A Cochrane review [Abstract] 1 included 76 studies with a total of 14 412 subjects. As compared with placebo (9 studies, n=1 109), women using oral misoprostol (OM)(a synthetic prostaglandin E1 analogue) were more likely to deliver vaginally within 24 hours (RR 0.16, 95% CI 0.05 to 0.49; 1 trial, n=96), needed less oxytocin (RR 0.42, 95% CI 0.37 to 0.49; 7 trials, n=933) and had a lower caesarean section rate (RR 0.72, 95% CI 0.54 to 0.95; 8 trials, n=1029).As compared with vaginal dinoprostone (12 studies, n=3 859), women given OM were less likely to need a caesarean section (RR 0.88, 95% CI 0.78 to 0.99; 11 trials, n=3 592).There was some evidence that they had slower inductions, but there were no other significant differences. As compared with intravenous oxytocin (9 studies, n=1 282 ),the caesarean section rate was significantly lower in women who received oral misoprostol (RR 0.77, 95% CI 0.60 to 0.98; 9 trials, n=1282), butthey had an increase in meconium-stained liquor (RR 1.65, 95% CI 1.04 to 2.60; 7 trials, n=1 172). 37 studies (n=6 417) compared oral and vaginal misoprostol and found no difference in the primary outcomes. However there were fewer babies born with a low Apgar score in the OM group (RR 0.60, 95% CI 0.44 to 0.82; 19 trials, 4009 babies).
A Cochrane review [Abstract] 2 included 61 studies with a total of 20 026 subjects. Compared with vaginal dinoprostone, oral misoprostol resulted in fewer caesarean sections (RR 0.84, 95% CI 0.78 to 0.90; 13 trials, n=9676). Subgroup analysis indicated that 10 µg to 25 µg (RR 0.80, 95% CI 0.74 to 0.87; 9 trials; n=8652) may differ from 50 µg (RR 1.10, 95% CI 0.91 to 1.34; 4 trials; n=1024) for caesarean section. Oral misoprostol decreased hyperstimulation with foetal heart rate changes (RR 0.49, 95% CI 0.40 to 0.59; 11 trials; n=9084). Compared with vaginal misoprostol, oral misoprostol resulted in fewer vaginal births within 24 hours (average RR 0.81, 95% CI 0.68 to 0.95; 16 trials, n=3451), and less hyperstimulation with foetal heart rate changes (RR 0.69, 95% CI 0.53 to 0.92, 25 trials, n=4857), with subgroup analysis suggesting that 10 µg to 25 µg orally (RR 0.28, 95% CI 0.14 to 0.57; 6 trials, n=957) may be superior to 50 µg orally (RR 0.82, 95% CI 0.61 to 1.11; 19 trials; n=3900).
| Active intervention vs placebo | Odds ratio | 95% CI |
|---|---|---|
| i.v. oxytocin with amniotomy | 0.05 | 0.07 to 0.32 |
| Vaginal misoprostol ≥ 50 μg | 0.09 | 0.06 to 0.24 |
| Titrated (low-dose) oral misoprostol solution | 0.10 | 0.07 to 0.29 |
| Vaginal misoprostol < 50 μg | 0.11 | 0.09 to 0.32 |
| Buccal/sublingual misoprostol | 0.11 | 0.05 to 0.19 |
| Vaginal PGE2 pessary (normal release) | 0.11 | 0.04 to 0.16 |
| Oral misoprostol tablet ≥ 50 μg | 0.16 | 0.05 to 0.20 |
| Double-balloon or Cook's catheter | 0.18 | 0.01 to 0.16 |
| Foley catheter | 0.19 | 0.09 to 0.46 |
| Oral misoprostol tablet < 50 μg | 0.22 | 0.07 to 0.39 |
Primary/Secondary Keywords