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Oral Misoprostol for Induction of Labour in Term PROM: A Systematic Review

  • Author Footnotes
    ⁎ L. Padayachee and M. Kale are joint first authors.
    Larissa Padayachee
    Correspondence
    Corresponding author: Larissa Padayachee.
    Footnotes
    ⁎ L. Padayachee and M. Kale are joint first authors.
    Affiliations
    Department of Obstetrics & Gynecology, Foothills Medical Centre, University of Calgary, Calgary, AB
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  • Author Footnotes
    ⁎ L. Padayachee and M. Kale are joint first authors.
    Mruganka Kale
    Footnotes
    ⁎ L. Padayachee and M. Kale are joint first authors.
    Affiliations
    Department of Obstetrics & Gynecology, Foothills Medical Centre, University of Calgary, Calgary, AB
    Search for articles by this author
  • Jaelene Mannerfeldt
    Affiliations
    Department of Obstetrics & Gynecology, Foothills Medical Centre, University of Calgary, Calgary, AB
    Search for articles by this author
  • Amy Metcalfe
    Affiliations
    Department of Obstetrics & Gynecology, Foothills Medical Centre, University of Calgary, Calgary, AB

    Department of Community Health Sciences, Foothills Medical Centre, University of Calgary, Calgary, AB

    Department of Medicine, Foothills Medical Centre, University of Calgary, Calgary, AB
    Search for articles by this author
  • Author Footnotes
    ⁎ L. Padayachee and M. Kale are joint first authors.
Published:April 30, 2020DOI:https://doi.org/10.1016/j.jogc.2020.02.111

      Abstract

      Objective

      To assess the efficacy of oral misoprostol for induction of labour (IOL) in the context of term pre-labour rupture of membranes (TPROM), and to assess pregnancy outcomes following the administration of oral misoprostol.

      Data Sources

      A systematic literature search was performed using Ovid Medline, Embase, PubMed, and the Cochrane Database of Systematic Reviews.

      Study Selection

      Eligible studies were quasi-experimental trials or randomized controlled trials involving the use of oral misoprostol in singleton cephalic term pregnancies with confirmed rupture of membranes and no spontaneous labour at the time of membranes rupture, in mothers with no contraindications to vaginal delivery. Studies were excluded if they utilized vaginal misoprostol, excluded primigravid participants, or if the full text of the article was not accessible in English.

      Data Extraction

      Data were extracted by two reviewers using a standardized data extraction form. Study quality was assessed using the modified Jadad score.

      Data Synthesis

      Twelve randomized controlled trials that included 1489 singleton pregnancies were included. Doses of oral misoprostol ranged from 20 to 200 μg. The incidence of vaginal birth ranged from 73.0%–95.0% in the oral misoprostol group compared with 52.4%–94% in the control group. Hyperstimulation was infrequent, ranging from 0% to 13.8% in the oral misoprostol group compared with 0%–24% in the control group. Two trials, involving a total of 144 women that compared 50 μg of oral misoprostol every 4 hours versus expectant management followed by PGE2 gel showed a higher incidence of vaginal birth with misoprostol (pooled risk ratio 1.33, 95% confidence interval 1.10–1.61).

      Conclusion

      Oral misoprostol appears to be a safe and effective for IOL in TPROM. However, the varying administration, dose, and frequency reported in the literature highlights the need to develop a standardized protocol for use in Canadian obstetrical practice.

      Résumé

      Objectif

      Évaluer l'efficacité du misoprostol par voie orale pour le déclenchement artificiel du travail (DAT) dans un contexte de rupture prématurée des membranes à terme (RPMT) et évaluer les issues de grossesse après l'administration de misoprostol par voie orale.

      Sources de données

      Une recherche documentaire systématique a été effectuée dans les bases de données Ovid Medline, Embase, PubMed et Cochrane Database of Systematic Reviews.

      Sélection des études

      Les études admissibles étaient des essais quasi-expérimentaux ou des essais cliniques randomisés portant sur le misoprostol par voie orale en cas de grossesse monofœtale à terme avec présentation céphalique et rupture confirmée des membranes, sans travail spontané lors de la rupture, chez des mères qui ne présentaient aucune contre-indication à l'accouchement vaginal. Les auteurs ont exclu les études qui portaient sur l'administration de misoprostol par voie vaginale, qui excluaient les participantes primigestes et les études dont le texte intégral de l'article n’était pas accessible en anglais.

      Extraction des données

      Deux évaluateurs ont extrait les données à l'aide d'un formulaire d'extraction de données normalisé. La qualité des études a été évaluée au moyen des scores de l’échelle de Jadad modifiée.

      Synthèse des données

      Douze essais cliniques randomisés totalisant 1 489 grossesses monofœtales ont été inclus. Les doses de misoprostol administrées par voie orale variaient de 20 à 200 μg. L'incidence de l'accouchement vaginal variait de 73,0 % à 95,0 % dans le groupe du misoprostol par voie orale, comparativement à un taux de 52,4 % à 94 % dans le groupe témoin. L'hyperactivité utérine était peu fréquente, allant de 0 % à 13,8 % dans le groupe du misoprostol par voie orale, comparativement à un taux de 0 % à 24 % dans le groupe témoin. Deux essais réalisés auprès de 144 femmes ont comparé l'administration d'une dose 50 μg de misoprostol par voie orale toutes les 4 heures à la prise en charge non interventionniste suivie de l'application de gel de PGE2; les essais ont indiqué une incidence plus élevée de l'accouchement vaginal avec l'administration de misoprostol (risque relatif global : 1,33; intervalle de confiance de 95 % : 1,10–1,61) en comparaison avec la prise en charge non interventionniste.

      Conclusion

      Le misoprostol par voie orale semble être sécuritaire et efficace pour le DAT en cas de RPMT. Toutefois, les différences rapportées dans la littérature relativement à l'administration, la dose et la fréquence mettent en lumière la nécessité de mettre au point un protocole normalisé pour l'administration de misoprostol par voie orale dans la pratique obstétricale canadienne.

      Keywords

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