Efficacy and safety of intravaginal misoprostol versus intracervical dinoprostone for labor induction at term: a systematic review and meta-analysis.
OBJECTIVE
Recent studies suggest that misoprostol may be more effective than dinoprostone in pregnant women with unfavorable cervix. The objective here is to investigate and compare the efficacy and safety of intravaginal misoprostol and intracervical dinoprostone for labor induction, including incidence of cesarean section, vaginal delivery rate within 24 h, uterine hyperstimulation, tachysystole, oxytocin augmentation, neonatal intensive care unit (NICU) admissions, and Apgar score of less than 7 at 1 and 5 min.


METHODS
Databases searched were MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials, up to July 2013. Randomized controlled trials comparing intravaginal misoprostol with intracervical dinoprostone in women with singleton pregnancy, intact membranes and unfavorable cervix (Bishop's <6) were included. Pooled relative risk, mean difference and 95% confidence intervals were calculated.


RESULTS
The use of misoprostol was significantly effective in increasing the rate of vaginal delivery within 24 h and less oxytocin augmentation when compared with dinoprostone. However, the incidents of uterine hyperstimulation and tachysystole were significantly higher under the misoprostol protocol than dinoprostone protocol. Furthermore, we found similar efficiency in the rate of cesarean delivery, NICU admission and Apgar score at 1 and 5 min among the study groups.


CONCLUSIONS
Intravaginal misoprostol appears to be more efficient for labor induction than intracervical dinoprostone; however, dinoprostone has been demonstrated to be safer because of the lower incidence of uterine hyperstimulation and tachysystole. Further high-quality studies assessing the possible effectiveness of misoprostol and dinoprostone in selected groups of patients are warranted.
Gynecology Department, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
Aihai
A
Liu
Jieqiang
J
Lv
Yue
Y
Hu
Junzhe
J
Lang
Luhang
L
Ma
Wenbing
W
Chen
D000282:Administration, Intravaginal; D000818:Animals; D002584:Cervix Uteri; D015232:Dinoprostone / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007751:Labor, Induced / Q000009:adverse effects*; D016595:Misoprostol / Q000008:administration & dosage / Q000009:adverse effects*; D007744:Obstetric Labor Complications / Q000139:chemically induced* / Q000517:prevention & control; D010120:Oxytocics / Q000008:administration & dosage / Q000009:adverse effects*; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D047929:Term Birth
D010120:Oxytocics; D016595:Misoprostol; D015232:Dinoprostone
dinoprostone; labor induction; misoprostol