Comparison 9. Vaginal isosorbide mononitrate (IMN) versus placebo.

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Vaginal birth not achieved in 24/48 hours	1	238	Risk Ratio (M‐H, Fixed, 95% CI)	0.97 [0.83, 1.15]
2 Additional induction agents required	4	1921	Risk Ratio (M‐H, Random, 95% CI)	0.87 [0.75, 1.00]
3 Maternal satisfaction	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only
3.1 How do you think your labour went? (easy/very difficult)	1	227	Mean Difference (IV, Fixed, 95% CI)	‐0.34 [‐0.94, 0.26]
3.2 What do you think about home treatment? (extremely good/not at all good)	1	227	Mean Difference (IV, Fixed, 95% CI)	0.61 [0.03, 1.19]
3.3 How painful was the treatment at home? (not at all/very)	1	227	Mean Difference (IV, Fixed, 95% CI)	0.58 [‐0.00, 1.16]
3.4 How anxious were you being at home taking the treatment? (not at all/very)	1	227	Mean Difference (IV, Fixed, 95% CI)	0.11 [‐0.39, 0.61]
3.5 Would you have the same treatment at home again? (definitely/definitely not)	1	227	Mean Difference (IV, Fixed, 95% CI)	0.62 [‐0.02, 1.26]
3.6 Would you advise a friend to have the same treatment at home? (definitely/definitely not)	1	227	Mean Difference (IV, Fixed, 95% CI)	0.41 [‐0.17, 0.99]
4 Maternal satisfaction	2		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only
4.1 Felt satisfied (very or extremely)	1	1049	Risk Ratio (M‐H, Fixed, 95% CI)	0.80 [0.67, 0.94]
4.2 Would recommend the same treatment	1	1049	Risk Ratio (M‐H, Fixed, 95% CI)	0.84 [0.77, 0.90]
4.3 Would recommend procedure	1	193	Risk Ratio (M‐H, Fixed, 95% CI)	1.01 [0.94, 1.08]
5 Perinatal death	2	1712	Risk Ratio (M‐H, Random, 95% CI)	1.61 [0.08, 33.26]
6 Neonatal trauma (long bone fracture, collarbone fracture, basal skull fracture, brachial plexus palsy, facial nerve palsy, phrenic nerve palsy, or subdural haemorrhage)	1	1362	Risk Ratio (M‐H, Fixed, 95% CI)	0.67 [0.19, 2.37]
7 Neonatal convulsions in the first 24 hours	1	1362	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
8 Tracheal ventilation > 24 hours	1	1362	Risk Ratio (M‐H, Fixed, 95% CI)	1.01 [0.14, 7.14]
9 Neonatal ICU admission for 5 or more days	1	1362	Risk Ratio (M‐H, Fixed, 95% CI)	0.67 [0.19, 2.37]
10 Neonatal transfer	1	1362	Risk Ratio (M‐H, Fixed, 95% CI)	1.07 [0.67, 1.70]
11 Maternal death	1	1362	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
12 Severe postpartum haemorrhage	1	1362	Risk Ratio (M‐H, Fixed, 95% CI)	1.55 [0.78, 3.09]
13 Deep vein thrombosis	1	1362	Risk Ratio (M‐H, Fixed, 95% CI)	3.03 [0.12, 74.16]
14 Oxytocin augmentation	3	1816	Risk Ratio (M‐H, Random, 95% CI)	0.95 [0.78, 1.14]
15 Epidural	1	350	Risk Ratio (M‐H, Fixed, 95% CI)	0.94 [0.82, 1.09]
16 Uterine hyperstimulation (with FHR changes)	1	102	Risk Ratio (M‐H, Fixed, 95% CI)	0.2 [0.01, 4.07]
17 Uterine hyperstimulation (FHR changes unclear)	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.09 [0.01, 1.62]
18 Assisted (instrumental) vaginal birth	2	1712	Risk Ratio (M‐H, Fixed, 95% CI)	0.81 [0.61, 1.07]
19 Caesarean section	6	2286	Risk Ratio (M‐H, Fixed, 95% CI)	0.99 [0.87, 1.14]
20 Apgar score < 7 at 5 minutes	5	2214	Risk Ratio (M‐H, Fixed, 95% CI)	0.88 [0.44, 1.76]
21 NICU (or SCBU) admission	6	1068	Risk Ratio (M‐H, Fixed, 95% CI)	0.89 [0.59, 1.36]
22 Postpartum haemorrhage (> 500 mL)	5	2214	Risk Ratio (M‐H, Fixed, 95% CI)	1.13 [0.95, 1.36]
23 Neonatal infection	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	1.0 [0.26, 3.89]
24 Side effects ‐ Maternal side effect ‐ nausea	4	1926	Risk Ratio (M‐H, Random, 95% CI)	2.39 [1.54, 3.70]
25 Side effects ‐ Maternal side effect ‐ headache	7	2300	Risk Ratio (M‐H, Random, 95% CI)	5.45 [3.38, 8.81]
26 Side effects ‐ Maternal side effects ‐ severe headache	1	220	Risk Ratio (M‐H, Fixed, 95% CI)	21.21 [2.91, 154.65]
27 Indicator of 'progress' in labour ‐ Admitted in established labour within 24 hours	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	2.75 [1.29, 5.88]
28 Indicator of 'progress' in labour ‐ Bishop score > 6 or active labour at 36 hours	1	102	Risk Ratio (M‐H, Fixed, 95% CI)	3.8 [1.54, 9.40]
29 Time to birth ‐ Time in hours from admission to birth (all women)	3	374	Mean Difference (IV, Random, 95% CI)	‐4.70 [‐6.08, ‐3.31]
30 Indicator of 'progress' in labour ‐ Bishop score on admission after treatment	1	200	Mean Difference (IV, Fixed, 95% CI)	2.73 [2.17, 3.29]
31 Indicator of 'progress' in labour ‐ Change in Bishop score	2	272	Mean Difference (IV, Fixed, 95% CI)	2.76 [2.48, 3.03]
32 Time to birth ‐ Interval from onset of labour to birth (hours)	1	200	Mean Difference (IV, Fixed, 95% CI)	‐1.24 [‐1.82, ‐0.66]
33 Indicator of 'progress' in labour ‐ Cervix unchanged after 48 hours	1	257	Risk Ratio (M‐H, Fixed, 95% CI)	0.83 [0.70, 0.97]
34 Time to birth ‐ Interval from admission to vaginal birth (hours)	1	128	Mean Difference (IV, Fixed, 95% CI)	‐0.70 [‐6.11, 4.71]
35 Total cost of care package (GBP)	1	350	Mean Difference (IV, Fixed, 95% CI)	11.98 [‐105.34, 129.30]