We have read with interest the review by Vaknin et al of randomized controlled trials (RCTs) comparing the transcervical balloon catheter with vaginal prostaglandins in your November issue. Since the end of the authors’ data search, there have been 2 further large RCTs. These studies have produced concordant results with Vaknin et al and add the additional findings that induction with a transcervical catheter is quicker than prostaglandin E2 (PGE2), and patient satisfaction was improved with the transcervical catheter. Furthermore, in the only study to report cord gas outcome, they were more favorable in the transcervical catheter group.

A Swedish study included 588 subjects with a Bishop score of 6 or less. Both nulliparous and parous women were included. This study found similar maternal and fetal outcomes between the prostaglandins and transcervical balloon catheter except that the induction to delivery intervals was significantly shorter with the balloon catheter.

An Australian study included 330 nulliparous women with a Bishop score of 4 or less. The focus on nulliparous women was because this group has the most adverse outcomes after the induction of labor with an unfavorable cervix. This study found no difference in cesarean section rates; however, as found in the published metaanalysis, there was an increased risk of uterine hyperstimulation and fetal compromise in the PGE2 group.

Taken together, the data from your metaanalysis and the 2 new RCTs suggest that the transcervical catheter should be used in preference to PGE2 for the induction of labor, in both nulliparous and multiparous women, for women with unfavorable cervixes based on safety, cost, patient satisfaction, and duration of labor.