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. 2020 Jul 15;2020(7):CD004945. doi: 10.1002/14651858.CD004945.pub5

James 2001.

Study characteristics
Methods RCT
Participants Number of women randomised: 74
Setting: Vellore, India
Study date: not reported
Inclusion criteria
  • Low‐risk women

  • Singleton pregnancy

  • Cephalic presentation

  • GA: 41 completed weeks (287 days)


Exclusion criteria
  • Presence of risk factors known to increase perinatal death and morbidity such as chronic hypertension, pre‐eclampsia, maternal diabetes mellitus, fetal growth restriction, multiple gestation, hydramnios, PROM, antepartum haemorrhage and previous caesarean section


State of cervix: not mentioned as a criterion
Interventions Induction group (n = 37):
Bishop < 5: cervical ripening with extra‐amniotically placed 16F Foley catheter with 20 mL of saline
Bishop > 5: stripping of membranes
Then, 12 hours later, IOL by AROM and oxytocin infusion
versus
EM group (n = 37): daily fetal movement counts; biophysical profile every second day
Outcomes Mother: mode of birth and indications; duration of labour; mean hospital stay
Baby: meconium staining of amniotic fluid; meconium aspiration; Apgar scores < 7 (at 1 and 5 min); need for neonatal intubation; birthweight; birthweight > 4000 g; signs of post‐maturity; perinatal deaths; abnormal electronic fetal trace monitoring
Notes Funding: not reported
Declarations of interest: not reported
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Low risk A table of random numbers was used.
Allocation concealment (selection bias) Unclear risk Allocation concealment was unclear since "... a series of consecutively numbered, sealed envelopes..." was used but no mention was made of opaqueness of the envelopes.
Blinding of participants and personnel (performance bias)
All outcomes High risk Blinding was not feasible.
Blinding of outcome assessment (detection bias)
All outcomes Unclear risk Blinded outcome assessment was not mentioned.
Incomplete outcome data (attrition bias)
All outcomes Low risk No loss to follow‐up or post‐randomisation exclusion
Selective reporting (reporting bias) Unclear risk All of the outcomes mentioned in the methods section were reported on in the results section; mean duration of labour was reported with no measure of variance. No access to trial protocol to further assess selective reporting
Other bias Low risk Appeared to be free of other bias