to 24 hours Show forest plot | 1 | 90 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.25 [0.13, 0.49] |
| 7 Oxytocin augmentation Show forest plot | 2 | 122 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.65 [0.53, 0.81] |
| 10 Epidural analgesia Show forest plot | 3 | 387 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.72 [0.53, 0.98] |
| 11 Instrumental vaginal delivery Show forest plot | 2 | 355 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.60 [0.43, 0.84] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2 Uterine hyperstimulation with FHR changes Show forest plot | 1 | 32 | Risk Ratio (M‐H, Fixed, 95% CI) | 3.0 [0.13, 68.57] |
| 3 Caesarean section Show forest plot | 1 | 32 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.33 [0.04, 2.87] |
| 7 Oxytocin augmentation Show forest plot | 1 | 32 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.88 [0.71, 1.09] |
| 10 Epidural analgesia Show forest plot | 1 | 32 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.85 [0.56, 1.27] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2 Uterine hyperstimulation with FHR changes Show forest plot | 1 | 32 | Risk Ratio (M‐H, Fixed, 95% CI) | 3.0 [0.13, 68.57] |
| 3 Caesarean section Show forest plot | 1 | 32 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.33 [0.04, 2.87] |
| 7 Oxytocin augmentation Show forest plot | 1 | 32 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.88 [0.71, 1.09] |
| 10 Epidural analgesia Show forest plot | 1 | 32 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.85 [0.56, 1.27] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2 Uterine hyperstimulation with FHR changes Show forest plot | 1 | 32 | Risk Ratio (M‐H, Fixed, 95% CI) | 3.0 [0.13, 68.57] |
| 3 Caesarean section Show forest plot | 1 | 32 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.33 [0.04, 2.87] |
| 7 Oxytocin augmentation Show forest plot | 1 | 32 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.88 [0.71, 1.09] |
| 10 Epidural analgesia Show forest plot | 1 | 32 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.85 [0.56, 1.27] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Vaginal delivery not achieved within 24 hours Show forest plot | 1 | 75 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.51 [0.05, 5.42] |
| 2 Uterine hyperstimulation with FHR changes Show forest plot | 2 | 106 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.0 [0.07, 14.64] |
| 3 Caesarean section Show forest plot | 2 | 107 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.02 [0.47, 2.22] |
| 7 Oxytocin augmentation Show forest plot | 1 | 32 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.33 [1.21, 4.51] |
| 10 Epidural analgesia Show forest plot | 1 | 32 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.57 [0.82, 3.00] |
| 13 Apgar score <7 at 5 minutes Show forest plot | 1 | 75 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.21 [0.01, 4.14] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Vaginal delivery not achieved within 24 hours Show forest plot | 1 | 75 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.51 [0.05, 5.42] |
| 2 Uterine hyperstimulation with FHR changes Show forest plot | 2 | 106 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.0 [0.07, 14.64] |
| 3 Caesarean section Show forest plot | 2 | 107 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.02 [0.47, 2.22] |
| 7 Oxytocin augmentation Show forest plot | 1 | 32 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.33 [1.21, 4.51] |
| 10 Epidural analgesia Show forest plot | 1 | 32 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.57 [0.82, 3.00] |
| 13 Apgar score <7 at 5 minutes Show forest plot | 1 | 75 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.21 [0.01, 4.14] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2 Uterine hyperstimulation with FHR changes Show forest plot | 1 | 32 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.0 [0.07, 14.64] |
| 3 Caesarean section Show forest plot | 1 | 32 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.0 [0.07, 14.64] |
| 7 Oxytocin augmentation Show forest plot | 1 | 32 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.33 [1.21, 4.51] |
| 10 Epidural analgesia Show forest plot | 1 | 32 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.57 [0.82, 3.00] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2 Uterine hyperstimulation with FHR changes Show forest plot | 1 | 32 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.0 [0.07, 14.64] |
| 3 Caesarean section Show forest plot | 1 | 32 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.0 [0.07, 14.64] |
| 7 Oxytocin augmentation Show forest plot | 1 | 32 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.33 [1.21, 4.51] |
| 10 Epidural analgesia Show forest plot | 1 | 32 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.57 [0.82, 3.00] |
