Department of Pharmacoeconomics, Faculty of Pharmacy and Pharmaceutical Sciences, Islamic Azad University of Tehran, Tehran, Iran; Department of Pharmacoeconomic and Pharmaceutical Management, Faculty of Pharmacy and Pharmaceutical Sciences, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran.
Department of Pharmacoeconomics, Faculty of Pharmacy and Pharmaceutical Sciences, Islamic Azad University of Tehran, Tehran, Iran; Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran.
Eur J Obstet Gynecol Reprod Biol. 2024 Jan;292:75-88. doi: 10.1016/j.ejogrb.2023.11.006. Epub 2023 Nov 8.
A large number of randomized controlled trials (RCTs) have been published on the effects of oral/vaginal misoprostol and oxytocin on delivery outcomes; however, data from these RCTs are conflicting. Although some meta-analyses summarized available findings in this regard, several eligible RCTs have been published since the release of those meta-analyses. Therefore, the current updated systematic review and meta-analysis of RCTs was conducted to compare the effects of oral/vaginal misoprostol and oxytocin on delivery and neonatal outcomes. A systematic search, using relevant keywords, was done in the online databases of PubMed/Medline, Scopus, and ISI Web of Science, up to April 2023, to identify eligible articles investigating the effect of oral/vaginal misoprostol and oxytocin on delivery outcomes including maternal [cesarean/vaginal delivery within 24 h after labour induction, Tachysystole, hypertonicity, hyper-stimulation, postpartum hemorrhage (PPH)] and neonatal outcomes [mean Apgar score, admission to neonatal intensive care unit (NICU), and death]. In total, 45 RCTs with a total sample size of 8406 participants were included. Meta-analysis revealed that vaginal misoprostol administration, compared with oxytocin, resulted in a significant reduction in the rate of cesarean and a significant increase in the rate of vaginal delivery and Tachysystole risk. Also, oral misoprostol was associated with a significant reduction in the rate of cesarean and a significant increase in the risk of hypertonicity compared with oxytocin. However, oral misoprostol had no significant effect on vaginal delivery compared with oxytocin. For other outcomes including hyper-stimulation, perinatal death, NICU admission, and mean Apgar score among newborns, we found no significant difference between oral/vaginal misoprostol and oxytocin. In total, vaginal/oral misoprostol might be a better method for labour induction compared with oxytocin. PROSPERO registration: CRD42023412325.
大量随机对照试验（RCT）已经发表，探讨了口服/阴道米索前列醇和催产素对分娩结局的影响；然而，这些 RCT 的数据存在矛盾。尽管一些荟萃分析总结了这方面的现有发现，但自这些荟萃分析发布以来，已经有几项合格的 RCT 发表。因此，进行了这项最新的系统评价和 RCT 荟萃分析，以比较口服/阴道米索前列醇和催产素对分娩和新生儿结局的影响。使用相关关键词，在在线数据库 PubMed/Medline、Scopus 和 ISI Web of Science 中进行了系统搜索，截至 2023 年 4 月，以确定调查口服/阴道米索前列醇和催产素对分娩结局（包括产妇[24 小时内剖宫产/阴道分娩、宫缩过速、高张力、高刺激、产后出血（PPH）]和新生儿结局[平均 Apgar 评分、新生儿重症监护病房（NICU）入院和死亡]影响的合格文章。共有 45 项 RCT 纳入了 8406 名参与者。Meta 分析显示，与催产素相比，阴道米索前列醇给药可显著降低剖宫产率，显著增加阴道分娩率和宫缩过速风险。此外，与催产素相比，口服米索前列醇可显著降低剖宫产率，增加高张力风险。然而，与催产素相比，口服米索前列醇对阴道分娩没有显著影响。对于其他结局，包括高刺激、围产儿死亡、NICU 入院和新生儿平均 Apgar 评分，我们没有发现口服/阴道米索前列醇与催产素之间有显著差异。总的来说，与催产素相比，阴道/口服米索前列醇可能是一种更好的引产方法。PROSPERO 注册号：CRD42023412325。
