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Am J Perinatol 2024; 41(S 01): e2034-e2046
DOI: 10.1055/s-0043-1770161
Original Article

Cervical Osmotic Dilators versus Dinoprostone for Cervical Ripening during Labor Induction: A Systematic Review and Meta-analysis of 14 Controlled Trials

Abdulrahman Al-Matary
1   Department of Neonatology, King Fahad Medical City, Riyadh, Saudi Arabia
,
Saud A. Alsharif
2   Department of Obstetrics and Gynecology, College of Medicine, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
,
Ibtihal A. Bukhari
3   Clinical Sciences Department, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
,
Saeed Baradwan
4   Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
,
Majed S. Alshahrani
5   Department of Obstetrics and Gynecology, Faculty of Medicine, Najran University, Najran, Saudi Arabia
,
Khalid Khadawardi
6   Department of Obstetrics and Gynecology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
,
Ehab Badghish 
7   Department of Obstetrics and Gynecology, Maternity and Children Hospital, Makkah, Saudi Arabia
,
Bayan Albouq 
8   Department of Obstetrics and Gynecology, Prince Mohammed Bin Abdulaziz National Guard Hospital, Madinah, Saudi Arabia
,
Afnan Baradwan
9   Department of Obstetrics and Gynecology, Mediclinic Almurjan Hospital, Jeddah, Saudi Arabia
,
Mohammed Abuzaid
10   Department of Obstetrics and Gynecology, Muhayl General Hospital, Muhayl, Saudi Arabia
,
Haifa Al-Jundy
11   Department of Obstetrics and Gynecology, Dr. Sulaiman Al-Habib Hospital, Riyadh, Saudi Arabia
,
Abdullah Alyousef
12   Department of Obstetrics and Gynecology, College of Medicine, Almaarefa University, Riyadh, Saudi Arabia
,
Wael S. Ragab
13   Department of Obstetrics and Gynecology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
,
Ahmed Abu-Zaid 
14   Department of Obstetrics and Gynecology, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
15   Department Pharmacology, College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, Tennessee
› Author Affiliations
Funding None.
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Abstract

Objective This study aimed to conduct a systematic review and meta-analysis of all randomized and nonrandomized controlled trials (RCTs and NCTs, respectively) that explored the maternal–neonatal outcomes of cervical osmotic dilators versus dinoprostone in promoting cervical ripening during labor induction.

Study Design Six major databases were screened until August 27, 2022. The quality of included studies was evaluated. The data were summarized as mean difference or risk ratio (RR) with 95% confidence interval (CI) in a random-effects model.

Results Overall, 14 studies with 15 arms were analyzed (n = 2,380 patients). Ten and four studies were RCTs and NCTs, respectively. The overall quality for RCTs varied (low risk n = 2, unclear risk n = 7, and high risk n = 1), whereas all NCTs had good quality (n = 4). For the primary endpoints, there was no significant difference between both groups regarding the rate of normal vaginal delivery (RR = 1.04, 95% CI: 0.95–1.14, p = 0.41) and rate of cesarean delivery (RR = 1.04, 95% CI: 0.93–1.17, p = 0.51). Additionally, there was no significant difference between both groups regarding the mean change in Bishop score and mean time from intervention to delivery. The rate of uterine hyperstimulation was significantly lower in the cervical osmotic dilator group. For the neonatal outcomes, during cervical ripening, the rate of fetal distress was significantly lower in the cervical osmotic dilator group. There was no significant difference between both groups regarding the mean Apgar scores, rate of meconium-stained amniotic fluid, rate of umbilical cord metabolic acidosis, rate of neonatal infection, and rate of neonatal intensive care unit admission.

Conclusion During labor induction, cervical ripening with cervical osmotic dilators and dinoprostone had comparable maternal–neonatal outcomes. Cervical osmotic dilators had low risk of uterine hyperstimulation compared with dinoprostone. Overall, cervical osmotic dilators might be more preferred over dinoprostone in view of their analogous cervical ripening effects, comparable maternal–neonatal outcomes, and lack of drug-related adverse events.

Key Points

  • This is the first analysis of cervical osmotic dilators versus PGE2 for cervical ripening during labor.

  • There was no difference between both arms regarding the rates of normal vaginal/cesarean deliveries.

  • There was no difference between both arms regarding the rates of neonatal adverse events.

  • Cervical osmotic dilators had significant lower risk of uterine hyperstimulation compared with PGE2.

  • Cervical osmotic dilators may be superior to PGE2 in view of their similar efficacy and better safety.

Keywords

cervical osmotic dilators - dilapan - lamicel - laminaria - dinoprostone - cervical ripening - labor induction - meta-analysis

Note

Review Manager Software version 5.4.0 for Windows and STATA Software version 17.0 for Windows were used.


Authors' Contributions

A.A.-M., S.A.A., I.A.B., S.B., M.S.A., K.K., E.B., B.A., A.B., M.A., H.A.-J., A.A., and W.S.R. contributed to literature review, data collection, data interpretation, and revision of manuscript for editorial and intellectual contents. A.A.-Z. contributed to study conception, data collection, data analysis, study supervision, and manuscript writing. All authors read and approved the final draft of the manuscript.


Supplementary Material



Publication History

Received: 23 September 2022

Accepted: 19 May 2023

Article published online:
19 June 2023

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