Background

A systematic review to determine the efficacy and safety of prostaglandins (PG) and Foley catheter (FC) for cervical priming in the outpatient setting. Various methods are available to achieve cervical ripening prior to induction of labour (IOL). In this systematic review, we will report the literature to date, and investigate the efficacy and safety of using the Foley catheter balloon or prostaglandins for cervical ripening, comparing both methods with each other, and discuss the implications of these findings for midwifery led units.

Methods

English peer-reviewed journals were systematically searched in the databases PubMed, MEDLINE, EMCARE, EMBASE and CINAHL, for studies investigating cervical ripening using the FC or PGs. Additional randomised controlled trials (RCTs) and non-RCTs were identified by a manual search. Search terms included: cervix dilatation effacement, cervix ripening, outpatient, ambulatory care, obstetric patients, pharmacological preparations, and Foley catheter. Only RCTs of FC versus PG or either intervention versus placebo or intervention in the in-patient Vs. outpatient setting were included. 15 RCTs were included.

Results

The results of this review show that both FC and PG analogues are equally effective cervical ripening agents. When compared to FC, PGs lead to a reduced requirement for oxytocin augmentation and a shorter intervention to delivery interval. However, PG use is also associated with an increased risk of hyperstimulation, cardiotocographic monitoring abnormalities and negative neonatal outcomes.

Conclusions

FC cervical ripening is an effective method of outpatient cervical priming, which is safe, acceptable, and cost-effective and thus has a potential role in both resource-rich and resource-poor countries. With appropriate dosing, some PG analogues also appear to offer similar outcomes.

中文翻译：

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药物和机械宫颈启动方法引产的功效及其对门诊管理的适用性：随机对照试验的系统评价

背景

一项系统评价，以确定前列腺素 (PG) 和福利导管(FC) 在门诊宫颈灌注中的有效性和安全性。有多种方法可以在引产 (IOL) 之前实现宫颈成熟。在这篇系统综述中，我们将报告迄今为止的文献，并研究使用弗利导管球囊或前列腺素促进宫颈成熟的有效性和安全性，比较这两种方法，并讨论这些发现对助产科主导单位的影响。

方法

在 PubMed、MEDLINE、EMCARE、EMBASE 和 CINAHL 数据库中系统地检索了英文同行评审期刊，以查找使用 FC 或 PG 调查宫颈成熟的研究。通过手动搜索确定了其他随机对照试验(RCT) 和非 RCT。搜索词包括：宫颈扩张消失、宫颈成熟、门诊、门诊护理、产科患者、药物制剂和福利导管。仅 FC 与 PG 或干预与安慰剂或住院患者干预的随机对照试验。门诊环境也包括在内。纳入了 15 项随机对照试验。

结果

本综述的结果表明，FC 和 PG 类似物都是同样有效的宫颈成熟剂。与 FC 相比，PG 可以减少催产素增强的需求，并缩短干预分娩间隔。然而，PG 的使用也与过度刺激、心电图监测异常和新生儿阴性结果的风险增加有关。

结论

FC宫颈促熟是一种有效的门诊宫颈促熟方法，安全、可接受且具有成本效益，因此在资源丰富和资源匮乏的国家都具有潜在作用。通过适当的剂量，一些 PG 类似物似乎也能提供类似的结果。