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Alimentary Pharmacology & Therapeutics Jun 2016Many strategies are used to prevent nonsteroidal anti-inflammatory drug (NSAID)-associated gastrointestinal toxicity, but the comparative effectiveness remains unclear. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Many strategies are used to prevent nonsteroidal anti-inflammatory drug (NSAID)-associated gastrointestinal toxicity, but the comparative effectiveness remains unclear.
AIM
To evaluate the comparative effectiveness of clinical strategies for preventing gastrointestinal toxicity induced by NSAIDs.
METHODS
MEDLINE, EMBASE and the Cochrane Library (from their inception to May 2015) were searched for randomised controlled trials comparing the risk of gastrointestinal adverse events in patients taking nonselective NSAIDs, selective cyclooxygenase(COX)-2 inhibitors or nonselective NSAIDs/COX-2 inhibitors plus gastroprotective agents [proton pump inhibitors (PPIs), histamine-2 receptor antagonists, misoprostol]. Both pairwise meta-analysis and Bayesian network meta-analysis were performed.
RESULTS
Analyses were based on 82 trials including 125 053 participants. Network meta-analysis demonstrated that selective COX-2 inhibitors + PPIs [Risk ratio (RR), 95% Credible Interval (CrI): ulcer complications 0.07, 0.02-0.18], selective COX-2 inhibitors (RR, 95% CrI: ulcer complications 0.25, 0.15- 0.38; symptomatic ulcer 0.12, 0.04-0.30), nonselective NSAIDs + PPIs (RR, 95% CrI: ulcer complications 0.28, 0.18-0.41; symptomatic ulcer 0.11, 0.04-0.23), nonselective NSAIDs + misoprostol (RR, 95% CrI: ulcer complications 0.47, 0.24-0.81; symptomatic ulcer 0.41, 0.13-1.00) were associated with significantly lower risk of clinical gastrointestinal events compared with nonselective NSAIDs. For all effectiveness endpoints, selective COX-2 inhibitors + PPIs was associated with the lowest absolute event probability and the highest rank, followed by selective COX-2 inhibitors and thirdly by nonselective NSAIDs + PPIs.
CONCLUSION
The combination of selective COX-2 inhibitors plus PPIs provides the best gastrointestinal protection, followed by selective COX-2 inhibitors, and thirdly by nonselective NSAIDs plus PPIs.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Anti-Ulcer Agents; Bayes Theorem; Gastrointestinal Diseases; Histamine H2 Antagonists; Humans; Misoprostol; Network Meta-Analysis; Proton Pump Inhibitors; Randomized Controlled Trials as Topic
PubMed: 27121479
DOI: 10.1111/apt.13642 -
The Cochrane Database of Systematic... Jun 2017Women with a prior caesarean delivery have an increased risk of uterine rupture and for women subsequently requiring induction of labour it is unclear which method is... (Review)
Review
BACKGROUND
Women with a prior caesarean delivery have an increased risk of uterine rupture and for women subsequently requiring induction of labour it is unclear which method is preferable to avoid adverse outcomes. This is an update of a review that was published in 2013.
OBJECTIVES
To assess the benefits and harms associated with different methods used to induce labour in women who have had a previous caesarean birth.
SEARCH METHODS
We searched Cochrane Pregnancy and Childbirth's Trials Register (31 August 2016) and reference lists of retrieved studies.
SELECTION CRITERIA
Randomised controlled trials (RCTs) comparing any method of third trimester cervical ripening or labour induction, with placebo/no treatment or other methods in women with prior caesarean section requiring labour induction in a subsequent pregnancy.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed studies for inclusion and trial quality, extracted data, and checked them for accuracy.
