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Mechanical methods were the first methods developed to ripen the cervix and induce labour. During recent decades they have been substituted by pharmacological methods. Potential advantages of mechanical methods, compared with pharmacological methods may include reduction in side effects that could improve neonatal outcomes. This is an update of a review first published in , last updated in We updated the search in March and added the search results to the awaiting classification section of the review.
Clinical trials comparing mechanical methods used for third trimester cervical ripening or labour induction with pharmacological methods. This review includes the following comparisons: 1 specific mechanical methods balloon catheter, laminaria tents or EASI compared with prostaglandins different types, different routes or with oxytocin; 2 single balloon compared to a double balloon; 3 addition of prostaglandins or oxytocin to mechanical methods compared with prostaglandins or oxytocin alone.
Two review authors independently assessed trials for inclusion and assessed risk of bias. Two review authors independently extracted data and assessed the quality of the evidence using the GRADE approach. This review includes a total of trials, with studies contributing data 22, women; 21 comparisons. Risk of bias of trials varied. All evidence was downgraded for lack of blinding and, for many comparisons, the effect estimates were too imprecise to make a valid judgement. Balloon versus vaginal PGE2: there may be little or no difference in vaginal deliveries not achieved within 24 hours risk ratio RR 1.
A balloon catheter probably reduces the risk of uterine hyperstimulation with fetal heart rate FHR changes RR 0. It is uncertain whether there is a difference in serious maternal morbidity or death RR 0. It is uncertain whether there is a difference in serious neonatal morbidity or perinatal death RR 0.
