Cervical Ripening in Low-Resource Settings: A Comparative Review of Mechanical and Pharmacological Strategies

Background: Induction of labor is a widely adopted obstetric procedure, particularly in cases where prolonging pregnancy poses risks to maternal or fetal health. Achieving effective cervical ripening is essential for successful induction, especially in women with an unfavorable cervix. Objective: This systematic review and meta-analysis aimed to compare the efficacy and safety of two commonly used. A comprehensive database search was conducted across four biomedical platforms for studies comparing dinoprostone and Foley’s catheter in women indicated for induction. The review followed PRISMA and Cochrane guidelines. Meta-analysis was performed using RevMan V5.4, applying a random- effects model due to observed heterogeneity. Results: A total of 41 studies encompassing 12,877 participants were included. Both methods demonstrated similar success rates in cervical ripening, time to delivery, and vaginal birth within 24 hours. However, Foley’s catheter was associated with lower risks of cesarean delivery (RR = 0.84), uterine hyperstimulation (RR = 0.39), and postpartum hemorrhage (RR = 0.76). Increased need for oxytocin augmentation was observed in the Foley group (RR = 1.18). No significant differences were noted in neonatal outcomes or infection risks. Conclusion: While both methods are effective, Foley’s catheter offers additional safety and cost advantages, making it an optimal choice for cervical ripening in resource-limited environments.