Foley catheter with simultaneous oxytocin on labor induction: a meta-analysis of randomized controlled trials

Objective: It is unclear that whether Foley catheter with simultaneous oxytocin could improve the efficacy of induction outcome.
Method: To conduct a meta-analysis of randomized controlled trial (RCT) studies to evaluate the effect of Foley catheter with simultaneous oxytocin on labor induction. PubMed, Embase, and other databases were searched from their inception to July 2017. We included all RCTs comparing Foley catheter with simultaneous oxytocin (i.e. intervention group) with Foley catheter followed by oxytocin (i.e. control group) in the three kinds of women (nulliparas and multiparas/only nulliparas/only multiparas). We estimate summarized relative risk (RR) and 95% confidence intervals (CIs) for dichotomous outcomes, standard mean difference for continuous outcomes. Fixed- and random-effects models were used, depending on heterogeneity.
Results: After application of our inclusion and exclusion criteria, six RCTs with a total of 1133 participants were identified. We found that only nulliparas had significant RR of delivery within 24 h (RR = 1.32, 95% CI: 1.12, 1.55, I2 = 46.5%). Meanwhile, there was no statistically significant difference between intervention and control groups in vaginal delivery in 24 h, cesarean delivery, time to delivery, and Apgar score at 5 min less than 7. Foley catheter with simultaneous oxytocin did not increase the risk of side effects, included chorioamnionitis, postpartum hemorrhage, uterine hyperstimulation, and neonatal intensive care unit admission.
Conclusion: The results seem to support the use of oxytocin to a Foley catheter at the initiation of labor induction, as it might lead to increases the rate of delivery within 24 h in nulliparas.

研究目标：同时使用Foley导管（Foley catheter）与催产素是否可提升引产效果，目前尚无明确定论。
研究方法：本研究针对随机对照试验（randomized controlled trial, RCT）开展荟萃分析（meta-analysis），以评估同时联用Foley导管与催产素对分娩引产的效果。检索PubMed、Embase及其他数据库自建库至2017年7月的相关文献。纳入所有对比「干预组（同时使用Foley导管与催产素）」与「对照组（先使用Foley导管后给予催产素）」的随机对照试验，研究对象涵盖三类女性：初产妇与经产妇、仅初产妇、仅经产妇。针对二分类结局指标，我们计算合并相对危险度（relative risk, RR）及95%置信区间（confidence interval, CI）；针对连续型结局指标，则计算标准化均数差。根据异质性检验结果，分别采用固定效应模型与随机效应模型进行统计分析。
研究结果：经纳入与排除标准筛选后，最终纳入6项随机对照试验，共纳入1133名受试者。分析结果显示，仅初产妇群体在24小时内分娩的相对危险度具有统计学意义（RR=1.32，95%CI：1.12, 1.55，I²=46.5%）。其余指标方面，两组在24小时内阴道分娩率、剖宫产率、至分娩的时间及5分钟阿普加评分（Apgar score）低于7分的比例上，均未观察到统计学显著差异。同时联用Foley导管与催产素并未增加不良反应发生风险，包括绒毛膜羊膜炎、产后出血、子宫过度刺激及新生儿重症监护病房（neonatal intensive care unit, NICU）收治率。
研究结论：本研究结果支持在引产启动时，于Foley导管使用的同时联合催产素，该方案或可提升初产妇群体的24小时内分娩率。