Background
Methods
Search strategy
Study selection and data collection
Selection of outcomes
Quality assessment
Statistical analysis
Results
Study characteristics
Study | Period | Country | Method | Sample size total (double/single) | Parity total (double/single) | Balloon Catheter | |
---|---|---|---|---|---|---|---|
Doublex | Singley | ||||||
Ahmed 2016 | 2013.03–2014.04 | Egypt | RCT | 78 (39/39) | all nulliparous | Cook | Foley (50 ml) |
Haugland 2012 | 2010.03–2011.01 | Norway | RCT | 178 (88/90) | NA | Cook | Foley (NA) |
Hoppe 2015 | 2010.01–2013.11 | USA | RCT | 98 (50/48) | nulliparous: 50 (25/25) multiparous: 48 (25/23) | Cook | Foley (30 ml) |
Pennell 2009* | 2001.07–2003.12 | Australia | RCT | 217 (107/110) | all nulliparous | Atad | Foley (30 ml) |
Rab 2015 | 2011.01–2013.12 | Egypt | RCT | 200 (100/100) | nulliparous: 113 (55/58) multiparous: 87 (45/42) | Cook | Foley (30 ml) |
Salim 2011 | 2008.06–2010.12 | Israel | RCT | 293 (148/145) | nulliparous: 155 (78/77) multiparous: 138 (70/68) | Cook | Foley (60 ml) |
Solt 2009 | 2006.01–2008.05 | Israel | RCT | 95 (45/50)§ | nulliparous: 95 (45/50) multiparous: 85 (NA)§ | Cook | Foley (NA) |
Study | Risk of bias for the included studies | Quality | ||||||
---|---|---|---|---|---|---|---|---|
Random sequence generation (selection bias) | Allocation concealment (selection bias) | Blinding of participants and personnel (performance bias)x | Blinding of outcome assessment (detection bias) | Incomplete outcome data (attrition bias) | Selective reporting (reporting bias)y | Other bias | ||
Ahmed 2016 | L | L | U | U | L | L | L | H |
Haugland 2012 | L | U | L | L | L | L | U | M |
Hoppe 2015A | L | L | H | H | L | L | L | M |
Pennell 2009 | L | L | H | L | L | L | L | H |
Rab 2014 | L | U | U | L | L | L | L | M |
Salim 2011A | L | L | H | U | L | L | L | H |
Solt 2009B | L | L | H | L | L | H | U | M |
Variables* | Number of studies analysed | Interventions | Pooled effect (95% CI)x | Q p-valuey | I2- statisticy | p-valuez | |
---|---|---|---|---|---|---|---|
Double | Single | ||||||
Maternal age (years)A | 5 [15,17–20] | 444 | 442 | 0.73 [−0.08, 1.53] | 0.89 | 0 | 0.08 |
Gestational weeks (weeks)A | 5 [15,17–20] | 444 | 442 | −0.07 [− 0.31, 0.17] | 0.71 | 0 | 0.56 |
Bishop score at catheter insertionB | 4 [15,17,19–20] | 337 | 332 | 0.02 [−0.19, 0.23] | 0.42 | 0 | 0.85 |
Induction indications | |||||||
PostdatesC | 2 [17–18] | 157 | 158 | 1.10 [0.51, 2.37] | 0.15 |
51%
| 0.81 |
Diabetes mellitus | 3 [17–18,20] | 305 | 303 | 1.35 [0.80, 2.26] | 0.20 | 39% | 0.26 |
Hypertensive disease | 3 [17–18,20] | 305 | 303 | 0.98 [0.66, 1.44] | 0.21 | 35% | 0.91 |
Intrauterine growth restriction | 2 [17–18] | 157 | 158 | 0.92 [0.39, 2.21] | 0.23 | 29% | 0.86 |
Effects of interventions
