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Systematic review with meta analysis
Uncertainty in evidence synthesis limits clinical applicability of a clinical and cost-effectiveness analysis of induction of labour methods
  1. Christina Davidson
  1. Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Houston, Texas, USA
  1. Correspondence to : Dr Christina Davidson, Department of Obstetrics and Gynecology, Baylor College of Medicine, 1709 Dryden Road, Suite 1100, Houston, TX 77030, USA; cmdavids{at}bcm.edu

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Commentary on: Alfirevic Z, Keeney E, Dowswell T, et al. Methods to induce labour: a systematic review, network meta-analysis and cost-effectiveness analysis. BJOG 2016;123:1462–70.

Context

The goal of induction of labour (IOL) is to achieve vaginal delivery by stimulation of uterine contractions before the spontaneous onset of labour. Variations in the management of IOL likely affect rates of caesarean delivery (CD), particularly the use of cervical ripening agents for the unfavourable cervix. This systematic review and meta-analysis looks at the various methods of labour induction and compares them from a clinical and cost-effectiveness perspective.

Methods

This was a review of randomised controlled trials (RCTs) examining pharmacological, mechanical and complementary (ie, acupuncture) interventions to induce labour. Outcomes included were vaginal delivery not achieved within 24 hours (VD24); uterine hyperstimulation with fetal heart rate (FHR) changes; CD; serious maternal and neonatal morbidity or mortality; instrumental delivery; maternal satisfaction with the method …

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