SynthesisBJOG : an international journal of obstetrics and gynaecology2016
Methods to induce labour: a systematic review, network meta-analysis and cost-effectiveness analysis.
Synthesis in BJOG : an international journal of obstetrics and gynaecology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06983535 (Induction of Labor), which is not on this map. Cited by 28 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Induction of Labor (IOL) Using Cervical Double-balloon (Cook Catheter) in Outpatient Versus Inpatient Setting (COOK Study): a Multicentre, Randomised Controlled Trial.
Who cites it
28 citing papers in PubMed, 2 syntheses or guidelines pooled it, 97 citations in OpenAlex.
- The effect of dexamethasone on labor induction: a systematic review.BMC pregnancy and childbirth · 2021Pooled it
- Methods to induce labour: a systematic review, network meta-analysis and cost-effectiveness analysis.BJOG : an international journal of obstetrics and gynaecology · 2016Pooled it
- Misoprostol as Oral Solution or Oral Tablet for Induction of Labour (MISOBEST): A Randomised Controlled Non-Inferiority Trial.BJOG : an international journal of obstetrics and gynaecology · 2025Trial
- Comparison of balloon catheter, oral misoprostol, or combination of both for cervical ripening in late-term and post-term nulliparous women: A Finnish randomized controlled multicenter pilot trial.Acta obstetricia et gynecologica Scandinavica · 2025Trial
- Oral misoprostol, low dose vaginal misoprostol, and vaginal dinoprostone for labor induction: Randomized controlled trial.PloS one · 2020Trial
- A comparison of vaginal versus buccal misoprostol for cervical ripening in women for labor induction at term (the IMPROVE trial): a triple-masked randomized controlled trial.American journal of obstetrics and gynecology · 2019Trial
- Tranexamic acid for treatment of women with post-partum haemorrhage in Nigeria and Pakistan: a cost-effectiveness analysis of data from the WOMAN trial.The Lancet. Global health · 2018Trial
- Cervical ripening with mechanical method vs oral misoprostol in pregnancies with elevated BMI: a cohort study.Archives of gynecology and obstetrics · 2026Article
- Methods of induction of labour: a network meta-analysis.The Cochrane database of systematic reviews · 2026Article
- Comparative Effectiveness, Safety, and Cost-Effectiveness of Labour Induction Methods: A Systematic Review.Cureus · 2025Review
- Article
- Cervical ripening at home or in hospital during induction of labour: the CHOICE prospective cohort study, process evaluation and economic analysis.Health technology assessment (Winchester, England) · 2024Observational
- Review
- Article
- Neuroimaging and neuroendocrine insights into food cravings and appetite interventions in obesity.Psychoradiology · 2023Review
- Induction of labour practices at Botshabelo District Hospital: Assessing the institutional guidelines.Journal of public health in Africa · 2022Article
- Analysis of Variables that Influence the Success Rates of Induction of Labor with Misoprostol: A Retrospective Observational Study.Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia · 2022Observational
- Sublingual misoprostol vs. oral misoprostol solution for induction of labor: A retrospective study.Frontiers in surgery · 2022Article
- Clinical predictive factors for vaginal delivery following induction of labour among pregnant women in Jordan.BMC pregnancy and childbirth · 2021Article
- Labour Induction with Misoprostol in German Obstetric Clinics: What Are the Facts on Such Use?Geburtshilfe und Frauenheilkunde · 2021Article
Corrections and comments
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Authors and funding
8 authors at 3 institutions in 1 country.
Funding
Abstract
objectivesTo compare the clinical effectiveness and cost-effectiveness of labour induction methods.
methodsWe conducted a systematic review of randomised trials comparing interventions for third-trimester labour induction (search date: March 2014). Network meta-analysis was possible for six of nine prespecified key outcomes: vaginal delivery within 24 hours (VD24), caesarean section, uterine hyperstimulation, neonatal intensive care unit (NICU) admissions, instrumental delivery and infant Apgar scores. We developed a decision-tree model from a UK NHS perspective and calculated incremental cost-effectiveness ratios, expected costs, utilities and net benefit, and cost-effectiveness acceptability curves. MAIN
resultsIn all, 611 studies comparing 31 active interventions were included. Intravenous oxytocin with amniotomy and vaginal misoprostol (≥50 μg) were most likely to achieve VD24. Titrated low-dose oral misoprostol achieved the lowest odds of caesarean section, but there was considerable uncertainty in ranking estimates. Vaginal (≥50 μg) and buccal/sublingual misoprostol were most likely to increase uterine hyperstimulation with high uncertainty in ranking estimates. Compared with placebo, extra-amniotic prostaglandin E2 reduced NICU admissions. There were insufficient data to conduct analyses for maternal and neonatal mortality and serious morbidity or maternal satisfaction. Conclusions were robust after exclusion of studies at high risk of bias. Due to poor reporting of VD24, the cost-effectiveness analysis compared a subset of 20 interventions. There was considerable uncertainty in estimates, but buccal/sublingual and titrated (low-dose) misoprostol showed the highest probability of being most cost-effective.
conclusionsFuture trials should be designed and powered to detect a method that is more cost-effective than low-dose titrated oral misoprostol. TWEETABLE ABSTRACT: New study ranks methods to induce labour in pregnant women on effectiveness and cost.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.