Cochrane for Clinicians

Putting Evidence into Practice

Mechanical Methods of Induction of Labor


Am Fam Physician. 2020 Nov 1;102(9):530-531.

Author disclosure: No relevant financial affiliations.

Clinical Question

Are mechanical methods of induction of labor safe and effective in the third trimester?

Evidence-Based Answer

Mechanical induction of labor with single or double balloon catheters is similar to induction with vaginal prostaglandin E2 (PGE2; also known as dinoprostone [Cervidil, Prostin E2]) in rates of vaginal delivery achieved within 24 hours, and it has a more favorable safety profile (21 fewer uterine tachysystole events per 1,000 deliveries). Mechanical induction also decreases serious neonatal morbidity and perinatal mortality compared with PGE2 (relative risk [RR] = 0.48). (Strength of Recommendation [SOR]: A, based on consistent, good-quality patient-oriented evidence.)

Balloon catheters reduce the risk of cesarean delivery compared with oxytocin (Pitocin; 126 fewer cesarean deliveries per 1,000 deliveries). (SOR: A, based on consistent, good-quality patient-oriented evidence.) There is no difference in neonatal or maternal morbidity or mortality between the two groups; vaginal delivery rates have not been appreciably compared.

Compared with low-dose vaginal misoprostol (Cytotec; 50 mcg or less every four or more hours), balloon catheters increase the risk of cesarean delivery (53 more cesarean deliveries per 1,000 deliveries), reduce the risk of uterine tachysystole (22 fewer events per 1,000 deliveries), and do not demonstrate a difference in rates of vaginal delivery achieved within 24 hours.1 (SOR: A, based on consistent, good-quality patient-oriented evidence.)

Practice Pointers

Induction of labor is a common obstetric procedure, occurring in approximately 20% of deliveries in the United States.1,2 Mechanical methods of induction of labor have been used for centuries, although their popularity decreased in the 1970s with the introduction of pharmacologic methods.1,2 More recently there has been a resurgence in the use of mechanical methods because they are generally considered safer than pharmacologic methods.2 This Cochrane review sought to determine the effectiveness and safety of mechanical methods of induction of labor in women beyond 24 weeks' gestation vs. pharmacologic methods and amniotomy.1

The review included 113 randomized controlled trials conducted on six continents involving a total of 22,373 women scheduled for induction of labor after 24 weeks' gestation.1 Most studies included nulliparous

Author disclosure: No relevant financial affiliations.


show all references

1. de Vaan MDT, ten Eikelder MLG, Jozwiak M, et al. Mechanical methods for induction of labour. Cochrane Database Syst Rev. 2019;(10):CD001233....

2. Penfield CA, Wing DA. Labor induction techniques: which is the best? Obstet Gynecol Clin North Am. 2017;44(4):567–582.

3. American College of Obstetricians and Gynecologists Committee on Practice Bulletins—Obstetrics.. ACOG Practice Bulletin no. 107: induction of labor. Obstet Gynecol. 2009;114(2 pt 1):386–397.

4. National Institute for Health and Care Excellence. Insertion of a double balloon catheter for induction of labour in pregnant women without previous caesarean section. Interventional procedures guidance (IPG528). July 23, 2015. Accessed January 22, 2020.

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, assistant medical editor.

A collection of Cochrane for Clinicians published in AFP is available at



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