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. 2024 Dec 9:11:1459793.
doi: 10.3389/fmed.2024.1459793. eCollection 2024.

Efficacy and safety of misoprostol compared with dinoprostone for labor induction at term: an updated systematic review and meta-analysis of randomized controlled trials

Nusrat Lakho  1 , Mahrukh Hyder  2 , Taimoor Ashraf  3 , Sajida Khan  4 , Ajay Kumar  5 , Maheen Jabbar  6 , Madhurta Kumari  5 , Asfia Qammar  7 , Sateesh Kumar  5 , Muskan Kumari  5 , Fnu Deepak  5 , Kapil Raj  5 , Azzam Ali  7
Affiliations

Efficacy and safety of misoprostol compared with dinoprostone for labor induction at term: an updated systematic review and meta-analysis of randomized controlled trials

Nusrat Lakho et al. Front Med (Lausanne). .

Abstract

Background: Labor induction is a common obstetric intervention, increasingly performed worldwide, often using prostaglandins like misoprostol and dinoprostone.

Objective: This study aims to compare the effectiveness and safety of intravaginal misoprostol versus dinoprostone for inducing labor, examining their impact on various maternal and neonatal outcomes.

Methods: A systematic review and meta-analysis were conducted using four databases-PubMed, Google Scholar, EBSCO, and the Cochrane Library-from January 2000 to April 2023. We included randomized controlled trials (RCTs) involving singleton pregnancies at term (37-42 weeks) with unfavorable cervices, where intravaginal misoprostol was compared to dinoprostone. Key outcomes evaluated for effectiveness included vaginal delivery within 24 h, overall vaginal delivery rate, and need for oxytocin augmentation. Safety outcomes assessed were tachysystole, uterine hyperstimulation, abnormal cardiotocography, NICU admissions, cesarean delivery, and APGAR scores. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using a random-effects model in Review Manager (RevMan) version 5.4.1.

Results: Eight RCTs with a total of 1,801 participants (937 in the misoprostol group and 864 in the dinoprostone group) met the inclusion criteria. Misoprostol required a significantly less oxytocin augmentation than dinoprostone [RR = 0.83; 95% CI (0.71, 0.97), p = 0.02]. Other outcomes, including rates of cesarean delivery, uterine tachysystole, hyperstimulation, and NICU admissions, showed no significant differences between the two groups, indicating comparable safety and efficacy profiles.

Conclusion: This meta-analysis demonstrates that intravaginal misoprostol is an effective and safe alternative to dinoprostone for labor induction at term. Misoprostol achieved comparable efficacy and safety outcomes while requiring less oxytocin augmentation, supporting its potential as a practical induction agent in clinical settings.

Keywords: dinoprostone; intravaginally; labor induction; misoprostol; term.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow chart.
Figure 2
Figure 2
Risk of bias graph.
Figure 3
Figure 3
Risk of bias summary.
Figure 4
Figure 4
Forest plot of vaginal delivery at less than 24 h.
Figure 5
Figure 5
Forest plot of cesarean delivery.
Figure 6
Figure 6
Forest plot of oxytocin augmentation.
Figure 7
Figure 7
Forest plot of tachysystole.
Figure 8
Figure 8
Forest plot of vaginal delivery.
Figure 9
Figure 9
Forest plot of instrumental delivery.
Figure 11
Figure 11
Forest plot of NICU admission.
Figure 10
Figure 10
Forest plot of APGAR score < 8 at 5 min.
Figure 12
Figure 12
Forest plot of abnormal cardiotocograph.
Figure 13
Figure 13
Forest plot of hyperstimulation.
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References

    1. ACOG Practice Bulletin No . 107: induction of labor. Obstet Gynecol. (2009) 114:386–97. doi: 10.1097/AOG.0b013e3181b48ef5 - DOI - PubMed
    1. Martin JA, Hamilton BE, Ventura SJ, Osterman MJ, Kirmeyer S, Mathews TJ, et al. . Births: final data for 2009. Natl Vital Stat Rep. 60:1–70. PMID: - PubMed
    1. Alfirevic Z, Keeney E, Dowswell T, Welton NJ, Dias S, Jones LV, et al. . Labour induction with prostaglandins: a systematic review and network meta-analysis. BMJ. (2015) 350:350. doi: 10.1136/bmj.h217 - DOI - PMC - PubMed
    1. Papalia N, D’Souza RD, Hobson SR. Optimal timing of labour induction in contemporary clinical practice. Best Pract Res Clin Obstet Gynaecol. (2022) 79:18–26. doi: 10.1016/j.bpobgyn.2021.12.002, PMID: - DOI - PubMed
    1. Middleton P, Shepherd E, Morris J, Crowther CA, Gomersall JC. Induction of labour at or beyond 37 weeks’ gestation. Cochrane Database Syst Rev. (2020) 2020:945. doi: 10.1002/14651858.CD004945.pub5 - DOI - PMC - PubMed

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