Department of Obstetrics and Gynecology, Alfaisal University, Riyadh, Saudi Arabia.
College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, TN, 38163, USA.
Reprod Sci. 2023 Feb;30(2):380-389. doi: 10.1007/s43032-022-00909-y. Epub 2022 Apr 19.
The objective of this study was to conduct a systematic review and meta-analysis of all randomized controlled trials (RCTs) that evaluated isosorbide mononitrate (ISMN) versus dinoprostone, a prostaglandin E2 (PGE2) analogue, in promoting cervical ripening during labor induction. We searched five major databases from inception till 02 May 2021. We assessed the risk of bias of included studies. We meta-analyzed various endpoints (n=12) and pooled the endpoints as mean difference (MD) or risk ratio (RR) with 95% confidence interval (CI). Overall, 4 RCTs met the inclusion criteria, comprising 818 patients; equally 409 patients were allocated to ISMN and PGE2 groups. Overall, the RCTs had a low risk of bias. The mean change in Bishop score at 24 h was significantly lower in disfavor of the ISMN group. The mean time from drug administration to delivery was significantly longer in disfavor of the ISMN group. The rate of oxytocin need was significantly higher in disfavor of the ISMN group. The rate of vaginal delivery at 24 h was significantly lower in disfavor of the ISMN group. The rates of headache and palpitations were significantly higher in disfavor of the ISMN group. The rate of abnormal fetal heart rate was significantly lower in favor of the ISMN group. There was no significant difference between both groups with regard to rates of cesarean delivery, postpartum hemorrhage, uterine hyperstimulation, and NICU admission. Compared with PGE2, ISMN appeared less effective for cervical ripening prior to labor induction and correlated with higher drug-related maternal toxicities.
本研究旨在对所有评价单硝酸异山梨酯（ISMN）与前列腺素 E2（PGE2）类似物地诺前列酮在引产时促进宫颈成熟的随机对照试验（RCT）进行系统评价和荟萃分析。我们从建库起至 2021 年 5 月 2 日检索了 5 个主要数据库。我们评估了纳入研究的偏倚风险。我们对各种结局指标（n=12）进行荟萃分析，并将结局指标作为均数差（MD）或风险比（RR）及其 95%置信区间（CI）进行汇总。总的来说，有 4 项 RCT 符合纳入标准，共纳入 818 例患者；ISMN 和 PGE2 组各有 409 例患者。总的来说，这些 RCT 的偏倚风险较低。24 小时时 Bishop 评分的平均变化明显不利于 ISMN 组。从用药到分娩的平均时间明显长于 ISMN 组。ISMN 组催产素需求率明显更高。24 小时时阴道分娩率明显低于 ISMN 组。ISMN 组头痛和心悸的发生率明显较高。ISMN 组胎儿心率异常的发生率明显较低。两组剖宫产率、产后出血率、子宫过度刺激率和新生儿重症监护病房（NICU）入住率均无显著差异。与 PGE2 相比，ISMN 在引产前促进宫颈成熟的效果较差，且与较高的药物相关母体毒性相关。
