Lakho Nusrat, Hyder Mahrukh, Ashraf Taimoor, Khan Sajida, Kumar Ajay, Jabbar Maheen, Kumari Madhurta, Qammar Asfia, Kumar Sateesh, Kumari Muskan, Deepak Fnu, Raj Kapil, Ali Azzam
Isra University Karachi-Campus, Karachi, Pakistan.
Jinnah Post Graduate Medical Centre, Karachi, Pakistan.
Front Med (Lausanne). 2024 Dec 9;11:1459793. doi: 10.3389/fmed.2024.1459793. eCollection 2024.
Labor induction is a common obstetric intervention, increasingly performed worldwide, often using prostaglandins like misoprostol and dinoprostone.
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.
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.
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), = 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.
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.
引产是一种常见的产科干预措施，在全球范围内的实施频率日益增加，通常使用米索前列醇和地诺前列酮等前列腺素。
本研究旨在比较阴道内使用米索前列醇与地诺前列酮引产的有效性和安全性，考察它们对各种孕产妇和新生儿结局的影响。
于2000年1月至2023年4月期间，使用四个数据库——PubMed、谷歌学术、EBSCO和考克兰图书馆进行系统评价和荟萃分析。我们纳入了涉及足月（37 - 42周）单胎妊娠且宫颈条件不佳的随机对照试验（RCT），比较阴道内使用米索前列醇与地诺前列酮的情况。评估有效性的关键结局包括24小时内阴道分娩、总体阴道分娩率以及催产素加强的需求。评估的安全性结局包括宫缩过速、子宫过度刺激、异常胎心监护、新生儿重症监护病房（NICU）入院、剖宫产以及阿氏评分。使用Review Manager（RevMan）5.4.1版本中的随机效应模型计算风险比（RRs）和95%置信区间（CIs）。
八项RCT共1801名参与者（米索前列醇组937名，地诺前列酮组864名）符合纳入标准。米索前列醇所需的催产素加强显著少于地诺前列酮[RR = 0.83；95% CI（0.71，0.97），P = 0.02]。包括剖宫产率、子宫宫缩过速、过度刺激和NICU入院率在内的其他结局在两组之间无显著差异，表明安全性和有效性相当。
这项荟萃分析表明，阴道内使用米索前列醇是足月引产时地诺前列酮的一种有效且安全的替代方法。米索前列醇在实现相当的有效性和安全性结局的同时，所需的催产素加强较少，支持其作为临床实践中一种实用引产药物的潜力。
