311: Concurrent Foley and prostaglandins versus concurrent Foley and oxytocin for cervical ripening: network meta-analysis

To determine whether Foley and concurrent prostaglandins or Foley and concurrent oxytocin decreases time to vaginal delivery via network meta-analysis (NMA). A NMA(PROSPERO CRD42018081948)was performed comparing Foley and misoprostol, Foley and dinoprostone, and Foley and oxytocin for cervical ripening. Foley alone was used as a node for indirect comparison. Database searches were performed from inception to 12/2017 with data abstracted from published manuscripts. Inclusion criteria included RCTs comparing Foley to combination Foley and misoprostol or dinoprostone, or Foley and concurrent oxytocin. Trials that directly compared Foley and oxytocin to Foley and prostaglandins were included. Foley catheters of any material or size, and gestational age >24wks with a live fetus were included. Quasi-randomized, cohorts and other combination methods for ripening were excluded. Misoprostol and dinoprostone combined methods were analyzed separately. Nulliparous and multiparous women were analyzed together. The primary outcome was mean time from induction to vaginal delivery. Secondary outcomes included time from induction to delivery, delivery < 24hrs, cesarean delivery, chorioamnionitis, endometritis, epidural use, and tachysystole. Data analyzed as a NMA using multivariate meta-regression. 19 RCTs were eligible for inclusion with 1,721 women included in the primary outcome. The mean time to vaginal delivery was not significantly different between the dual agent methods(Foley/misoprostol 14.6hrs, SD 2.1; Foley/dinoprostone 20.0hrs, SD 3.2; Foley/oxytocin 14.3hrs, SD 3.5)(Figure). The time to all delivery and delivery < 24hrs were not significantly different (Figure). There were no differences in the secondary outcomes(Table). Time to vaginal delivery and delivery overall are similar when comparing Foley with combined misoprostol, combined dinoprostone, and combined oxytocin. Dinoprostone comparisons are limited by small sample size. No significant differences were seen in maternal adverse events, but this is limited by the sample size of studies used in indirect comparisons.View Large Image Figure ViewerDownload Hi-res image Download (PPT)