| 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 | 4 | 553 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.91 [0.64, 1.28] |
| 5 Serious maternal morbidity or death Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.33 [0.01, 8.09] |
| 6 Cervix unfavourable/unchanged after 12 to 24 hours Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.77 [0.56, 1.07] |
| 7 Oxytocin augmentation Show forest plot | 5 | 577 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.84 [0.72, 0.97] |
| 10 Epidural analgesia Show forest plot | 2 | 400 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.02 [0.89, 1.19] |
| 11 Instrumental vaginal delivery Show forest plot | 2 | 400 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.81 [0.59, 1.10] |
| 13 Apgar score <7 at 5 minutes Show forest plot | 2 | 104 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.33 [0.01, 7.95] |
| 23 Postpartum haemorrhage Show forest plot | 2 | 280 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.65 [0.16, 2.65] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Vaginal delivery not achieved within 24 hours Show forest plot | 1 | 73 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.28 [0.87, 1.87] |
| 2 Uterine hyperstimulation with FHR changes Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.0 [0.18, 21.71] |
| 3 Caesarean section Show forest plot | 3 | 353 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.93 [0.63, 1.38] |
| 5 Serious maternal morbidity or death Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.33 [0.01, 8.09] |
| 6 Cervix unfavourable/unchanged after 12 to 24 hours Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.77 [0.56, 1.07] |
| 7 Oxytocin augmentation Show forest plot | 4 | 377 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.85 [0.71, 1.02] |
| 10 Epidural analgesia Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.96 [0.85, 1.10] |
| 11 Instrumental vaginal delivery Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.88 [0.61, 1.25] |
| 13 Apgar score <7 at 5 minutes Show forest plot | 2 | 104 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.33 [0.01, 7.95] |
| 23 Postpartum haemorrhage Show forest plot | 1 | 80 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.5 [0.05, 5.30] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 7 Oxytocin augmentation Show forest plot | 1 | 24 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.0 [0.39, 2.58] |
| 13 Apgar score <7 at 5 minutes Show forest plot | 1 | 24 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 3 Caesarean section Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.85 [0.42, 1.69] |
| 7 Oxytocin augmentation Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.81 [0.63, 1.05] |
| 10 Epidural analgesia Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.20 [0.80, 1.82] |
| 11 Instrumental vaginal delivery Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.69 [0.38, 1.26] |
| 23 Postpartum haemorrhage Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.75 [0.13, 4.40] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Vaginal delivery not achieved within 24 hours Show forest plot | 1 | 73 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.28 [0.87, 1.87] |
| 2 Uterine hyperstimulation with FHR changes Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.0 [0.18, 21.71] |
| 3 Caesarean section Show forest plot | 2 | 273 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.11 [0.71, 1.74] |
| 5 Serious maternal morbidity or death Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.33 [0.01, 8.09] |
| 6 Cervix unfavourable/unchanged after 12 to 24 hours Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.77 [0.56, 1.07] |
| 7 Oxytocin augmentation Show forest plot | 2 | 273 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.98 [0.82, 1.18] |
| 10 Epidural analgesia Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.96 [0.85, 1.10] |
| 11 Instrumental vaginal delivery Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.88 [0.61, 1.25] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Vaginal delivery not achieved within 24 hours Show forest plot | 1 | 73 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.28 [0.87, 1.87] |
| 2 Uterine hyperstimulation with FHR changes Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.0 [0.18, 21.71] |
| 3 Caesarean section Show forest plot | 3 | 353 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.93 [0.63, 1.38] |
| 5 Serious maternal morbidity or death Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.33 [0.01, 8.09] |
| 6 Cervix unfavourable/unchanged after 12 to 24 hours Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.77 [0.56, 1.07] |
| 7 Oxytocin augmentation Show forest plot | 3 | 353 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.84 [0.70, 1.01] |
