{"title":"球囊导管置入引产6小时与12小时：随机对照试验的系统回顾和元分析》。","authors":"Attyia Rashid MBBS, MCPS, FCPS , Muhammad Imran MBBS , Shujaat Ali MBBS , Areeba Mariam Mehmood MBBS , Saba Khalil MBBS , Dawood Azam Farooq MBBS , Ateeba Kamran MBBS , Shamaila Zamir MBBS, MPH , Ubaid Khan MBBS, MD , Mohamed Abuelazm MBBCh","doi":"10.1016/j.ajogmf.2024.101474","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>Balloon catheters have shown promising results in the induction of labor (IOL); however, evidence regarding the optimal time of balloon catheter placement is still lacking. Thus, this study aims to evaluate the efficacy and safety of 6-hour placement compared to 12 hours.</div></div><div><h3>Data Source</h3><div>We conducted a comprehensive search through a search strategy across “Embase, SCOPUS, PubMed (via MEDLINE), and Cochrane Central Register of Controlled Trials (CENTRAL)” from inception until April 20, 2024.</div></div><div><h3>Study Eligibility Criteria</h3><div>We included the randomized controlled trials (RCTs) evaluating the efficacy and safety of 6-hour balloon catheter placement compared with 12 hours for cervical ripening in IOL. Covidence was used to screen eligible articles.</div></div><div><h3>Methods</h3><div>All relevant outcome data were synthesized using risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CIs) in meta-analysis models within RevMan 5.4. PROSPERO ID: <span><span>CRD42024540935</span><svg><path></path></svg></span>.</div></div><div><h3>Results</h3><div>We included five RCTs with 960 women undergoing the IOL with balloon catheter placement. Six-hour placement was associated with significant lower insertion to overall delivery interval (MD: –4.25, 95% CI [–5.34, –3.15], <em>P</em><.00001) and insertion to vaginal delivery interval (MD: –4.65, 95% CI [–6.08, –3.23], <em>P</em><0.00001) without significant difference in BISHOP score change (MD: –0.02, 95% CI [–0.23, 0.20], <em>P</em>=.88), catheter removal to delivery interval (MD: 0.72, 95% CI [–0.39, 1.83], <em>P</em>=.20) and total duration of oxytocin infusion (MD: –0.36, 95% CI [–0.85, 0.14], <em>P</em>=.16) compared to 12 hours. Also, significantly lower overall cesarean delivery (CD) rate (RR: 0.81, 95% CI [0.68, 0.96], <em>P</em>=.01) and CD due to malpresentation (RR: 0.39, 95% CI [0.16, 0.93], <em>P</em>=.03) were observed with 6-hour placement.</div></div><div><h3>Conclusion</h3><div>A planned 6-hour balloon catheter placement reduced insertion to delivery intervals and CD rate and has equal efficacy in BISHOP score change and catheter removal to delivery interval compared to 12 hours.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 11","pages":"Article 101474"},"PeriodicalIF":3.8000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Six vs 12-hour balloon catheter placement for the induction of labor: a systematic review and meta-analysis of randomized controlled trials\",\"authors\":\"Attyia Rashid MBBS, MCPS, FCPS , Muhammad Imran MBBS , Shujaat Ali MBBS , Areeba Mariam Mehmood MBBS , Saba Khalil MBBS , Dawood Azam Farooq MBBS , Ateeba Kamran MBBS , Shamaila Zamir MBBS, MPH , Ubaid Khan MBBS, MD , Mohamed Abuelazm MBBCh\",\"doi\":\"10.1016/j.ajogmf.2024.101474\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><div>Balloon catheters have shown promising results in the induction of labor (IOL); however, evidence regarding the optimal time of balloon catheter placement is still lacking. 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PROSPERO ID: <span><span>CRD42024540935</span><svg><path></path></svg></span>.</div></div><div><h3>Results</h3><div>We included five RCTs with 960 women undergoing the IOL with balloon catheter placement. Six-hour placement was associated with significant lower insertion to overall delivery interval (MD: –4.25, 95% CI [–5.34, –3.15], <em>P</em><.00001) and insertion to vaginal delivery interval (MD: –4.65, 95% CI [–6.08, –3.23], <em>P</em><0.00001) without significant difference in BISHOP score change (MD: –0.02, 95% CI [–0.23, 0.20], <em>P</em>=.88), catheter removal to delivery interval (MD: 0.72, 95% CI [–0.39, 1.83], <em>P</em>=.20) and total duration of oxytocin infusion (MD: –0.36, 95% CI [–0.85, 0.14], <em>P</em>=.16) compared to 12 hours. 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引用次数: 0
摘要
