Oral/vaginal misoprostol better than oxytocin for labour induction in pregnant women

The updated systematic review and meta-analysis of RCTs revealed that compared with oxytocin, the administration of vaginal misoprostol led to a significant increase in the rate of vaginal delivery and Tachysystole risk and a significant reduction in the rate of cesarean. Oral misoprostol was tied to a significant reduction in cesarean rate and a significant rise in the hypertonicity risk but had no significant effect on vaginal delivery versus oxytocin.

A large number of randomized controlled trials (RCTs) have been published on the effects of oxytocin and vaginal/oral misoprostol on delivery outcomes, however, data from these RCTs have been conflicting. Some meta-analyses summarized available findings in this regard but several eligible RCTs have been published since the release of those meta-analyses.

Therefore, Majid Davari Dolatabadi, Tehran University of Medical Sciences, Tehran, Iran, and colleagues compared the effects of oral/vaginal misoprostol and oxytocin on neonatal and delivery outcomes in an updated systematic review and meta-analysis of RCTs.

For this purpose, the researchers conducted a systematic search of online databases up to April 2023 to identify articles investigating the effect of oxytocin and oral/vaginal misoprostol on delivery outcomes including neonatal and maternal outcomes. A total of 45 RCTs comprising 8406 participants were included.

Maternal outcomes include Tachysystole, cesarean/vaginal delivery within 24 hours after labour induction, hyper-stimulation, hypertonicity, and postpartum haemorrhage (PPH). Neonatal outcomes included admission to NICU (neonatal intensive care unit), mean Apgar score, and death.

Based on the study, the researchers reported the following findings:

• Vaginal misoprostol administration, compared with oxytocin, resulted in a significant reduction in the rate of cesarean and a significant increase in the rate of vaginal delivery and Tachysystole risk.
• Oral misoprostol was associated with a significant reduction in the rate of cesarean and a significant increase in the risk of hypertonicity compared with oxytocin.
• Oral misoprostol had no significant effect on vaginal delivery compared with oxytocin.
• For other outcomes including perinatal death, hyper-stimulation, NICU admission, and mean Apgar score among newborns, no significant difference was found between oral/vaginal misoprostol and oxytocin.

"The findings showed that vaginal misoprostol increased vaginal deliveries but raised the risk of Tachysystole and reduced cesarean rates," the researchers wrote. "Oral misoprostol reduced cesarean rates and increased the hypertonicity risk compared to oxytocin."

They noted that oral misoprostol had no significant effect on vaginal delivery compared to oxytocin.

Reference:

Ameri, A., Jafari-Azar, Z., Anabi, M., & Dolatabadi, M. D. (2023). Effect of misoprostol versus oxytocin on delivery outcomes after labour induction in pregnant women: A systematic review and meta-analysis of randomized controlled trials. European Journal of Obstetrics & Gynecology and Reproductive Biology. https://doi.org/10.1016/j.ejogrb.2023.11.006