| 10 Epidural analgesia Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.96 [0.85, 1.10] |
| 11 Instrumental vaginal delivery Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.88 [0.61, 1.25] |
| 13 Apgar score <7 at 5 minutes Show forest plot | 1 | 80 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.33 [0.01, 7.95] |
| 23 Postpartum haemorrhage Show forest plot | 1 | 80 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.5 [0.05, 5.30] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Vaginal delivery not achieved within 24 hours Show forest plot | 1 | 73 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.28 [0.87, 1.87] |
| 2 Uterine hyperstimulation with FHR changes Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.0 [0.18, 21.71] |
| 3 Caesarean section Show forest plot | 3 | 353 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.93 [0.63, 1.38] |
| 5 Serious maternal morbidity or death Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.33 [0.01, 8.09] |
| 6 Cervix unfavourable/unchanged after 12 to 24 hours Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.77 [0.56, 1.07] |
| 7 Oxytocin augmentation Show forest plot | 3 | 353 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.84 [0.70, 1.01] |
| 10 Epidural analgesia Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.96 [0.85, 1.10] |
| 11 Instrumental vaginal delivery Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.88 [0.61, 1.25] |
| 13 Apgar score <7 at 5 minutes Show forest plot | 1 | 80 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.33 [0.01, 7.95] |
| 23 Postpartum haemorrhage Show forest plot | 1 | 80 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.5 [0.05, 5.30] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Vaginal delivery not achieved within 24 hours Show forest plot | 1 | 73 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.28 [0.87, 1.87] |
| 2 Uterine hyperstimulation with FHR changes Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.0 [0.18, 21.71] |
| 3 Caesarean section Show forest plot | 2 | 273 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.11 [0.71, 1.74] |
| 5 Serious maternal morbidity or death Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.33 [0.01, 8.09] |
| 6 Cervix unfavourable/unchanged after 12 to 24 hours Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.77 [0.56, 1.07] |
| 7 Oxytocin augmentation Show forest plot | 2 | 273 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.98 [0.82, 1.18] |
| 10 Epidural analgesia Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.96 [0.85, 1.10] |
| 11 Instrumental vaginal delivery Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.88 [0.61, 1.25] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2 Uterine hyperstimulation with FHR changes Show forest plot | 2 | 159 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.16 [0.03, 0.87] |
| 3 Caesarean section Show forest plot | 2 | 159 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.65 [0.38, 1.11] |
| 8 Uterine hyperstimulation without FHR changes Show forest plot | 1 | 90 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.2 [0.01, 4.05] |
| 13 Apgar score <7 at 5 minutes Show forest plot | 1 | 69 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.21 [0.01, 4.13] |
| 18 Maternal side‐effects (all) Show forest plot | 2 | 460 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.2 [0.02, 1.70] |
| 19 Nausea (maternal) Show forest plot | 1 | 69 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.34 [0.01, 8.13] |
| 20 Vomitting (maternal) Show forest plot | 1 | 69 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.34 [0.01, 8.13] |
| 21 Diarrhoea (maternal) Show forest plot | 2 | 159 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.33 [0.01, 7.97] |
| 22 Other maternal side effects Show forest plot | 2 | 159 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.33 [0.01, 7.97] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2 Uterine hyperstimulation with FHR changes Show forest plot | 2 | 159 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.16 [0.03, 0.87] |
| 3 Caesarean section Show forest plot | 2 | 159 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.65 [0.38, 1.11] |
| 8 Uterine hyperstimulation without FHR changes Show forest plot | 1 | 90 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.2 [0.01, 4.05] |
| 13 Apgar score <7 at 5 minutes Show forest plot | 1 | 69 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.21 [0.01, 4.13] |
| 18 Maternal side‐effects (all) Show forest plot | 2 | 460 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.2 [0.02, 1.70] |
| 19 Nausea (maternal) Show forest plot | 1 | 69 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.34 [0.01, 8.13] |
| 20 Vomitting (maternal) Show forest plot | 1 | 69 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.34 [0.01, 8.13] |
