Table 4.
Effect estimates and quality of evidence for clinical interventions that influence uterine rupture rates
| Comparison | No. of studies | Comparison 1 (no. of women with uterine rupture/no. of women) | Comparison 2 (no. of women with uterine rupture/no. of women) | Risk Difference, M-H, Random (95% CI) | I2 (%) | Certainty of Evidence |
|---|---|---|---|---|---|---|
| Pharmacologic induction | ||||||
| PGE1 vs. spontaneous labor | Prospective cohort (2) | 3/117 | 21/357 | -0.01 (− 0.10, 0.08) | 83 | Very Low |
| PGE2 vs. no PGE2/spontaneous labor | RCT (1) | 0/143 | 0/151 | 0.00 (− 0.01, 0.01) | NA | Low |
| Prospective cohort (6) | 7/819 | 38/6090 | 0.00 (0.00, 0.01) | 0 | Very Low | |
| Oxytocin vs. spontaneous labor/no oxytocin |
Prospective cohort (2) Retrospective cohort (1) |
2/766 | 1/1621 | 0.00 (0.00, 0.01) | 0 | Very Low |
| Epidural analgesia vs. no epidural | Retrospective cohort (1) | 0/87 | 0/150 | 0.00 (− 0.02, 0.02) | NA | Very Low |
| Mifepristone vs. placebo | RCT (1) | 0/16 | 0/16 | 0.00 (− 0.11, 0.11) | NA | Low |
| Oxytocin vs. PGE2 | Prospective cohort (1) | 0/208 | 0/146 | 0.00 (− 0.01, 0.01) | NA | Very Low |
| Non-pharmacologic induction | ||||||
| Membrane sweep vs. spontaneous labor | RCT (1) | 0/62 | 0/61 | 0.00 (− 0.03, 0.03) | NA | Very Low |
| Retrospective cohort (1) | 0/62 | 0/79 | 0.00 (− 0.03, 0.03) | NA | Very Low | |
| Pharmacologic vs. Non-pharmacologic or Combined (pharmacologic + non-pharmacologic) | ||||||
| Oxytocin + amniotomy vs. PGE2 + amniotomy | RCT (1) | 0/21 | 1/21 | -0.05 (− 0.17, 0.07) | NA | Very Low |
| Oxytocin vs. Cook balloon + oxytocin | Retrospective cohort (1) | 2/150 | 0/64 | 0.01 (− 0.02, 0.04) | NA | Very Low |
| Double-balloon catheter + PGE2 vs. PGE2 | Prospective cohort (1) | 0/98 | 1/112 | -0.01 (− 0.03, 0.02) | NA | Very Low |
| 30 mL Foley catheter vs. 80 mL Foley catheter | RCT (1) | 1/77 | 1/77 | 0.00 (−0.04, 0.04) | NA | Low |
| Induction (oxytocin, prostaglandin, oxytocin + prostaglandin, or amniotomy) vs. spontaneous labor | Prospective cohort (1) | 35/3259 | 54/8519 | 0.00 (0.00, 0.01) | NA | Very Low |
| Induction (oxytocin +/− PGE1 +/− Foley catheter) vs. expectant management | Retrospective cohort (1) | 22/1631 | 59/11045 | 0.01 (0.00, 0.01) | NA | Very Low |
CI confidence interval, NA not applicable, NS not specified, no. number, PGE1/PGE2 prostaglandin 1/prostaglandin 2; RCT randomized clinical trial, VD vaginal delivery, vs. versus