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Objective: Balloon catheters have shown promising results in the induction of labor (IOL); however, evidence regarding the optimal time of balloon catheter placement is still lacking. Thus, this study aims to evaluate the efficacy and safety of six-hour placement compared to 12 hours., Data Source: We conducted a comprehensive search through a search strategy across "Embase, SCOPUS, PubMed (via MEDLINE), and Cochrane Central Register of Controlled Trials (CENTRAL)" from inception until April 20, 2024., Study Eligibility Criteria: We included the randomized controlled trials (RCTs) evaluating the efficacy and safety of six-hour balloon catheter placement compared with 12 hours for cervical ripening in IOL. Covidence was used to screen eligible articles., Methods: All relevant outcome data were synthesized using risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CIs) in meta-analysis models within RevMan 5.4., Prospero Id: CRD42024540935 RESULTS: We included five RCTs with 960 women undergoing the IOL with balloon catheter placement. Six-hour placement was associated with significant lower insertion to overall delivery interval (MD: -4.25, 95% CI [-5.34, -3.15], P< 0.00001) and insertion to vaginal delivery interval (MD: -4.65, 95% CI [-6.08, -3.23], P< 0.00001) without significant difference in BISHOP score change (MD: -0.02, 95% CI [-0.23, 0.20], P= 0.88), catheter removal to delivery interval (MD: 0.72, 95% CI [-0.39, 1.83], P= 0.20) and total duration of oxytocin infusion (MD: -0.36, 95% CI [-0.85, 0.14], P= 0.16) compared to twelve hours. Also, significantly lower overall cesarean delivery (CD) rate (RR: 0.81, 95% CI [0.68, 0.96], P= 0.01) and CD due to malpresentation (RR: 0.39, 95% CI [0.16, 0.93], P= 0.03) were observed with six-hour placement., Conclusion: A planned six-hour balloon catheter placement reduced insertion to delivery intervals and CD rate and has equal efficacy in BISHOP score change and catheter removal to delivery interval compared to twelve hours., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2024. Published by Elsevier Inc.)

Background: Due to limited research on the effectiveness and safety of intravenous (IV) fluids administered during labor, there are no guidelines available. Thus, this meta-analysis aims to evaluate efficacy of IV Ringer's lactate during labor as compared to usual care., Methods: Six databases were searched for the randomized controlled trials (RCTs) comparing the effects of IV Ringer's lactate at 125 mL/h or 250 mL/hr during labor in nulliparous women at term as compared to usual care, and the search results were imported to Covidence for screening of the articles. All the concerned outcomes were pooled as risk ratios (RR) or mean difference (MD) with 95% CI in the meta-analysis models using RevMan 5.4., Results: Pooled data from 7 RCTs with 967 nulliparous women showed that the active stage of labor duration (MD -32.16 with 95% CI [40.43 to -23.90], p  < 0.00001), need of oxytocin augmentation (RR 0.72 with 95% CI [0.54 to 0.96], p  = 0.03) and incidence of prolonged labor (RR 0.57 with 95% CI [0.34 to 0.95], p  = 0.03) was significantly lower with IV Ringer's lactate. However, the total duration of labor ( p  = 0.23), duration of second stage of labor ( p  = 0.31) and cesarean section rate ( p  = 0.070) did not differ between the two groups. The test for subgroup analysis based on infusion rate was significant ( p  = 0.01) for the active stage of labor., Conclusion: IV Ringer's lactate reduced the duration of active labor, the need for oxytocin augmentation and the prolonged labor incidence. However, it did not differ in effect on immediate neonatal health but was found to have more potential for reducing maternal vomiting as compared to usual care with unrestricted oral intake. Further research is needed to explore its effects in the larger and more diverse populations and with different IV fluids for evidence-based guidelines.

Background: Lateral internal sphincterotomy (LIS) has been the gold standard for treating chronic anal fissure (CAF) that persists despite other measures. The authors aim to evaluate the effects of the close method (CLIS) of performing LIS as compared to the open method (OLIS)., Methods: Databases were searched for relevant studies and results were screened to identify eligible articles, and all concerned outcomes were pooled as odd ratio (OR) or mean difference (MD) with 95% CI in the meta-analysis models using RevMan 5.4., Results: Pooled data from 16 trials with 1,711 patients with idiopathic CAF showed that the CLIS has significant lower risk of delayed fissure healing [OR: 0.28, 95% CI (0.10, 0.77), P = 0.01], duration of hospital stay [MD: -0.82 with 95% CI (-1.07, -0.57), P < 0.00001] and postoperative visual analogue pain score (VAPS) at 24 h [MD: -0.30 with 95% CI (-0.39, -0.21), P < 0.00001]. Also, the risk of overall complications [OR: 0.33 with 95% CI (0.19, 0.55), P < 0.0001], incontinence [OR: 0.28 with 95% CI (0.20, 0.38), P < 0.00001], and postoperative pain [OR: 0.56 with 95% CI (0.35, 0.91), P = 0.02] was significantly lower with CLIS., Conclusion: CLIS is a safer option than OLIS for treating anal fissure. The risk of delayed fissure healing, incontinence, post-op pain and overall complication was significantly lower. However, the risk of surgical site infection, postoperative bleeding and recurrence did not differ. Future research with more prolonged follow-up is necessary to document recurrence reliably., Competing Interests: The author declared no conflicts of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)