Outcomes | Number of studies analysed | Interventions | Effect measure | Pooled effect (95% CI) | Q p-value | I2- statistic | p-value | Sensitivity analysis | |
---|---|---|---|---|---|---|---|---|---|
Double | Single | ||||||||
placement difficulty/failure | 4 [15–16,18,20] | 382 | 384 | RR | 1.34 [0.66, 2.71] | 0.55 | 0 | 0.42 | stable |
spontaneous expulsion | 4 [15,17,19–20] | 337 | 332 | RR | 0.86 [0.60, 1.23] |
0.0002
|
85%
| 0.40 | stable |
insertion to delivery intervalA | 6 [15–20] | 532 | 532 | MD | 0.98 [− 0.03, 2.00] | 0.16 | 36% | 0.06 |
Unstable
I
|
1.36 [−0.63, 3.34] |
0.02
|
61%
| 0.18 |
Unstable
II
| |||||
insertion to expulsion/removal intervalB | 4 [15,17,19–20] | 278 | 267 | MD | 1.72 [−0.35, 3.79] |
< 0.00001
|
93%
| 0.10 |
Unstable
III
|
expulsion to delivery interval | 2 [19,21] | 145 | 150 | MD | −2.81 [−10.82, 5.19] |
0.06
|
72%
| 0.49 | – |
Bishop score incrementC | 5 [15,17,19–21] | 382 | 382 | MD | 0.57 [0.28, 0.86] | 0.30 | 18% |
0.0001
| stable |
vaginal delivery within 24 h | 3 [17–18,20] | 305 | 303 | RR | 0.95 [0.72, 1.26] | 0.11 |
54%
| 0.74 |
Unstable
IV
|
normal vaginal deliveryD | 6 [15–20] | 532 | 532 | RR | 1.02 [0.86, 1.20] |
0.03
|
59%
| 0.84 |
Unstable
V
|
assisted vaginal deliveryD | 4 [16,18–20] | 443 | 445 | RR | 1.08 [0.84, 1.41] | 0.48 | 0 | 0.54 | stable |
analgesia usage | 4 [17–20] | 405 | 403 | RR | 1.07 [0.99, 1.16] | 0.72 | 0 | 0.10 | stable |
maternal adverse events | |||||||||
maternal infection | 5 [17–21] | 450 | 453 | RR | 1.04 [0.66, 1.66] | 0.38 | 5% | 0.85 | stable |
postpartum haemorrhage | 3 [15,18–19] | 246 | 249 | RR | 1.03 [0.74, 1.42] | 0.73 | 0 | 0.88 | stable |
neonatal adverse events | |||||||||
low Apgar score (< 7 at 5 min)E | 3 [17–18,20] | 305 | 303 | RR | 0.53 [0.15, 1.88] | 0.46 | 0 | 0.32 | – |
NICU admission | 3 [17–18,20] | 305 | 303 | RR | 0.70 [0.45, 1.07 | 0.90 | 0 | 0.10 | stable |
length of hospitalisation | 2 [19–20] | 248 | 245 | MD | 0.16 [−0.10, 0.41] | 0.28 | 15% | 0.22 | – |
satisfactionF | |||||||||
pain during the process | 2 [15,19] | 139 | 139 | MD | 0.07 [−0.53, 0.67] | 0.42 | 0 | 0.82 | – |
maternal total satisfaction | 2 [15,19] | 139 | 139 | MD | −0.10 [−1.25, 1.04] |
0.08
|
68%
| 0.86 | – |
Outcomes* | Number of studies analysed | Interventions | Effect measure | Pooled effect (95% CI) | Q p-value | I2- statistic | p-value | Sensitivity analysis | |
---|---|---|---|---|---|---|---|---|---|
Double | Single | ||||||||
caesarean delivery | 5 [15,17-18,20–21] | 294 | 301 | RR | 0.86 [0.56, 1.33] |
0.02
|
65%
| 0.50 | stable |
placement difficulty/failure | 2 [15,18] | 146 | 149 | RR | 0.72 [0.15, 3.55] | 0.57 | 0 | 0.69 | – |
spontaneous expulsion | 1 [15] | 39 | 39 | RR | 0.88 [0.70, 1.10] | – | – | 0.27 | – |