| 21 Diarrhoea (maternal) Show forest plot | 2 | 159 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.33 [0.01, 7.97] |
| 22 Other maternal side‐effects Show forest plot | 2 | 159 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.33 [0.01, 7.97] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2 Uterine hyperstimulation with FHR changes Show forest plot | 2 | 159 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.16 [0.03, 0.87] |
| 3 Caesarean section Show forest plot | 2 | 159 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.65 [0.38, 1.11] |
| 8 Uterine hyperstimulation without FHR changes Show forest plot | 1 | 90 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.2 [0.01, 4.05] |
| 13 Apgar score <7 at 5 minutes Show forest plot | 1 | 69 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.21 [0.01, 4.13] |
| 18 Maternal side‐effects (all) Show forest plot | 2 | 460 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.2 [0.02, 1.70] |
| 19 Nausea (maternal) Show forest plot | 1 | 69 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.34 [0.01, 8.13] |
| 20 Vomitting (maternal) Show forest plot | 1 | 69 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.34 [0.01, 8.13] |
| 21 Diarrhoea (maternal) Show forest plot | 2 | 159 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.33 [0.01, 7.97] |
| 22 Other maternal side‐effects Show forest plot | 2 | 159 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.33 [0.01, 7.97] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 3 Caesarean section Show forest plot | 3 | 491 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.13 [0.64, 1.99] |
| 7 Oxytocin augmentation Show forest plot | 3 | 491 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.73 [0.56, 0.96] |
| 8 Uterine hyperstimulation without FHR changes Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 10 Epidural analgesia Show forest plot | 1 | 24 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.67 [0.25, 1.78] |
| 11 Instrumental vaginal delivery Show forest plot | 3 | 491 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.72 [1.09, 2.70] |
| 13 Apgar score <7 at 5 minutes Show forest plot | 2 | 467 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.33 [0.58, 3.05] |
| 18 Maternal side‐effects (all) Show forest plot | 1 | 400 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 20 Vomitting (maternal) Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 21 Diarrhoea (maternal) Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 23 Postpartum haemorrhage Show forest plot | 1 | 267 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.12 [0.57, 2.20] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 3 Caesarean section Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.0 [0.26, 3.89] |
| 7 Oxytocin augmentation Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.35 [0.19, 0.64] |
| 8 Uterine hyperstimulation without FHR changes Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 11 Instrumental vaginal delivery Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.11 [0.47, 2.62] |
| 13 Apgar score <7 at 5 minutes Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.25 [0.51, 3.04] |
| 18 Maternal side‐effects (all) Show forest plot | 1 | 400 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 20 Vomitting (maternal) Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 21 Diarrhoea (maternal) Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 3 Caesarean section Show forest plot | 1 | 141 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.21 [0.57, 2.58] |
| 7 Oxytocin augmentation Show forest plot | 1 | 141 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.27 [0.85, 1.88] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 3 Caesarean section Show forest plot | 1 | 126 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.83 [0.23, 2.93] |
| 7 Oxytocin augmentation Show forest plot | 1 | 126 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.66 [0.37, 1.16] |
| 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 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.92 [0.68, 1.23] |
| 2 Uterine hyperstimulation with FHR changes Show forest plot | 2 | 321 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.76 [0.89, 8.56] |
| 3 Caesarean section Show forest plot | 5 | 537 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.92 [0.63, 1.36] |
| 7 Oxytocin augmentation Show forest plot | 3 | 361 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.83 [0.65, 1.06] |
| 8 Uterine hyperstimulation without FHR changes Show forest plot | 4 | 386 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.31 [0.63, 2.72] |
| 9 Uterine rupture Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.33 [0.01, 8.09] |
| 10 Epidural analgesia Show forest plot | 3 | 204 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.01 [0.81, 1.27] |
