Department of Obstetrics & Gynecology, Foothills Medical Centre, University of Calgary, Calgary, AB.
Department of Obstetrics & Gynecology, Foothills Medical Centre, University of Calgary, Calgary, AB.
J Obstet Gynaecol Can. 2020 Dec;42(12):1525-1531.e1. doi: 10.1016/j.jogc.2020.02.111. Epub 2020 Apr 30.
To assess the efficacy of oral misoprostol for induction of labour (IOL) in the context of term pre-labour rupture of membranes (TPROM), and to assess pregnancy outcomes following the administration of oral misoprostol.
A systematic literature search was performed using Ovid Medline, Embase, PubMed, and the Cochrane Database of Systematic Reviews.
Eligible studies were quasi-experimental trials or randomized controlled trials involving the use of oral misoprostol in singleton cephalic term pregnancies with confirmed rupture of membranes and no spontaneous labour at the time of membranes rupture, in mothers with no contraindications to vaginal delivery. Studies were excluded if they utilized vaginal misoprostol, excluded primigravid participants, or if the full text of the article was not accessible in English.
Data were extracted by two reviewers using a standardized data extraction form. Study quality was assessed using the modified Jadad score.
Twelve randomized controlled trials that included 1489 singleton pregnancies were included. Doses of oral misoprostol ranged from 20 to 200 μg. The incidence of vaginal birth ranged from 73.0%-95.0% in the oral misoprostol group compared with 52.4%-94% in the control group. Hyperstimulation was infrequent, ranging from 0% to 13.8% in the oral misoprostol group compared with 0%-24% in the control group. Two trials, involving a total of 144 women that compared 50 μg of oral misoprostol every 4 hours versus expectant management followed by PGE gel showed a higher incidence of vaginal birth with misoprostol (pooled risk ratio 1.33, 95% confidence interval 1.10-1.61).
Oral misoprostol appears to be a safe and effective for IOL in TPROM. However, the varying administration, dose, and frequency reported in the literature highlights the need to develop a standardized protocol for use in Canadian obstetrical practice.
评估口服米索前列醇在足月胎膜早破（TPROM）情况下引产（IOL）的疗效，并评估口服米索前列醇给药后的妊娠结局。
使用 Ovid Medline、Embase、PubMed 和 Cochrane 系统评价数据库进行系统文献检索。
合格的研究是涉及在胎膜破裂时无自发性分娩且无阴道分娩禁忌证的单胎头位足月胎膜早破孕妇中使用口服米索前列醇的准实验性试验或随机对照试验。如果研究使用阴道米索前列醇、排除初产妇，或者文章全文无法以英文获取，则将其排除。
两位评审员使用标准化数据提取表提取数据。使用改良 Jadad 评分评估研究质量。
纳入了 12 项随机对照试验，共纳入 1489 例单胎妊娠。口服米索前列醇的剂量范围为 20-200μg。口服米索前列醇组阴道分娩率为 73.0%-95.0%，对照组为 52.4%-94%。过度刺激不常见，口服米索前列醇组为 0%-13.8%，对照组为 0%-24%。两项涉及 144 名妇女的试验比较了每 4 小时给予 50μg 口服米索前列醇与期待治疗后给予 PGE 凝胶，结果显示米索前列醇组阴道分娩率更高（合并风险比 1.33，95%置信区间 1.10-1.61）。
口服米索前列醇似乎是 TPROM 中 IOL 的一种安全有效的方法。然而，文献中报告的不同给药途径、剂量和频率突出表明需要制定一个标准化方案，以用于加拿大产科实践。
