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SYSTEMATIC REVIEW article

Front. Med.
Sec. Obstetrics and Gynecology
Volume 11 - 2024 | doi: 10.3389/fmed.2024.1459793
This article is part of the Research Topic Reviews in Obstetrics and Gynecology View all 6 articles

Efficacy and safety of misoprostol compared with dinoprostone for labor induction at term: An updated systematic review and meta-analysis of randomized controlled trials

Provisionally accepted
Nusrat Lakho Nusrat Lakho 1Mahrukh Hyder Mahrukh Hyder 2Taimoor Ashraf Taimoor Ashraf 3Sajida Khan Sajida Khan 4Ajay Kumar Ajay Kumar 5Maheen Jabbar Maheen Jabbar 6Madhurta Kumari Madhurta Kumari 5Asfia Qammar Asfia Qammar 7Sateesh Kumar Sateesh Kumar 5,8Muskan Kumari Muskan Kumari 5FNU Deepak FNU Deepak 5,8Kapil Raj Kapil Raj 5,8Azzam Ali Azzam Ali 9*
  • 1 Isra University Karachi-Campus, Karachi, Punjab, Pakistan
  • 2 Jinnah Post Graduate Medical Centre, Karachi, Sindh, Pakistan
  • 3 Nishtar Medical College, Multan, Punjab, Pakistan
  • 4 Sri Aurobindo University, Indore, Madhya Pradesh, India
  • 5 Shaheed Mohtarma Benazir Bhutto Medical University, Larkana, Sindh, Pakistan
  • 6 Bahria University Medical & Dental College, Karachi, Punjab, Pakistan
  • 7 Dow Medical College, Dow University of Health Sciences, Karachi, Punjab, Pakistan
  • 8 Shaheed Mohtarma Benazir Bhutto Medical University, Larkana, Pakistan
  • 9 Dow University of Health Sciences, Karachi, Pakistan

The final, formatted version of the article will be published soon.

    Abstract Background: Labor induction is a common obstetric intervention, increasingly performed worldwide, often using prostaglandins like misoprostol and dinoprostone. Objective: 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. Methods: 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 hours, 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. Results: 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), p = 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. Conclusion: 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.

    Keywords: Misoprostol, Dinoprostone, Intravaginally, labor induction, term

    Received: 04 Jul 2024; Accepted: 26 Nov 2024.

    Copyright: © 2024 Lakho, Hyder, Ashraf, Khan, Kumar, Jabbar, Kumari, Qammar, Kumar, Kumari, Deepak, Raj and Ali. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Azzam Ali, Dow University of Health Sciences, Karachi, Pakistan

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.