{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T21:08:34Z","timestamp":1769634514756,"version":"3.49.0"},"reference-count":48,"publisher":"Georg Thieme Verlag KG","issue":"S 01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:p>\n            Objective\u2003This study aimed to conduct a systematic review and meta-analysis of all randomized and nonrandomized controlled trials (RCTs and NCTs, respectively) that explored the maternal\u2013neonatal outcomes of cervical osmotic dilators versus dinoprostone in promoting cervical ripening during labor induction.<\/jats:p><jats:p>\n            Study Design\u2003Six major databases were screened until August 27, 2022. The quality of included studies was evaluated. The data were summarized as mean difference or risk ratio (RR) with 95% confidence interval (CI) in a random-effects model.<\/jats:p><jats:p>\n            Results\u2003Overall, 14 studies with 15 arms were analyzed (n\u2009=\u20092,380 patients). Ten and four studies were RCTs and NCTs, respectively. The overall quality for RCTs varied (low risk n\u2009=\u20092, unclear risk n\u2009=\u20097, and high risk n\u2009=\u20091), whereas all NCTs had good quality (n\u2009=\u20094). For the primary endpoints, there was no significant difference between both groups regarding the rate of normal vaginal delivery (RR\u2009=\u20091.04, 95% CI: 0.95\u20131.14, p\u2009=\u20090.41) and rate of cesarean delivery (RR\u2009=\u20091.04, 95% CI: 0.93\u20131.17, p\u2009=\u20090.51). Additionally, there was no significant difference between both groups regarding the mean change in Bishop score and mean time from intervention to delivery. The rate of uterine hyperstimulation was significantly lower in the cervical osmotic dilator group. For the neonatal outcomes, during cervical ripening, the rate of fetal distress was significantly lower in the cervical osmotic dilator group. There was no significant difference between both groups regarding the mean Apgar scores, rate of meconium-stained amniotic fluid, rate of umbilical cord metabolic acidosis, rate of neonatal infection, and rate of neonatal intensive care unit admission.<\/jats:p><jats:p>\n            Conclusion\u2003During labor induction, cervical ripening with cervical osmotic dilators and dinoprostone had comparable maternal\u2013neonatal outcomes. Cervical osmotic dilators had low risk of uterine hyperstimulation compared with dinoprostone. Overall, cervical osmotic dilators might be more preferred over dinoprostone in view of their analogous cervical ripening effects, comparable maternal\u2013neonatal outcomes, and lack of drug-related adverse events.<\/jats:p><jats:p>\n            Key Points\n          <\/jats:p>","DOI":"10.1055\/s-0043-1770161","type":"journal-article","created":{"date-parts":[[2023,6,19]],"date-time":"2023-06-19T22:47:31Z","timestamp":1687214851000},"page":"e2034-e2046","source":"Crossref","is-referenced-by-count":3,"special_numbering":"S","title":["Cervical Osmotic Dilators versus Dinoprostone for Cervical Ripening during Labor Induction: A Systematic Review and Meta-analysis of 14 Controlled Trials"],"prefix":"10.1055","volume":"41","author":[{"given":"Abdulrahman","family":"Al-Matary","sequence":"additional","affiliation":[{"name":"Department of Neonatology, King Fahad Medical City, Riyadh, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saud A.","family":"Alsharif","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, College of Medicine, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ibtihal A.","family":"Bukhari","sequence":"additional","affiliation":[{"name":"Clinical Sciences Department, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saeed","family":"Baradwan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Majed S.","family":"Alshahrani","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine, Najran University, Najran, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khalid","family":"Khadawardi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8983-0585","authenticated-orcid":false,"given":"Ehab","family":"Badghish","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Maternity and Children Hospital, Makkah, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2106-8082","authenticated-orcid":false,"given":"Bayan","family":"Albouq","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Prince Mohammed Bin Abdulaziz National Guard Hospital, Madinah, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Afnan","family":"Baradwan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Mediclinic Almurjan Hospital, Jeddah, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammed","family":"Abuzaid","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Muhayl General Hospital, Muhayl, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haifa","family":"Al-Jundy","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Dr. Sulaiman Al-Habib Hospital, Riyadh, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdullah","family":"Alyousef","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, College of Medicine, Almaarefa University, Riyadh, Saudi 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Shirley","year":"2018","journal-title":"Drugs"},{"issue":"06","key":"ref37","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1097\/AOG.0000000000004799","article-title":"Cervical ripening efficacy of synthetic osmotic cervical dilator compared with oral misoprostol at term: a randomized controlled trial","volume":"139","author":"R Gavara","year":"2022","journal-title":"Obstet Gynecol"},{"issue":"25","key":"ref38","doi-asserted-by":"crossref","first-page":"5616","DOI":"10.1080\/14767058.2021.1888912","article-title":"Comparing the efficacy of dilapan with extra-amniotic saline infusion and oral misoprostol for cervical ripening in term pregnancies","volume":"35","author":"M Kashanian","year":"2022","journal-title":"J Matern Fetal Neonatal Med"},{"key":"ref39","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.ejogrb.2018.08.004","article-title":"Synthetic osmotic dilators in the induction of labour-an international multicentre observational 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