What do systematic reviews say?

Labour induction vs expectant management

Labour induction leads to lower admission to neonatal intensive care unit compared with expectant management (infant/child outcomes) (high certainty).

• Induction of labour at or beyond 37 weeks' gestation 2020 · Cochrane Headline outcomes only
  RR 0.88 [0.8, 0.96]
  17 studies · 17826 participants
  High

Balloon (Foley or ATAD) vs low‐dose vaginal misoprostol

Balloon (Foley or ATAD) showed no clear difference in neonatal intensive care unit admission compared with low‐dose vaginal misoprostol (low certainty).

• Mechanical methods for induction of labour 2023 · Cochrane Headline outcomes only
  RR 1 [0.61, 1.63]
  9 studies · 1302 participants
  Low

Balloon (Foley or ATAD) vs low‐dose oral misoprostol

Balloon (Foley or ATAD) showed no clear difference in neonatal intensive care unit admission compared with low‐dose oral misoprostol (low certainty).

• Mechanical methods for induction of labour 2023 · Cochrane Headline outcomes only
  RR 0.82 [0.58, 1.17]
  5 studies · 2873 participants
  Low

Balloon (Foley or ATAD) vs vaginal prostaglandin E2

Balloon (Foley or ATAD) showed no clear difference in neonatal intensive care unit admission compared with vaginal prostaglandin E2 (low certainty).

• Mechanical methods for induction of labour 2023 · Cochrane Headline outcomes only
  RR 0.82 [0.65, 1.04]
  12 studies · 3647 participants
  Low

Oral misoprostol vs intravenous (IV) oxytocin

It is very uncertain whether oral misoprostol changes admission to neonatal intensive care unit compared with intravenous oxytocin (very low certainty).

• Low‐dose oral misoprostol for induction of labour 2021 · Cochrane Headline outcomes only
  RR 0.65 [0.12, 3.45]
  4 studies · 517 participants
  Very low

Oral misoprostol vs mechanical methods

Oral misoprostol showed no clear difference in admission to neonatal intensive care unit compared with mechanical methods (low certainty).

• Low‐dose oral misoprostol for induction of labour 2021 · Cochrane Headline outcomes only
  RR 1.24 [0.87, 1.76]
  5 studies · 2886 participants
  Low

Oral misoprostol one‐ to two‐hourly vs oral misoprostol four‐ to six‐hourly

• Low‐dose oral misoprostol for induction of labour 2021 · Cochrane Headline outcomes only
  no estimate extracted
  1 study · 64 participants
  Very low

Oral misoprostol vs placebo/no treatment

• Low‐dose oral misoprostol for induction of labour 2021 · Cochrane Headline outcomes only
  no estimate extracted
  1 study · 130 participants
  Very low

Intracervical PGE₂ vs placebo

Intracervical PGE₂ showed no clear difference in neonatal intensive care unit admission compared with placebo (low certainty).

• Pharmacological and mechanical interventions for labour induction in outpatient settings 2017 · Cochrane Headline outcomes only
  RR 1.61 [0.43, 6.05]
  3 studies · 215 participants
  Low

Vaginal misoprostol vs placebo

Vaginal misoprostol showed no clear difference in neonatal intensive care unit admission compared with placebo (low certainty).

• Pharmacological and mechanical interventions for labour induction in outpatient settings 2017 · Cochrane Headline outcomes only
  RR 0.89 [0.54, 1.47]
  4 studies · 325 participants
  Low

Vaginal PGE₂ vs placebo or expectant management

Vaginal PGE₂ showed no clear difference in neonatal intensive care unit admission compared with placebo or expectant management (low certainty).

• Pharmacological and mechanical interventions for labour induction in outpatient settings 2017 · Cochrane Headline outcomes only
  RR 0.32 [0.1, 1.03]
  3 studies · 230 participants
  Low

Oral misoprostol vs vaginal dinoprostone

Oral misoprostol showed no clear difference in admission to neonatal intensive care unit compared with vaginal dinoprostone (low certainty).

• Low‐dose oral misoprostol for induction of labour 2021 · Cochrane Headline outcomes only
  RR 0.8 [0.6, 1.07]
  11 studies · 9278 participants
  Low

Oral misoprostol vs vaginal misoprostol

Oral misoprostol showed no clear difference in admission to neonatal intensive care unit compared with vaginal misoprostol (moderate certainty).

• Low‐dose oral misoprostol for induction of labour 2021 · Cochrane Headline outcomes only
  RR 1.03 [0.86, 1.23]
  23 studies · 4450 participants
  Moderate