270 Oral misoprostol versus vaginal dinoprostone for labor induction: a meta-analysis of randomized clinical trials

Abstract

The current evidence is dispersed regarding whether oral misoprostol has equal effect to vaginal dinoprostone in induction of labour (IOL). Dinoprostone (PGE2) preparations are expensive and need appropriate storage. Misoprostol (PGE1) is easy to store, stable at room temperature and cheap. We searched 8 electronic databases, from inception up to February 2020, for randomized clinical trials comparing oral misoprostol and vaginal dinoprostone for IOL among women with unfavorable cervix. All Randomized clinical trials found were included. These studies included nulliparous or multiparous women prepared for IOL with a gestational age > 34 weeks with a singleton pregnancy in the cephalic presentation. In this concern, women did not have any contraindication to vaginal delivery despite the presence of unfavorable cervix (Bishop’s <6) were included. Additionally, participants with intact amniotic membranes along with the absence of fetal distress or active labor were included. Women with a history of caesarean delivery or uterine surgery were excluded. The screening process was performed by two reviewers independently screened and reviewed all articles. 6 studies met our inclusion criteria comprehending an overall 1694 women. Out of them, 791 women received oral misoprostol, the remaining 903 participants received dinoprostone. Multiparous women within misoprostol group experienced a statistically significant higher rates of vaginal deliveries within 24 hours (RR 1.15; 95 CI% 1, 1.33;P=0.04).No statistically significant difference in C/S rate between misoprostol and dinoprostone groups (RR 0.94; 95 CI% 0.78, 1.12;P=0.48) Oral misoprostol accomplished safety and efficacy as vaginal dinoprostone for IOL among women with unfavorable cervix with a preferable outcome regarding the rate of vaginal delivery within 24 hours among multiparous women. There was no significant difference between oral misoprostol and vaginal dinoprostone in the pattern of oxytocin use, the rates of vaginal delivery within 48 hours and maternal complications.View Large Image Figure ViewerDownload Hi-res image Download (PPT)