目的:已经进行了一些系统评价和荟萃分析,以总结各种引产药疗效的证据。然而,最有效的药物或策略尚未最终确定。我们旨在对已发表的系统评价进行荟萃评价和网络荟萃分析,以确定目前使用的药物的有效性和安全性,机械,并结合引产方法。
方法:在经验丰富的医学图书馆员的协助下,我们使用PubMed对文献进行了系统的搜索,EMBASE,和Cochrane中央控制试验登记册。从成立到2021年5月31日,我们系统地搜索了电子数据库。
方法:我们考虑了比较住院引产不同药物或方法的随机对照试验的系统评价和荟萃分析。
方法:我们采用已发表系统综述的随机对照试验数据,进行了频率随机效应网络荟萃分析。我们进行了直接成对荟萃分析,以比较各种引产剂和安慰剂或不治疗的疗效。我们使用累积排序曲线下的表面进行排序以确定最佳处理。评估的主要结果是剖宫产,24小时内阴道分娩,手术阴道分娩,过度刺激,新生儿重症监护室入院,出生5分钟时的Apgar评分<7。
结果:我们纳入了11项系统评价,并从207项随机对照试验中提取了数据,共有40,854名参与者。在评估所有药物和方法的疗效时,单球囊导管与米索前列醇的联合应用在降低>24小时剖宫产和阴道分娩的几率方面最有效(累积排序曲线下表面各0.9).在药物中,小剂量阴道米索前列醇最有效地降低了剖宫产的几率,而高剂量阴道米索前列醇在24小时内实现阴道分娩最有效(每次0.9的累积排序曲线下表面).单球囊导管(累积排序曲线0.8下的表面)和双球囊导管(累积排序曲线0.9下的表面)在降低手术阴道分娩和过度刺激的几率方面最有效。口腔或舌下米索前列醇(0.9的累积排序曲线下的表面)以及单球囊导管和米索前列醇的组合(0.9的累积排序曲线下的表面)最有效地降低了Apgar评分异常和新生儿重症监护病房入院的几率。
结论:单球囊导管联合米索前列醇是降低剖宫产几率和延长阴道分娩时间的最有效方法。这种方法与新生儿重症监护病房的入院人数减少有关。
Several systematic reviews and meta-analyses have been conducted to summarize the evidence for the efficacy of various labor induction agents. However, the most effective agents or strategies have not been conclusively determined. We aimed to perform a meta-
review and network meta-analysis of published systematic reviews to determine the efficacy and safety of currently employed pharmacologic, mechanical, and combined methods of labor induction.
With the assistance of an experienced medical librarian, we performed a systematic search of the literature using PubMed, EMBASE, and the Cochrane Central Register of Control Trials. We systematically searched electronic databases from inception to May 31, 2021.
We considered systematic reviews and meta-analyses of randomized controlled trials comparing different agents or methods for inpatient labor induction.
We conducted a frequentist random-effects network meta-analysis employing data from randomized controlled trials of published systematic reviews. We performed direct pairwise meta-analyses to compare the efficacy of the various labor induction agents and placebo or no treatment. We performed ranking to determine the best treatment using the surface under the cumulative ranking curve. The main outcomes assessed were cesarean delivery, vaginal delivery within 24 hours, operative vaginal delivery, hyperstimulation, neonatal intensive care unit admissions, and Apgar scores of <7 at 5 minutes of birth.
We included 11 systematic reviews and extracted data from 207 randomized controlled trials with a total of 40,854 participants. When assessing the efficacy of all agents and methods, the combination of a single-balloon catheter with misoprostol was the most effective in reducing the odds of cesarean delivery and vaginal birth >24 hours (surface under the cumulative ranking curve of 0.9 for each). Among the pharmacologic agents, low-dose vaginal misoprostol was the most effective in reducing the odds of cesarean delivery, whereas high-dose vaginal misoprostol was the most effective in achieving vaginal delivery within 24 hours (surface under the cumulative ranking curve of 0.9 for each). Single-balloon catheter (surface under the cumulative ranking curve of 0.8) and double-balloon catheter (surface under the cumulative ranking curve of 0.9) were the most effective in reducing the odds of operative vaginal delivery and hyperstimulation. Buccal or sublingual misoprostol (surface under the cumulative ranking curve of 0.9) and the combination of single-balloon catheter and misoprostol (surface under the cumulative ranking curve of 0.9) most effectively reduced the odds of abnormal Apgar scores and neonatal intensive care unit admissions.
The combination of a single-balloon catheter with misoprostol was the most effective method in reducing the odds for cesarean delivery and prolonged time to vaginal delivery. This method was associated with a reduction in admissions to the neonatal intensive care unit.