Maternal Fetal Medicine Associates, PLLC, New York, USA.
BJOG. 2011 May;118(6):647-54. doi: 10.1111/j.1471-0528.2011.02905.x. Epub 2011 Feb 18.
There are a number of agents used for cervical ripening prior to the induction of labour. Two commonly used agents are intravaginal misoprostol and a transcervical Foley catheter.
To review the evidence comparing misoprostol and transcervical Foley catheter placement for induction of labour, and perform a meta-analysis comparing these two induction agents.
We conducted database searches of PubMed, Embase, the Cochrane Library Database, and the ClinicalTrials.gov website. Bibliographies of all relevant articles were reviewed.
Prospective, randomised trials comparing the use of intravaginal misoprostol and transcervical Foley catheter for the purpose of cervical ripening and induction of labour were included. We excluded studies in which the patients in these two intervention groups also received other induction agents concurrently, such as oral misoprostol, oxytocin, or other prostaglandins.
The primary outcomes selected were time to delivery, and the rates of caesarean section, uterine tachysystole, and chorioamnionitis. Random-effects generalised linear models with a poisson distribution and log link function were used to compare the two induction agents across the studies.
Nine studies (1603 patients) were identified as eligible to be included in this meta-analysis. There were no significant differences in the mean time to delivery (mean difference 1.08 ± 2.19 hours shorter for misoprostol, P = 0.2348), the rate of caesarean delivery (RR 0.991; 95% CI 0.768, 1.278), or in the rate of chorioamnionitis (RR 1.130; 95% CI 0.611, 2.089) between women who received misoprostol compared with transcervical Foley catheter. Patients who received misoprostol had significantly higher rates of tachysystole compared with women who received a transcervical Foley catheter (RR 2.844; 95% CI 1.392, 5.812).
Intravaginal misoprostol and transcervical Foley catheter have similar effectiveness as induction agents. Transcervical Foley catheter is associated with a lower incidence of tachysystole.
在引产之前，有许多药物可用于宫颈成熟。两种常用的药物是阴道内米索前列醇和经宫颈 Foley 导管。
综述比较米索前列醇和经宫颈 Foley 导管用于引产的证据，并对这两种引产药物进行荟萃分析。
我们对 PubMed、Embase、Cochrane 图书馆数据库和 ClinicalTrials.gov 网站进行了数据库检索。还回顾了所有相关文章的参考文献。
纳入比较阴道内米索前列醇和经宫颈 Foley 导管用于宫颈成熟和引产的目的的前瞻性、随机试验。我们排除了这些两组干预患者同时使用其他引产药物（如口服米索前列醇、催产素或其他前列腺素）的研究。
选择的主要结局是分娩时间，以及剖宫产率、子宫过速收缩和绒毛膜羊膜炎的发生率。使用具有泊松分布和对数链接函数的随机效应广义线性模型比较了这两种诱导剂在研究中的差异。
有 9 项研究（1603 名患者）被确定符合纳入本荟萃分析的条件。米索前列醇组的平均分娩时间（米索前列醇组平均提前 1.08 ± 2.19 小时，P = 0.2348）、剖宫产率（RR 0.991；95%CI 0.768，1.278）或绒毛膜羊膜炎率（RR 1.130；95%CI 0.611，2.089）均无显著差异。与经宫颈 Foley 导管组相比，接受米索前列醇的女性发生过速收缩的比例显著更高（RR 2.844；95%CI 1.392，5.812）。
阴道内米索前列醇和经宫颈 Foley 导管作为引产药物具有相似的效果。经宫颈 Foley 导管与较低的过速收缩发生率相关。
