The efficacy and safety of oral and vaginal misoprostol versus dinoprostone on women experiencing labor: A systematic review and updated meta-analysis of 53 randomized controlled trials.
Journal
Medicine
ISSN: 1536-5964
Titre abrégé: Medicine (Baltimore)
Pays: United States
ID NLM: 2985248R
Informations de publication
Date de publication:
04 Oct 2024
04 Oct 2024
Historique:
medline:
28
10
2024
pubmed:
28
10
2024
entrez:
28
10
2024
Statut:
ppublish
Résumé
Induction of labor is the process of artificially stimulating the uterus to start labor before the spontaneous onset of labor. It has several medical indications. Commonly used agents are vaginal misoprostol, vaginal prostaglandin E2 (dinoprostone), and oral misoprostol. Through October 2023, a literature review was carried out in Cochrane, PubMed, Web of Science, and Scopus to identify randomized clinical studies assessing if oral and vaginal misoprostol has better efficacy of induction of labor over vaginal prostaglandin E2 or dinoprostone as a primary outcome. The data were pooled as mean difference, risk ratio, and 95% confidence interval. Fifty-three RCTs involving 10,455 patients showed a statistically significant difference in the overall success rate of induction between the misoprostol and prostaglandins E2 (PGE2) groups. They required less additional oxytocin compared to the PGE2 groups. The frequency of tachysystole, uterine hyperstimulation, abnormal cardiotocography, meconium-stained amniotic fluid, and Apgar score <7 at 1 minute were all higher in misoprostol groups than in PGE2 groups. No difference was found in cesarean section, fever, Neonatal Intensive Care Unit admission, or Apgar scores at 1 minute or 5 minutes. Vaginal misoprostol is more effective at inducing labor but may be less safe than vaginal dinoprostone. Oral misoprostol is generally as safe as vaginal dinoprostone. Vaginal dinoprostone requires lower doses but may need more oxytocin administration.
Sections du résumé
BACKGROUND
BACKGROUND
Induction of labor is the process of artificially stimulating the uterus to start labor before the spontaneous onset of labor. It has several medical indications. Commonly used agents are vaginal misoprostol, vaginal prostaglandin E2 (dinoprostone), and oral misoprostol.
METHODS
METHODS
Through October 2023, a literature review was carried out in Cochrane, PubMed, Web of Science, and Scopus to identify randomized clinical studies assessing if oral and vaginal misoprostol has better efficacy of induction of labor over vaginal prostaglandin E2 or dinoprostone as a primary outcome. The data were pooled as mean difference, risk ratio, and 95% confidence interval.
RESULTS
RESULTS
Fifty-three RCTs involving 10,455 patients showed a statistically significant difference in the overall success rate of induction between the misoprostol and prostaglandins E2 (PGE2) groups. They required less additional oxytocin compared to the PGE2 groups. The frequency of tachysystole, uterine hyperstimulation, abnormal cardiotocography, meconium-stained amniotic fluid, and Apgar score <7 at 1 minute were all higher in misoprostol groups than in PGE2 groups. No difference was found in cesarean section, fever, Neonatal Intensive Care Unit admission, or Apgar scores at 1 minute or 5 minutes.
CONCLUSION
CONCLUSIONS
Vaginal misoprostol is more effective at inducing labor but may be less safe than vaginal dinoprostone. Oral misoprostol is generally as safe as vaginal dinoprostone. Vaginal dinoprostone requires lower doses but may need more oxytocin administration.
Identifiants
pubmed: 39465774
doi: 10.1097/MD.0000000000039861
pii: 00005792-202410040-00083
doi:
Substances chimiques
Misoprostol
0E43V0BB57
Dinoprostone
K7Q1JQR04M
Oxytocics
0
Types de publication
Journal Article
Systematic Review
Meta-Analysis
Langues
eng
Sous-ensembles de citation
IM
Pagination
e39861Informations de copyright
Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.
Déclaration de conflit d'intérêts
The authors have no funding and conflicts of interest to disclose.
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