Abstract：
Several systematic reviews and meta-analyses have summarized the evidence on the efficacy and safety of various outpatient cervical ripening methods. However, the method with the highest efficacy and safety profile has not been determined conclusively. We performed a systematic review and network meta-analysis of published randomized controlled trials to assess the efficacy and safety of cervical ripening methods currently employed in the outpatient setting.
With the assistance of an experienced medical librarian, we performed a systematic search of the literature using MEDLINE, Embase, Scopus, Web of Science, Cochrane Library, and ClinicalTrials.gov. We systematically searched electronic databases from inception to January 14, 2020.
We considered randomized controlled trials comparing a variety of methods for outpatient cervical ripening.
We conducted a frequentist random effects network meta-analysis employing data from randomized controlled trials. We performed a direct, pairwise meta-analysis to compare the efficacy of various outpatient cervical ripening methods, including placebo. We employed ranking strategies to determine the most efficacious method using the surface under the cumulative ranking curve; a higher surface under the cumulative ranking curve value implied a more efficacious method. We assessed the following outcomes: time from intervention to delivery, cesarean delivery rates, changes in the Bishop score, need for additional ripening methods, incidence of Apgar scores <7 at 5 minutes, and uterine hyperstimulation.
We included data from 42 randomized controlled trials including 6093 participants. When assessing the efficacy of all methods, 25 μg vaginal misoprostol was the most efficacious in reducing the time from intervention to delivery (surface under the cumulative ranking curve of 1.0) without increasing the odds of cesarean delivery, the need for additional ripening methods, the incidence of a low Apgar score, or uterine hyperstimulation. Acupressure (surface under the cumulative ranking curve of 0.3) and primrose oil (surface under the cumulative ranking curve of 0.2) were the least effective methods in reducing the time to delivery interval. Among effective methods, 50 mg oral mifepristone was associated with the lowest odds of cesarean delivery (surface under the cumulative ranking curve of 0.9).
When balancing efficacy and safety, vaginal misoprostol 25 μg represents the best method for outpatient cervical ripening.
With the assistance of an experienced medical librarian, we performed a systematic search of the literature using MEDLINE, Embase, Scopus, Web of Science, Cochrane Library, and ClinicalTrials.gov. We systematically searched electronic databases from inception to January 14, 2020.
We considered randomized controlled trials comparing a variety of methods for outpatient cervical ripening.
We conducted a frequentist random effects network meta-analysis employing data from randomized controlled trials. We performed a direct, pairwise meta-analysis to compare the efficacy of various outpatient cervical ripening methods, including placebo. We employed ranking strategies to determine the most efficacious method using the surface under the cumulative ranking curve; a higher surface under the cumulative ranking curve value implied a more efficacious method. We assessed the following outcomes: time from intervention to delivery, cesarean delivery rates, changes in the Bishop score, need for additional ripening methods, incidence of Apgar scores <7 at 5 minutes, and uterine hyperstimulation.
We included data from 42 randomized controlled trials including 6093 participants. When assessing the efficacy of all methods, 25 μg vaginal misoprostol was the most efficacious in reducing the time from intervention to delivery (surface under the cumulative ranking curve of 1.0) without increasing the odds of cesarean delivery, the need for additional ripening methods, the incidence of a low Apgar score, or uterine hyperstimulation. Acupressure (surface under the cumulative ranking curve of 0.3) and primrose oil (surface under the cumulative ranking curve of 0.2) were the least effective methods in reducing the time to delivery interval. Among effective methods, 50 mg oral mifepristone was associated with the lowest odds of cesarean delivery (surface under the cumulative ranking curve of 0.9).
When balancing efficacy and safety, vaginal misoprostol 25 μg represents the best method for outpatient cervical ripening.
摘要：
目的：一些系统评价和荟萃分析总结了各种门诊宫颈成熟方法的有效性和安全性的证据。然而,具有最高疗效和安全性的方法尚未最终确定.我们对已发表的随机对照试验进行了系统评价和网络荟萃分析，以评估目前门诊使用的宫颈成熟方法的有效性和安全性。
方法：在经验丰富的医学图书馆员的协助下，我们使用MEDLINE对文献进行了系统的搜索，Embase,Scopus,WebofScience,科克伦图书馆,和ClinicalTrials.gov.从成立到2020年1月14日，我们系统地搜索了电子数据库。
方法：我们考虑了比较多种方法用于门诊宫颈成熟的随机对照试验。
方法：我们使用来自随机对照试验的数据进行了频率随机效应网络荟萃分析。我们表演了一个直接的，成对荟萃分析比较各种门诊宫颈成熟方法的疗效，包括安慰剂。我们采用了排名策略，使用累积排名曲线下的曲面来确定最有效的方法；累积排名曲线值下的较高曲面意味着更有效的方法。我们评估了以下结果：从干预到分娩的时间，剖宫产率,主教得分的变化，需要额外的成熟方法，5分钟时Apgar评分<7的发生率，和子宫过度刺激.
结果：我们纳入了42项随机对照试验的数据，包括6093名参与者。在评估所有方法的功效时，25μg阴道米索前列醇最有效地减少了从干预到分娩的时间（在1.0的累积排序曲线下的表面），而不增加剖宫产的几率，需要额外的成熟方法，低Apgar评分的发生率,或者子宫过度刺激.针压（0.3的累积排序曲线下的表面）和樱草油（0.2的累积排序曲线下的表面）是减少分娩间隔时间的最不有效的方法。在有效的方法中，50mg口服米非司酮与剖宫产的几率最低（累积排序曲线下的表面为0.9）。
结论：当平衡疗效和安全性时，阴道米索前列醇25μg是门诊促宫颈成熟的最佳方法。
方法：在经验丰富的医学图书馆员的协助下，我们使用MEDLINE对文献进行了系统的搜索，Embase,Scopus,WebofScience,科克伦图书馆,和ClinicalTrials.gov.从成立到2020年1月14日，我们系统地搜索了电子数据库。
方法：我们考虑了比较多种方法用于门诊宫颈成熟的随机对照试验。
方法：我们使用来自随机对照试验的数据进行了频率随机效应网络荟萃分析。我们表演了一个直接的，成对荟萃分析比较各种门诊宫颈成熟方法的疗效，包括安慰剂。我们采用了排名策略，使用累积排名曲线下的曲面来确定最有效的方法；累积排名曲线值下的较高曲面意味着更有效的方法。我们评估了以下结果：从干预到分娩的时间，剖宫产率,主教得分的变化，需要额外的成熟方法，5分钟时Apgar评分<7的发生率，和子宫过度刺激.
结果：我们纳入了42项随机对照试验的数据，包括6093名参与者。在评估所有方法的功效时，25μg阴道米索前列醇最有效地减少了从干预到分娩的时间（在1.0的累积排序曲线下的表面），而不增加剖宫产的几率，需要额外的成熟方法，低Apgar评分的发生率,或者子宫过度刺激.针压（0.3的累积排序曲线下的表面）和樱草油（0.2的累积排序曲线下的表面）是减少分娩间隔时间的最不有效的方法。在有效的方法中，50mg口服米非司酮与剖宫产的几率最低（累积排序曲线下的表面为0.9）。
结论：当平衡疗效和安全性时，阴道米索前列醇25μg是门诊促宫颈成熟的最佳方法。
