Digital versus speculum-based balloon catheter insertion for labor induction: a systematic review and meta-analysis.

Autor: Seo D; Department of Obstetrics and Gynaecology, Monash University, Faculty of Medicine, Nursing and Health Sciences, Monash Medical Centre, 246 Clayton Rd, Clayton, Victoria 3168 Australia (Seo, Davies-Tuck, Warty, Smith, and Palmer); School of Clinical Sciences, Monash University, Faculty of Medicine, Nursing and Health Sciences, 27 Rainforest Walk, Clayton, Victoria, 3168 Australia (Seo); Gravida Health Pty. Ltd., Wheelers Hill, Victoria, 3150, Australia (Seo, Kaur, Warty, Smith). Electronic address: densearn.seo@monash.edu., Kaur R; Gravida Health Pty. Ltd., Wheelers Hill, Victoria, 3150, Australia (Seo, Kaur, Warty, Smith)., Ponganam MP; Monash School of Medicine, Faculty of Medicine, Nursing and Health Sciences, 27 Rainforest Walk, Clayton Victoria 3168, Australia (Ponganam)., Sam KW; Gold Coast University Hospital, Queensland Health, 1 Hospital Blvd, Southport, Queensland, 4215, Australia (Sam)., Hill M; Mercy Hospital for Women, 163 Studley Rd, Heidelberg Victoria 3084, Australia (Hill)., Davies-Tuck M; Department of Obstetrics and Gynaecology, Monash University, Faculty of Medicine, Nursing and Health Sciences, Monash Medical Centre, 246 Clayton Rd, Clayton, Victoria 3168 Australia (Seo, Davies-Tuck, Warty, Smith, and Palmer); Hudson Institute of Medical Research, 27-31 Wright St, Clayton Victoria 3168, Australia (Davies-Tuck)., Warty RR; Department of Obstetrics and Gynaecology, Monash University, Faculty of Medicine, Nursing and Health Sciences, Monash Medical Centre, 246 Clayton Rd, Clayton, Victoria 3168 Australia (Seo, Davies-Tuck, Warty, Smith, and Palmer); Gravida Health Pty. Ltd., Wheelers Hill, Victoria, 3150, Australia (Seo, Kaur, Warty, Smith)., Smith V; Department of Obstetrics and Gynaecology, Monash University, Faculty of Medicine, Nursing and Health Sciences, Monash Medical Centre, 246 Clayton Rd, Clayton, Victoria 3168 Australia (Seo, Davies-Tuck, Warty, Smith, and Palmer); Gravida Health Pty. Ltd., Wheelers Hill, Victoria, 3150, Australia (Seo, Kaur, Warty, Smith)., Tan TC; Duke-NUS Medical School, 8 College Rd, 169857, Singapore (Tan); Mount Elizabeth Novena Hospital, 38 Irrawaddy Rd, 329563, Singapore (Tan)., Fox D; Collective for Midwifery, Child and Family Health Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia (Fox)., Palmer KR; Department of Obstetrics and Gynaecology, Monash University, Faculty of Medicine, Nursing and Health Sciences, Monash Medical Centre, 246 Clayton Rd, Clayton, Victoria 3168 Australia (Seo, Davies-Tuck, Warty, Smith, and Palmer); Monash Women's, Monash Health, 246 Clayton Rd, Clayton, Victoria Australia (Palmer).
Jazyk: angličtina
Zdroj: American journal of obstetrics & gynecology MFM [Am J Obstet Gynecol MFM] 2024 Dec; Vol. 6 (12), pp. 101519. Date of Electronic Publication: 2024 Oct 05.
DOI: 10.1016/j.ajogmf.2024.101519
Abstrakt: Objectives: Induction of labor is commonly undertaken when ongoing pregnancy poses a risk to either the mother or fetus. Often cervical preparation is required with mechanical methods increasingly popular due to their improved safety. This study evaluates the efficacy, safety, and acceptability of digital versus speculum-based balloon insertion for cervical preparation, aiming to identify gaps and inform future research.
Data Source: PubMed, Ovid MEDLINE, EMBASE, and Scopus were searched from database inception until 30 June 2023.
Study Eligibility Criteria: Included studies were randomized controlled trials comparing digital versus speculum-based insertion of catheter-related balloons for labor induction in individuals with viable singleton pregnancies, in both inpatient and outpatient settings, written in English. Exclusions included studies not using cervical balloons, comparisons to nonballoon methods, nonhuman studies, and nonprimary literature like guidelines, reviews, commentaries, and opinion pieces.
Methods: Title and abstract screening were performed by 4 authors. Full-text articles were assessed against inclusion criteria. Selection was agreed upon by consensus among 3 authors, with a fourth consulted for disputes. The risk of bias was assessed using the Cochrane Risk of Bias Tool 2.0 for randomized trials. A meta-analysis was also performed.
Results: Out of 3397 studies, 4 met the inclusion criteria, all being randomized controlled trials with some concerns in at least one domain but no high risk of bias. Two studies found digital insertion significantly less painful than speculum-based insertion (P<.001), while one reported no difference (P=.72). Maternal satisfaction was comparable, with one study favoring digital insertion (P=.011). Meta-analysis findings for other outcome measures suggest no difference between speculum or digital insertion. However, due to substantial heterogeneity, findings for procedural time, time from induction to delivery, and epidural rate should be cautiously interpreted.
Conclusions: Digital insertion for cervical preparation appears associated with reduced pain and higher patient acceptability compared to speculum-based insertion. Additionally, efficacy and safety were comparable, indicating it is a preferable option for clinical use. There was no difference in other procedural, obstetric, or neonatal outcomes, however, more rigorous research employing standardized outcome measures is needed to facilitate a clinically meaningful interpretation.
(Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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