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Meta-Analysis
. 2023 Jan 27;28(1):51.
doi: 10.1186/s40001-023-01007-8.

Comparison of the effect of oral and vaginal misoprostol on labor induction: updating a systematic review and meta-analysis of interventional studies

Maryam Rahimi  1 , Ladan Haghighi  1 , Hamid Reza Baradaran  2   3 , Mobin Azami  4 , Samaneh Saghafian Larijani  1 , Paniz Kazemzadeh  5 , Yousef Moradi  6   7
Affiliations
Meta-Analysis

Comparison of the effect of oral and vaginal misoprostol on labor induction: updating a systematic review and meta-analysis of interventional studies

Maryam Rahimi et al. Eur J Med Res. .

Abstract

Objectives: This study is aimed to compare the effect of oral misoprostol with vaginal misoprostol to induce labor as a systematic review and meta-analysis.

Methods: Electronic databases including PubMed [Medline], Scopus, Web of science, Embase, Ovid, Cochrane library, and ClinicalTrials.gov were searched using the relevant keywords. All RCTs comparing the effect of oral vs vaginal misoprostol on labor induction were considered. The Cochrane Risk of Bias checklist was used for assessing quality of included RCTs. All statistical analyses were completed using STATA (Version 16) and Revman (Version 5).

Results: Thirty-three RCTs with 5162 patients (1560 in oral and 2602 in vaginal groups) were included in this meta-analysis. Labor induction length did differ significantly between the two routes of misoprostol administration [Standardized Mean Difference: 0.40 h, 95% confidence interval (CI) 0.34, 0.46; I2: 66.35%; P = 0.04]. In addition, the risk of neonatal death, tachysystole, uterine hyperstimulation, preeclampsia, non-FHR and abortion was lower in the oral misoprostol group and the risk of hypertonus, PROM, oxytocin need and cesarean fever was higher in this group than the vaginal misoprostol group.

Conclusions: Based on results of this meta-analysis, it can be inferred that currently, clinical specialists can decide to use this drug orally or vaginally on a case-by-case basis, depending on the condition of the pregnant mother and the baby.

Keywords: Labor induction; Meta-analysis; Oral misoprostol; Systematic review; Vaginal misoprostol.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram for related article numbers which included in meta-analysis
Fig. 2
Fig. 2
Forest plot for pooled weighted mean difference of induction labor length in oral and vaginal misoprostol groups
Fig. 3
Fig. 3
Results of publication bias and effect of age and follow-up duration on pooled weighted mean difference (WMD)
Fig. 4
Fig. 4
Forest plot for pooled risk ratio of Apgar < 7 at 1 min in oral than vaginal misoprostol groups
Fig. 5
Fig. 5
Forest plot for pooled risk ratio of Apgar < 7 at 5 min in oral than vaginal misoprostol groups
See this image and copyright information in PMC

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