| 11 Instrumental vaginal delivery Show forest plot | 2 | 269 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.68 [0.38, 1.19] |
| 13 Apgar score <7 at 5 minutes Show forest plot | 2 | 240 | Risk Ratio (M‐H, Fixed, 95% CI) | 3.0 [0.12, 72.77] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2 Uterine hyperstimulation with FHR changes Show forest plot | 1 | 121 | Risk Ratio (M‐H, Fixed, 95% CI) | 6.67 [0.86, 51.67] |
| 3 Caesarean section Show forest plot | 3 | 268 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.75 [0.40, 1.43] |
| 7 Oxytocin augmentation Show forest plot | 2 | 161 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.55 [0.35, 0.88] |
| 8 Uterine hyperstimulation without FHR changes Show forest plot | 2 | 135 | Risk Ratio (M‐H, Fixed, 95% CI) | 5.0 [0.26, 98.00] |
| 10 Epidural analgesia Show forest plot | 2 | 135 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.05 [0.85, 1.30] |
| 13 Apgar score <7 at 5 minutes Show forest plot | 1 | 40 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 3 Caesarean section Show forest plot | 1 | 69 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.54 [0.48, 4.99] |
| 10 Epidural analgesia Show forest plot | 1 | 69 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.13 [0.55, 2.31] |
| 11 Instrumental vaginal delivery Show forest plot | 1 | 69 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.94 [0.46, 1.91] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2 Uterine hyperstimulation with FHR changes Show forest plot | 1 | 121 | Risk Ratio (M‐H, Fixed, 95% CI) | 6.67 [0.86, 51.67] |
| 3 Caesarean section Show forest plot | 1 | 121 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.63 [0.15, 2.67] |
| 7 Oxytocin augmentation Show forest plot | 1 | 121 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.43 [0.26, 0.72] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2 Uterine hyperstimulation with FHR changes Show forest plot | 1 | 55 | Risk Ratio (M‐H, Fixed, 95% CI) | 7.44 [0.43, 128.16] |
| 3 Caesarean section Show forest plot | 1 | 55 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.67 [0.10, 4.39] |
| 7 Oxytocin augmentation Show forest plot | 1 | 55 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.44 [0.22, 0.91] |
| 8 Uterine hyperstimulation without FHR changes Show forest plot | 1 | 95 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 10 Epidural analgesia Show forest plot | 1 | 95 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.0 [0.82, 1.22] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2 Uterine hyperstimulation with FHR changes Show forest plot | 1 | 55 | Risk Ratio (M‐H, Fixed, 95% CI) | 7.44 [0.43, 128.16] |
| 3 Caesarean section Show forest plot | 1 | 55 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.67 [0.10, 4.39] |
| 7 Oxytocin augmentation Show forest plot | 1 | 55 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.44 [0.22, 0.91] |
| 8 Uterine hyperstimulation without FHR changes Show forest plot | 1 | 95 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 10 Epidural analgesia Show forest plot | 1 | 95 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.0 [0.82, 1.22] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2 Uterine hyperstimulation with FHR changes Show forest plot | 1 | 55 | Risk Ratio (M‐H, Fixed, 95% CI) | 7.44 [0.43, 128.16] |
| 3 Caesarean section Show forest plot | 1 | 55 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.67 [0.10, 4.39] |
| 7 Oxytocin augmentation Show forest plot | 1 | 55 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.44 [0.22, 0.91] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2 Uterine hyperstimulation with FHR changes Show forest plot | 1 | 66 | Risk Ratio (M‐H, Fixed, 95% CI) | 3.0 [0.33, 27.38] |
| 3 Caesarean section Show forest plot | 1 | 66 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.5 [0.05, 5.25] |
| 7 Oxytocin augmentation Show forest plot | 1 | 66 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.41 [0.20, 0.86] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2 Uterine hyperstimulation with FHR changes Show forest plot | 1 | 66 | Risk Ratio (M‐H, Fixed, 95% CI) | 3.0 [0.33, 27.38] |
| 3 Caesarean section Show forest plot | 1 | 66 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.5 [0.05, 5.25] |
| 7 Oxytocin augmentation Show forest plot | 1 | 66 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.41 [0.20, 0.86] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2 Uterine hyperstimulation with FHR changes Show forest plot | 1 | 66 | Risk Ratio (M‐H, Fixed, 95% CI) | 3.0 [0.33, 27.38] |
| 3 Caesarean section Show forest plot | 1 | 66 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.5 [0.05, 5.25] |