insertion to delivery intervalA | 4 [15,17-18,20] | 249 | 251 | MD | 0.88 [− 0.43, 2.18] | 0.59 | 0 | 0.19 | stable |
0.43 [−0.84, 1.71] | 0.26 | 26% | 0.50 | stable | |||||
insertion to expulsion/removal interval | 2 [15,17] | 64 | 64 | MD | 0.88 [−0.00, 1.76] | 0.38 | 0 | 0.05 | – |
expulsion to delivery interval | 1 [21] | 45 | 50 | MD | −8.00 [−16.35, 0.35] | – | – | 0.06 | – |
Bishop score incrementC | 3 [15,17,21] | 109 | 114 | MD | 1.08 [0.38, 1.78] | 0.11 |
56%
|
0.002
|
Unstable
I
|
vaginal delivery within 24 h | 3 [17–18,20] | 210 | 212 | RR | 0.91 [0.75, 1.10] | 0.19 | 40% | 0.33 | stable |
normal vaginal deliveryD | 4 [15,17-18,20] | 249 | 251 | RR | 1.00 [0.78, 1.29] | 0.17 |
58%
| 0.98 |
Unstable
II
|
assisted vaginal deliveryD | 2 [18,20] | 185 | 187 | RR | 1.02 [0.65, 1.59] | 0.56 | 0 | 0.94 | – |
analgesia usage | 2 [18,20] | 185 | 187 | RR | 1.06 [0.95, 1.19] | 0.32 | 1% | 0.28 | – |
maternal adverse events | |||||||||
maternal infection | 3 [18,20–21] | 230 | 237 | RR | 1.16 [0.69, 1.95] | 0.27 | 24% | 0.58 | stable |
postpartum haemorrhage | 2 [15,18] | 146 | 149 | RR | 1.00 [0.72, 1.40] | 0.49 | 0 | 0.98 | – |
neonatal adverse events | |||||||||
low Apgar score (< 7 at 5 min)E | 2 [18,20] | 185 | 187 | RR | 0.21 [0.01, 4.23] | – | – | 0.31 | – |
NICU admission | 1 [18] | 107 | 110 | RR | 0.74 [0.45, 1.22] | – | – | 0.24 | – |
satisfactionF | |||||||||
pain during the process | 1 [15] | 39 | 39 | MD | −0.40 [−1.69, 0.89] | – | – | 0.54 | – |
maternal total satisfaction | 1 [15] | 39 | 39 | MD | 0.47 [−0.42, 1.36] | – | – | 0.30 | – |
Outcomes* | Number of studies analysed | Interventions | Effect measure | Pooled effect (95% CI) | Q p-value | I2- statistic | p-value | Sensitivity analysis | |
---|---|---|---|---|---|---|---|---|---|
Double | Single | ||||||||
caesarean delivery | 2 [17,20] | 95 | 91 | RR | 1.35 [0.54, 3.36] | 0.43 | 0 | 0.52 | – |
insertion to delivery intervalA | 2 [17,20] | 95 | 91 | MD | −0.48 [−2.24, 1.28] | 0.62 | 0 | 0.60 | – |
−1.05 [− 2.68, 0.58] | 0.70 | 0 | 0.21 | – | |||||
insertion to expulsion/removal interval | 1 [17] | 25 | 23 | MD | 2.30 [−0.97, 5.57] | – | – | 0.17 | – |
Bishop score incrementC | 1 [17] | 25 | 23 | MD | 0.20 [−0.88, 1.28] | – | – | 0.72 | – |
vaginal delivery within 24 h | 2 [17,20] | 95 | 91 | RR | 1.05 [0.93, 1.18] | 0.21 | 36% | 0.46 | – |
normal vaginal deliveryD | 2 [17,20] | 95 | 91 | RR | 0.92 [0.83, 1.02] | 0.36 | 0 | 0.13 | – |
assisted vaginal deliveryD | 1 [20] | 70 | 68 | RR | 8.75 [0.48, 159.42] | – | – | 0.14 | – |
analgesia usage | 1 [20] | 70 | 68 | RR | 1.20 [0.70, 2.07] | – | – | 0.51 | – |
maternal adverse events (infection) | 1 [20] | 70 | 68 | RR | 2.92 [0.12, 70.35] | – | – | 0.51 | – |
neonatal adverse events (low Apgar score)E | 1 [20] | 70 | 68 | RR | Not estimable§ | – | – | – | – |