Summary of findings for the main comparison. Vaginal PGE2 versus intravenous (IV) oxytocin.
| Vaginal PGE2 compared with IV oxytocin for term labour induction for women with a previous caesarean section | ||||||
| Patient or population: women with one previous lower segment caesarean section and requiring labour induction due to prolonged pregnancy or pre‐eclampsia, singleton in cephalic presentation, GA ≥ 37 weeks, BS < 9, no cephalopelvic disproportion anticipated Setting: UK Intervention: vaginal prostaglandin E2 (2.5 mg pessary) Comparison: intravenous oxytocin | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Risk with oxytocin | Risk with prostaglandin E2 | |||||
| Vaginal delivery not achieved within 24 hours | ‐ | ‐ | ‐ | ‐ | ‐ | Not reported |
| Uterine hyperstimulation with fetal heart rate changes | ‐ | ‐ | ‐ | ‐ | ‐ | Not reported |
| Caesarean section | Study population | RR 0.67 (0.22 to 2.03) | 42 (1 RCT) | ⊕⊕⊝⊝ Low1 | ||
| 286 per 1000 | 191 per 1000 (63 to 580) | |||||
| Serious neonatal morbidity/perinatal death | Study population | RR 3.00 (0.13 to 69.70) | 42 (1 RCT) | ⊕⊕⊝⊝ Low1 | ||
| 0 per 1000 | 0 per 1000 (0 to 0) | |||||
| Serious maternal morbidity or death | Study population | RR 3.00 (0.13 to 69.70) | 42 (1 RCT) | ⊕⊕⊝⊝ Low1 | ||
| 0 per 1000 | 0 per 1000 (0 to 0) | |||||
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). BS: Bishop score; CI: Confidence interval; GA: gestational age; RR: Risk ratio | ||||||
| GRADE Working Group grades of evidence High quality: we are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect Very low quality: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect | ||||||
1Wide CI crossing the line of no effect, small sample size, and few events (imprecision, downgraded 2 levels).