| 7 Oxytocin augmentation Show forest plot | 1 | 66 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.41 [0.20, 0.86] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2 Uterine hyperstimulation with FHR changes Show forest plot | 2 | 140 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.18 [0.03, 0.99] |
| 3 Caesarean section Show forest plot | 7 | 1466 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.07 [0.80, 1.42] |
| 4 Serious neonatal morbidity or perinatal death Show forest plot | 1 | 955 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 7 Oxytocin augmentation Show forest plot | 4 | 1219 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.09 [0.95, 1.24] |
| 8 Uterine hyperstimulation without FHR changes Show forest plot | 1 | 40 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.2 [0.01, 3.92] |
| 10 Epidural analgesia Show forest plot | 3 | 1179 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.11 [0.96, 1.29] |
| 11 Instrumental vaginal delivery Show forest plot | 3 | 1179 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.89 [0.70, 1.13] |
| 12 Meconium stained liquor Show forest plot | 1 | 955 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.86 [0.67, 1.10] |
| 13 Apgar score <7 at 5 minutes Show forest plot | 3 | 1064 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.51 [0.20, 1.31] |
| 14 Neonatal intensive care unit admission Show forest plot | 1 | 955 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.51 [0.24, 1.09] |
| 16 Perinatal death Show forest plot | 1 | 955 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 18 Maternal side‐effects (all) Show forest plot | 2 | 351 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.34 [0.08, 1.36] |
| 19 Nausea (maternal) Show forest plot | 1 | 69 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.34 [0.01, 8.13] |
| 20 Vomitting (maternal) Show forest plot | 1 | 69 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.34 [0.01, 8.13] |
| 21 Diarrhoea (maternal) Show forest plot | 1 | 69 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 22 Other maternal side‐effects Show forest plot | 1 | 69 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 23 Postpartum haemorrhage Show forest plot | 2 | 1155 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.28 [0.79, 2.09] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2 Uterine hyperstimulation with FHR changes Show forest plot | 2 | 140 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.18 [0.03, 0.99] |
| 3 Caesarean section Show forest plot | 4 | 287 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.13 [0.70, 1.81] |
| 7 Oxytocin augmentation Show forest plot | 1 | 40 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.4 [0.09, 1.83] |
| 8 Uterine hyperstimulation without FHR changes Show forest plot | 1 | 40 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.2 [0.01, 3.92] |
| 13 Apgar score <7 at 5 minutes Show forest plot | 2 | 109 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.21 [0.01, 4.13] |
| 18 Maternal side‐effects (all) Show forest plot | 2 | 351 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.34 [0.08, 1.36] |
| 19 Nausea (maternal) Show forest plot | 1 | 69 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.34 [0.01, 8.13] |
| 20 Vomitting (maternal) Show forest plot | 1 | 69 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.34 [0.01, 8.13] |
| 21 Diarrhoea (maternal) Show forest plot | 1 | 69 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 22 Other maternal side‐effects Show forest plot | 1 | 69 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 3 Caesarean section Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.85 [0.42, 1.69] |
| 7 Oxytocin augmentation Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.81 [0.63, 1.05] |
| 10 Epidural analgesia Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.20 [0.80, 1.82] |
| 11 Instrumental vaginal delivery Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.69 [0.38, 1.26] |
| 23 Postpartum haemorrhage Show forest plot | 1 | 200 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.75 [0.13, 4.40] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2 Uterine hyperstimulation with FHR changes Show forest plot | 2 | 140 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.18 [0.03, 0.99] |
| 3 Caesarean section Show forest plot | 2 | 140 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.03 [0.54, 1.94] |
| 13 Apgar score <7 at 5 minutes Show forest plot | 1 | 69 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.21 [0.01, 4.13] |
| 18 Maternal side‐effects (all) Show forest plot | 2 | 351 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.34 [0.08, 1.36] |
| 19 Nausea (maternal) Show forest plot | 1 | 69 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.34 [0.01, 8.13] |
| 20 Vomitting (maternal) Show forest plot | 1 | 69 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.34 [0.01, 8.13] |
