Comparative analysis of pharmacologic and mechanical methods for labor induction in patients at full-term pregnancy—A systematic review

Abstract

Background Induction of labor is performed for either maternal or fetal indications to reduce perinatal morbidity and mortality without increasing maternal morbidity. The aim of this study was to review the scientific literature regarding induction of labor in patients with full-term pregnancy and create a systematic review of the literature to answer the question: “In patients with full-term gestation - does combining the Foley balloon with dinoprostone for the artificial induction of labor - offer better perinatal results over time from the application of the labor induction method until birth?”. Methods A literature search was performed on 23/08/2023 in the PubMed database; only articles published within the past 5 years were considered. We included articles in which labor was triggered with a vaginal device with dinoprostone, oxytocin, and/or a Foley catheter in full-term patients who met the following criteria: monofetal pregnancy, cranial presentation, intact membranes, and no history of uterine scar. We used the keywords “induction,” “labour,” “term,” “Foley,” “dinoproston,” “oxytocin.” Results The Pubmed database currently has approximately 20,000 scientific papers about labor induction. Only two studies met the proposed criteria. Considering the small volume of eligible data for the proposed research, the main meta-analysis addressing the topic was also considered. Conclusions The use of dinoprostone and oxytocin infusion is effective for triggering labor under conditions of compliance with obstetrical indications and pharmacological characteristics. Studies that compare the success of artificial induction of labor with Foley balloon and Foley+dinoprostone in patients with full term gestation are limited, but nevertheless, the association of Foley balloon with artificial induction with dinoprostone seems to be a cost-effective method. The limited number of scientific studies on this topic determines a risk of bias, inconsistency and imprecision, and for the future, we propose to carry out a randomized prospective study to study the topic.