Table 1 Characteristics of studies included in the systematic review

AbdelLatif 2018 [22]

Egypt

Clinical interventional randomized case-controlled trial

26 ± 4.36

25.63 ± 3.79

60

60

Primigravida

> 40 W

a) Initial dose of oxytocin (1 to 2 mIU/min.

b) Increase interval 30 min.

c) Dosage increment (1 to 2 mIU).

d) Usual dose for good labour (8 to12 mIU/min.

e) Maximum dose (30 mIU/min.

received a prefilled syringe with two milliliters (8 mg) of dexamethasone intra-muscular

not receive

dexamethasone or any other cervical ripening agent.

2.54 ± 0.94

3.59 ± 0.86

7.35 ± 1.15

8.69 ± 1.09

25.09 ± 12.99

30.73 ± 12.96

AboRomia 2013 [23]

Egypt

An experimental prospective case control design

18.6 ± 1.4

18.8 ± 1.7

86

86

Primigravida

38 w

No labour induction

received an intramuscular injection of8 mg (2 ml) of dexamethasone

placebo (2 ml saline IM)

3.6 ± 0.7

3.8 ± 0.8

17.9 ± 3.5

22.4 ± 8.6

6.9 ± 1.9

7.0 ± 1.8

Ahmed 2019 [32]

Egypt

Interventional randomized case controlled trial

26.5 ± 2.3

25.8 ± 2.9

50

50

Primigravida

40 W

a) Initial dose of oxytocin (1 to 2 mIU/min.

b) Increase interval 30 min.

c) Dosage increment (1 to 2 mIU).

d) Usual dose for good labour (8 to12 mIU/min.

e) Maximum dose (30 mIU/min.

received a prefilled syringe with two milliliters (8 mg) of dexamethasone with infusion drip

placebo (2 ml saline IV)

6.4 ± 0.9

4.8 ± 0.9

2.6 ± 0.7

4.1 ± 1.3

3.5 ± 1.1

3.8 ± 0.8

6.1 ± 1.3

7.8 ± 1.7

Barkai 1997 [21]

Israel

A double-blind, randomized study

29.0 ± 4.5

27.8 ± 4.8

50

48

Primigravida

And multigravida

36 to 42 weeks

Intravenous oxytocin

was administered in an initial dose of 2.5 mIU/min and at a constant increase Of 2.5 mIU/min every 20 min until three contractions in 10 min were achieved

receive either 20 mg of dexamethasone in saline solution

extraamniotically

saline solution only administered extra-amniotically

7.8 ± 3.1

9.9 ± 3.9

11.9 ± 3.0

14.5 ± 4.8

El-Refaie 2011 [24]

Egypt

Prospective, randomized, double blinded placebo controlled trial

24.4 ± 3.6

24.9 ± 3.7

60

60

Nulliparous women

41 w

started at a dose of

4 mU per minute, to be increased by 4 mU per minute every 30 min up to a maximum of 32 mU per minute.

a single dose of 8 mg dexamethasone in 2 mL solution intramuscular

2 mL isotonic

Saline IM

166.2 ± 30.3

203.6 ± 27.8

318.4 ± 36.1

330.9 ± 24.5

18.9 ± 8.5

21.1 ± 7.3

EL-SHERBINI 2018 [25]

Egypt

Prospective randomized single-blinded

placebo-controlled study

27.3 ± 3.8

27.1 ± 4.3

50

50

primigravida

38-40w

2.5mIU/min of oxytocin intravenous drip (in 500 mL lactated Ringer’s solution), with the dose increased by 2.5mIU/ml every 20 min until labor was established

received IM dexamethasone

(8 mg) 6 h before IOL then IM 2 ml saline at the beginning of active phase

placebo (2 ml saline) IM 6 h before IOL and at the beginning of the active phase.

3.71 ± 0.70

4.75 ± 0.72

21.6 ± 5.3

30.0 ± 5.3

Elmaraghy 2018 [26]

Egypt

Double blinded randomized, controlled trial

Not reported

Not reported

50

50

Nulliparous

38–42 w

Started by 5 drops /minute of 500 cc saline 5 units of oxytocin with the dose increased by 5–10 drops/ minute every 30 min till optimal contractions are reached

Eight mg (2 ml) dexamethasone IM

at least half an hour and maximally 6 h before labor induction.

2 ml of distilled

water IM at as a same way

3.38 ± 1.16

6.24 ± 1.384

41.2 ± 36.3

65 ± 35.66

Hajivandi 2013 [7]

Iran

One blinded randomized, controlled trial

23.5 ± 3.83

22.8 ± 3.89

50

50

Primigravida

40–42 w

Oxytocin started at 10 units per 1000 cc of ringer at a rate of 2.5 mU / min and increased by the same amount every 15 min until regular contractions continued.

Eight mg (2 ml) of dexamethasone

IM at 12 h before labor induction

2 ml of normal saline IM at 12 h before initiation of labor induction

7.2 ± 1.32

2.98 ± 0.89

3.1 ± 0.68

4.2 ± 1.3

Kashanian 2008 [20]

Iran

A double-blind, randomized, controlled trial

24.38 ± 4.5

22.85 ± 3.5

61

61

Nulliparous

Started with 2.5 mU/min of oxytocin, with the dose increased by 2.5 mU/min every 20 min.

