Summary of findings 2. Amniotic membranes sweeping compared to vaginal/intracervical prostaglandins for induction of labour.
| Amniotic membrane sweeping compared to vaginal/intracervical prostaglandins for induction of labour | ||||||
| Patient or population: pregnant women carrying a live fetus at or near term (≥ 36 weeks' gestation). Setting: antenatal environments where amniotic membrane sweeping is likely to be used. Intervention: amniotic membrane sweeping Comparison: vaginal/intracervical prostaglandins | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with vaginal/intracervical prostaglandins | Risk with amniotic membrane sweeping | |||||
| Spontaneous onset of labour | Study population | RR 1.24 (0.98 to 1.57) | 339 (3 RCTs) | ⊕⊕⊝⊝ LOW 1 2 | ||
| 521 per 1000 | 647 per 1000 (511 to 819) | |||||
| Induction of labour | Study population | RR 0.90 (0.56 to 1.45) | 157 (2 RCTs) | ⊕⊕⊝⊝ LOW 3 4 | ||
| 319 per 1000 | 288 per 1000 (179 to 463) | |||||
| Caesarean section | Study population | RR 0.69 (0.44 to 1.09) | 339 (3 RCTs) | ⊕⊕⊝⊝ LOW 1 5 | ||
| 221 per 1000 | 152 per 1000 (97 to 241) | |||||
| Spontaneous vaginal birth | Study population | RR 1.12 (0.95 to 1.32) | 252 (2 RCTs) | ⊕⊕⊝⊝ LOW 6 7 | ||
| 659 per 1000 | 738 per 1000 (626 to 870) | |||||
| Uterine hyperstimulation with/without fetal heart rate (FHR) changes ‐ not reported | ‐ | ‐ | ‐ | ‐ | ‐ | No study reported on this outcome |
| Maternal death or serious maternal morbidity | Study population | RR 0.93 (0.27 to 3.21) | 87 (1 RCT) | ⊕⊕⊝⊝ LOW 8 9 | ||
| 108 per 1000 | 101 per 1000 (29 to 347) | |||||
| Neonatal death or serious neonatal perinatal morbidity | Study population | RR 0.40 (0.12 to 1.33) | 269 (2 RCTs) | ⊕⊕⊝⊝ LOW 10 11 | ||
| 70 per 1000 | 28 per 1000 (8 to 94) | |||||
| *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). CI: Confidence interval; RR: Risk ratio | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: 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 certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect. | ||||||
1 We downgraded (1) level for risk of serious bias due to evidence of design limitations in all trials. All trials had unclear risk of selection bias (allocation concealment) and detection bias (blinding of outcome assessment). All three trials have high risk of performance bias (blinding of participants and personnel). One trial was at high risk of other bias.
2 We downgraded (1) level for risk of serious imprecision due to the total (cumulative) sample size of 339 being less than the optimal information size (OIS) of 704.
3 We downgraded (1) level for risk of serious bias due to evidence of design limitations in all trials. All trials had unclear risk of selection bias (allocation concealment) and detection bias (blinding of outcome assessment). All trials have high risk of performance bias (blinding of participants and personnel). One trial was at high risk of other bias.
4 We downgraded (1) level for risk of serious imprecision due to the total (cumulative) sample size of 157 being less than the optimal information size (OIS) of 1572
5 We downgraded (1) level for risk of serious imprecision due to the total (cumulative) sample size of 339 being less than the optimal information size (OIS) of 2568
6 We downgraded (1) level for risk of serious bias due to evidence of design limitations in all trials. All trials had unclear risk of selection bias (allocation concealment) and detection bias (blinding of outcome assessment). All trials have high risk of performance bias (blinding of participants and personnel).
7 We downgraded (1) level for risk of serious imprecision due to the total (cumulative) sample size of 252 being less than the optimal information size (OIS) of 358
8 We downgraded (1) level for risk of serious bias due to evidence of design limitations. We found an unclear risk of selection bias (allocation concealment) and detection bias (blinding of outcome assessment). We found this trial to be of high risk of performance bias (blinding of participants and personnel) and other bias.
9 We downgraded (1) level for risk of serious imprecision due to the total (cumulative) sample size of 80 being less than the optimal information size (OIS) of 5908
10 We downgraded (1) level for risk of serious bias due to evidence of design limitations in all trials. All trials had unclear risk of selection bias (allocation concealment) and detection bias (blinding of outcome assessment). All trials have high risk of performance bias (blinding of participants and personnel). One trial was at high risk of other bias.
11 We downgraded (1) level for risk of serious imprecision due to the total (cumulative) sample size of 269 being less than the optimal information size (OIS) of 9496