目的：球囊导管在引产（IOL）中显示出了良好的效果；然而，关于球囊导管置入的最佳时间仍缺乏证据。因此，本研究旨在评估 6 小时置管与 12 小时置管相比的有效性和安全性：数据来源：我们通过检索策略在 "Embase、SCOPUS、PubMed（通过 MEDLINE）和 Cochrane 对照试验中央注册中心（CENTRAL）"进行了全面检索，检索时间从开始到 2024 年 4 月 20 日：我们纳入了评估 6 小时球囊导管置入与 12 小时宫颈成熟 IOL 的有效性和安全性的随机对照试验 (RCT)。研究采用Covidence筛选符合条件的文章：在RevMan 5.4的荟萃分析模型中，使用风险比（RR）或平均差（MD）及95%置信区间（CI）对所有相关结果数据进行综合：CRD42024540935 结果：我们纳入了五项研究，960 名妇女接受了球囊导管置入人工晶体手术。6小时置管与明显较低的插入到总分娩间隔（MD：-4.25，95% CI [-5.34，-3.15]，P< 0.00001）和插入到阴道分娩间隔（MD：-4.65，95% CI [-6.08，-3.23]，P< 0.00001），而BISHOP评分变化（MD：-0.02，95% CI [-0.23，0.20]，P= 0.88）、导管拔除到分娩间隔（MD：0.72，95% CI [-0.39，1.83]，P= 0.20）和输注催产素总时间（MD：-0.36，95% CI [-0.85，0.14]，P= 0.16）与12小时相比无明显差异。此外，六小时置管可明显降低总体剖宫产率（RR：0.81，95% CI [0.68，0.96]，P= 0.01）和因胎位不正导致的剖宫产率（RR：0.39，95% CI [0.16，0.93]，P= 0.03）：结论：与 12 小时相比，计划中的 6 小时球囊导管置入缩短了插入到分娩的时间间隔，降低了 CD 率，在 BISHOP 评分变化和导管拔出到分娩的时间间隔方面具有同等疗效。
Six vs 12-hour balloon catheter placement for the induction of labor: a systematic review and meta-analysis of randomized controlled trials
Objective
Balloon catheters have shown promising results in the induction of labor (IOL); however, evidence regarding the optimal time of balloon catheter placement is still lacking. Thus, this study aims to evaluate the efficacy and safety of 6-hour placement compared to 12 hours.
Data Source
We conducted a comprehensive search through a search strategy across “Embase, SCOPUS, PubMed (via MEDLINE), and Cochrane Central Register of Controlled Trials (CENTRAL)” from inception until April 20, 2024.
Study Eligibility Criteria
We included the randomized controlled trials (RCTs) evaluating the efficacy and safety of 6-hour balloon catheter placement compared with 12 hours for cervical ripening in IOL. Covidence was used to screen eligible articles.
Methods
All relevant outcome data were synthesized using risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CIs) in meta-analysis models within RevMan 5.4. PROSPERO ID: CRD42024540935.
Results
We included five RCTs with 960 women undergoing the IOL with balloon catheter placement. Six-hour placement was associated with significant lower insertion to overall delivery interval (MD: –4.25, 95% CI [–5.34, –3.15], P<.00001) and insertion to vaginal delivery interval (MD: –4.65, 95% CI [–6.08, –3.23], P<0.00001) without significant difference in BISHOP score change (MD: –0.02, 95% CI [–0.23, 0.20], P=.88), catheter removal to delivery interval (MD: 0.72, 95% CI [–0.39, 1.83], P=.20) and total duration of oxytocin infusion (MD: –0.36, 95% CI [–0.85, 0.14], P=.16) compared to 12 hours. Also, significantly lower overall cesarean delivery (CD) rate (RR: 0.81, 95% CI [0.68, 0.96], P=.01) and CD due to malpresentation (RR: 0.39, 95% CI [0.16, 0.93], P=.03) were observed with 6-hour placement.
Conclusion
A planned 6-hour balloon catheter placement reduced insertion to delivery intervals and CD rate and has equal efficacy in BISHOP score change and catheter removal to delivery interval compared to 12 hours.
期刊介绍：
The American Journal of Obstetrics and Gynecology (AJOG) is a highly esteemed publication with two companion titles. One of these is the American Journal of Obstetrics and Gynecology Maternal-Fetal Medicine (AJOG MFM), which is dedicated to the latest research in the field of maternal-fetal medicine, specifically concerning high-risk pregnancies. The journal encompasses a wide range of topics, including:
Maternal Complications: It addresses significant studies that have the potential to change clinical practice regarding complications faced by pregnant women.
Fetal Complications: The journal covers prenatal diagnosis, ultrasound, and genetic issues related to the fetus, providing insights into the management and care of fetal health.
Prenatal Care: It discusses the best practices in prenatal care to ensure the health and well-being of both the mother and the unborn child.
Intrapartum Care: It provides guidance on the care provided during the childbirth process, which is critical for the safety of both mother and baby.
Postpartum Issues: The journal also tackles issues that arise after childbirth, focusing on the postpartum period and its implications for maternal health. AJOG MFM serves as a reliable forum for peer-reviewed research, with a preference for randomized trials and meta-analyses. The goal is to equip researchers and clinicians with the most current information and evidence-based strategies to effectively manage high-risk pregnancies and to provide the best possible care for mothers and their unborn children.
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