8 mg (2 mL) of the product IM 6 h before initiation of labor induction

2 mL of distilled water IM 6 h before initiation of labor induction

3.09 ± 1.5

4.21 ± 1.8

2.46 ± 1.38

3.87 ± 5.73

22.23 ± 16.09

29.01 ± 15.32

Kashanian 2008 [20]

Iran

A double-blind randomized clinical trial

28.22 ± 5.85

26.58 ± 7.31

41

43

Primigravida

And multigravida

> 40 w

induction with oxytocin at a dose of 2.5 mIu/min was initiated in both groups, and was increased at a dose of 2.5 mIu/min every 20 min until the women entered the active phase of labor and continued until delivery

dexamethasone 20 mg mixed with normal saline to achieve a 20 mL volume was infused extra-amniotic space for 6 h.

20 mL of normal saline was infused extra-amniotic

similar to the previous group

7.25 ± 2.86

9.76 ± 3.91

Laloha 2015 [30]

Iran

A randomized, clinical, and double – blind trial

21.7 ± 0.67

22.4 ± 0.67

86

86

primparous,

40 w

It was used but the method was not mentioned

2 ml injected with Dexamethasone (IV) four hours before labor induction

2 ml injected with distilled water (IV) four hours before the start of labor induction.

2.87 ± 1.57

3.8 ± 1.72

3.47 ± 1.1

3.6 ± 0.99

Mansouri 2003 [19]

Iran

A double blind randomized study

26 ± 7.07

25 ± 5.54

34

31

Primigravida

And multigravida

39-41w

It was used but the method was not mentioned

20 mL of normal saline containing 20 mg of dexamethasone were infused into the extra-amniotic space

20 mL of normal saline, were infused into the extra-amniotic space.

6.6 ± 2.33

8.2 ± 3

8.4 ± 2.62

10.5 ± 3.35

Mousa 2014 [28]

Egypt

Double blinded randomized, controlled trial

26 ± 4.36

25.63 ± 3.79

60

60

Nulliparous women

> 41w

Starting by infusion of 5 drops/minute of 500 cc Ringer’s solution + 5 units of oxytocin with the dose increased 5 drops/minutes every 30 min.

2 ml dexamethasone was administrated IM at 6 h before labor induction

2 ml distilled water (IM) six hours before the start of labor induction

2.54 ± 0.94

3.59 ± 0.86

4.82 ± 0.56

5.12 ± 0.58

25.09 ± 12.99

30.73 ± 12.96

Pahlavan 2017 [31]

Iran

A randomized double-blind clinical trial

24.2 ± 3.9

23.9 ± 4.1

61

60

nulliparous

40–42 w

The augmentation of labor with the use of intravenous oxytocin infusion (2.5 m units/ per minute) began in both groups.

2 ml dexamethasone intramuscular 4 mg/mL before starting oxytocin infusion

2 ml sterile water IM before starting oxytocin infusion

2.1 ± 1.9

3.1 ± 1.3

2.9 ± 0.9

4.9 ± 8.1

35.4 ± 11.6

49.2 ± 16.9

Salman 2017 [18]

Iraq

A double blind randomized case- control study

28.53 ± 5.38

28.8 ± 5.71

58

41

nulliparous

40w

After extra amniotic

Catheter expelled, intravenous oxytocin administered as an initial dose until three contractions per ten minute were achieved.

the method was not mentioned.

20 mg dexamethasone mixed with 20 cc of sterile saline solution infused into the extra-amniotic space

500 ml of pure

saline solution, with a rate of 5 drop/min through the

Catheter into the extra-amniotic space.

184.53 ± 44.6

222.0 ± 47.62

33.25 ± 9.14

44.02 ± 7.0

Shehata 2019 [12]

Egypt

randomized controlled clinical trial

18–35

18–35

60

60

Primigravida.

> 41 w

After six hours of the initial dose, the labor induction was started via oxytocin a. Initial dose of oxytocin (1 to 2 mIU/min.) b. Increase interval 30 Minutes.c. Dosage increment 1 to 2 mIU. d. Usual dose for good labour 8 to12 mIU/min. e. Maximum dose 30 mIU/min.

prefilled syringe with two milliliters

Dexamethasone. before six hours labor induction

did not receive dexamethasone or any other cervical ripening agent.

2.49 ± 0.67

3.66 ± 0.77

7.22 ± 1.21

9.11 ± 1.9

26.8 ± 8.7

30.3 ± 9.3

Ziaei 2003 [29]

Iran

RCT

23.66 ± 5.02

24.21 ± 5.09

33

33

Primigravida

And

multigravida

> 41 w

24 h from the beginning of the first dose, the injection of oxytocin started by 2 mU per minute. If necessary, it was increased by 2 mu per minute every 15 min, not exceeding 32 mu per minute

10 mg of dexamethasone IM two doses, at an interval of 12 h, 24 h from the beginning of the first dose, the intravenous oxytocin was started.

the control group, who received only intravenous oxytocin 24 h’ after enrolling.

1.7 ± 1.5

4 ± 1.7