| 21 Diarrhoea (maternal) Show forest plot | 1 | 69 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 22 Other maternal side‐effects Show forest plot | 1 | 69 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 3 Caesarean section Show forest plot | 1 | 499 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.29 [0.82, 2.03] |
| 4 Serious neonatal morbidity or perinatal death Show forest plot | 1 | 499 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 7 Oxytocin augmentation Show forest plot | 1 | 499 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.10 [0.94, 1.28] |
| 10 Epidural analgesia Show forest plot | 1 | 499 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.19 [1.03, 1.39] |
| 11 Instrumental vaginal delivery Show forest plot | 1 | 499 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.92 [0.71, 1.18] |
| 12 Meconium stained liquor Show forest plot | 1 | 499 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.95 [0.72, 1.27] |
| 13 Apgar score <7 at 5 minutes Show forest plot | 1 | 499 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.16 [0.02, 1.27] |
| 14 Neonatal intensive care unit admission Show forest plot | 1 | 499 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.34 [0.11, 1.03] |
| 16 Perinatal death Show forest plot | 1 | 499 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 23 Postpartum haemorrhage Show forest plot | 1 | 499 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.62 [0.86, 3.05] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 3 Caesarean section Show forest plot | 1 | 456 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.68 [0.19, 2.51] |
| 4 Serious neonatal morbidity or perinatal death Show forest plot | 1 | 456 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 7 Oxytocin augmentation Show forest plot | 1 | 456 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.94 [1.35, 2.80] |
| 10 Epidural analgesia Show forest plot | 1 | 456 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.15 [0.77, 1.70] |
| 11 Instrumental vaginal delivery Show forest plot | 1 | 456 | Risk Ratio (M‐H, Fixed, 95% CI) | 5.98 [1.37, 25.99] |
| 12 Meconium stained liquor Show forest plot | 1 | 456 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.77 [0.48, 1.24] |
| 13 Apgar score <7 at 5 minutes Show forest plot | 1 | 456 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.42 [0.34, 5.88] |
| 14 Neonatal intensive care unit admission Show forest plot | 1 | 492 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.0 [0.33, 3.06] |
| 16 Perinatal death Show forest plot | 1 | 465 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 23 Postpartum haemorrhage Show forest plot | 1 | 456 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.04 [0.44, 2.47] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2 Uterine hyperstimulation with FHR changes Show forest plot | 1 | 100 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 2.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 100 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 3 Caesarean section Show forest plot | 2 | 300 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.70 [0.42, 1.18] |
| 3.2 PGE2 (repeated doses) vs placebo/no treatment | 2 | 300 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.70 [0.42, 1.18] |
| 6 Cervix unfavourable/unchanged after 12 to 24 hours Show forest plot | 1 | 36 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.13 [0.03, 0.47] |
| 6.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 36 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.13 [0.03, 0.47] |
| 8 Uterine hyperstimulation without FHR changes Show forest plot | 1 | 100 | Risk Ratio (M‐H, Fixed, 95% CI) | 3.0 [0.13, 71.92] |
| 8.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 100 | Risk Ratio (M‐H, Fixed, 95% CI) | 3.0 [0.13, 71.92] |
| 10 Epidural analgesia Show forest plot | 1 | 100 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.83 [0.62, 1.12] |
| 10.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 100 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.83 [0.62, 1.12] |
| 12 Meconium stained liquor Show forest plot | 2 | 300 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.43 [0.28, 0.66] |
| 12.2 PGE2 (repeated doses) vs placebo/no treatment | 2 | 300 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.43 [0.28, 0.66] |
| 13 Apgar score <7 at 5 minutes Show forest plot | 1 | 100 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.2 [0.01, 4.06] |
| 13.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 100 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.2 [0.01, 4.06] |
| 14 Neonatal intensive care unit admission Show forest plot | 1 | 100 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.2 [0.02, 1.65] |
| 14.2 PGE2 (repeated doses) vs placebo/no treatment | 1 | 100 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.2 [0.02, 1.65] |
