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Balancing the efficacy and safety of misoprostol: a meta‐analysis comparing 25 versus 50 micrograms of intravaginal misoprostol for the induction of labour
Author(s) -
McMaster K,
SanchezRamos L,
Kaunitz AM
Publication year - 2015
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.12935
Subject(s) - medicine , misoprostol , relative risk , meconium , obstetrics , apgar score , vaginal delivery , confidence interval , oxytocin , caesarean section , randomized controlled trial , anesthesia , pregnancy , fetus , surgery , abortion , genetics , biology
Background The optimal dose of misoprostol for the induction of labour remains uncertain. Objectives To compare the efficacy and safety of 25 versus 50 micrograms of intravaginal misoprostol tablets for the induction of labour and cervical ripening. Search strategy We performed electronic and manual searches to identify relevant randomised trials. Selection criteria The efficacy outcomes assessed were rates of vaginal delivery within 24 hours, delivery within one dose, and oxytocin augmentation, and interval to delivery. The safety outcomes assessed were incidences of tachysystole, hyperstimulation, caesarean delivery, cesarean delivery for non‐reassuring fetal heart rate ( FHR ), operative vaginal delivery, abnormal 5‐minute Apgar score, abnormal cord gas values, admission to a neonatal intensive care unit ( NICU ), and meconium passage. Data collection and analysis Thirteen studies (1945 women) were included. Relative risk ( RR ) and 95% confidence intervals (CI) were calculated using fixed‐effects and random‐effects models. Main results We found that 25 micrograms was less efficacious, with lower rates of delivery after one dose ( RR 0.59; 95% CI 0.39–0.88) and vaginal delivery within 24 hours ( RR 0.88; 95% CI 0.79–0.96), and with increased rates of oxytocin augmentation ( RR 1.54, 95% CI 1.36–1.75). We noted an improved safety profile with 25 micrograms, however, with decreased rates of tachysystole ( RR 0.46; 95% CI 0.35–0.61), hyperstimulation ( RR 0.5; 95% CI 0.31–0.78), caesarean deliveries for non‐reassuring FHR ( RR 0.67; 95% CI 0.52–0.87), NICU admissions ( RR 0.63; 95% CI 0.4–0.98), and meconium passage ( RR 0.65; 95% CI 0.45–0.96). Conclusions Although 50 micrograms of intravaginal misoprostol may be more efficacious, safety concerns make the 25‐microgram dose preferable.