MAIN RESULTS
Eight studies (data from 707 women and babies) are included in this updated review. Meta-analysis was not possible because studies compared different methods of labour induction. All included studies had at least one design limitation (i.e. lack of blinding, sample attrition, other bias, or reporting bias). One study stopped prematurely due to safety concerns. Vaginal PGE2 versus intravenous oxytocin (one trial, 42 women): no clear differences for caesarean section (risk ratio (RR) 0.67, 95% confidence interval (CI) 0.22 to 2.03, evidence graded low), serious neonatal morbidity or perinatal death (RR 3.00, 95% CI 0.13 to 69.70, evidence graded low), serious maternal morbidity or death (RR 3.00, 95% CI 0.13 to 69.70, evidence graded low). Also no clear differences between groups for the reported secondary outcomes. The GRADE outcomes vaginal delivery not achieved within 24 hours, and uterine hyperstimulation with fetal heart rate changes were not reported. Vaginal misoprostol versus intravenous oxytocin (one trial, 38 women): this trial stopped early because one woman who received misoprostol had a uterine rupture (RR 3.67, 95% CI 0.16 to 84.66) and one had uterine dehiscence. No other outcomes (including GRADE outcomes) were reported. Foley catheter versus intravenous oxytocin (one trial, subgroup of 53 women): no clear difference between groups for vaginal delivery not achieved within 24 hours (RR 1.47, 95% CI 0.89 to 2.44, evidence graded low), uterine hyperstimulation with fetal heart rate changes (RR 3.11, 95% CI 0.13 to 73.09, evidence graded low), and caesarean section (RR 0.93, 95% CI 0.45 to 1.92, evidence graded low). There were also no clear differences between groups for the reported secondary outcomes. The following GRADE outcomes were not reported: serious neonatal morbidity or perinatal death, and serious maternal morbidity or death. Double-balloon catheter versus vaginal PGE2 (one trial, subgroup of 26 women): no clear difference in caesarean section (RR 0.97, 95% CI 0.41 to 2.32, evidence graded very low). Vaginal delivery not achieved within 24 hours, uterine hyperstimulation with fetal heart rate changes, serious neonatal morbidity or perinatal death, and serious maternal morbidity or death were not reported. Oral mifepristone versus Foley catheter (one trial, 107 women): no primary/GRADE outcomes were reported. Fewer women induced with mifepristone required oxytocin augmentation (RR 0.54, 95% CI 0.38 to 0.76). There were slightly fewer cases of uterine rupture among women who received mifepristone, however this was not a clear difference between groups (RR 0.29, 95% CI 0.08 to 1.02). No other secondary outcomes were reported. Vaginal isosorbide mononitrate (IMN) versus Foley catheter (one trial, 80 women): fewer women induced with IMN achieved a vaginal delivery within 24 hours (RR 2.62, 95% CI 1.32 to 5.21, evidence graded low). There was no difference between groups in the number of women who had a caesarean section (RR 1.00, 95% CI 0.39 to 2.59, evidence graded very low). More women induced with IMN required oxytocin augmentation (RR 1.65, 95% CI 1.17 to 2.32). There were no clear differences in the other reported secondary outcomes. The following GRADE outcomes were not reported: uterine hyperstimulation with fetal heart rate changes, serious neonatal morbidity or perinatal death, and serious maternal morbidity or death. 80 mL versus 30 mL Foley catheter (one trial, 154 women): no clear difference between groups for the primary outcomes: vaginal delivery not achieved within 24 hours (RR 1.05, 95% CI 0.91 to 1.20, evidence graded moderate) and caesarean section (RR 1.05, 95% CI 0.89 to 1.24, evidence graded moderate). However, more women induced using a 30 mL Foley catheter required oxytocin augmentation (RR 0.81, 95% CI 0.66 to 0.98). There were no clear differences between groups for other secondary outcomes reported. Several GRADE outcomes were not reported: uterine hyperstimulation with fetal heart rate changes, serious neonatal morbidity or perinatal death, and serious maternal morbidity or death. Vaginal PGE2 pessary versus vaginal PGE2 tablet (one trial, 200 women): no difference between groups for caesarean section (RR 1.09, 95% CI 0.74 to 1.60, evidence graded very low), or any of the reported secondary outcomes. Several GRADE outcomes were not reported: vaginal delivery not achieved within 24 hours, uterine hyperstimulation with fetal heart rate changes, serious neonatal morbidity or perinatal death, and serious maternal morbidity or death.
AUTHORS' CONCLUSIONS
RCT evidence on methods of induction of labour for women with a prior caesarean section is inadequate, and studies are underpowered to detect clinically relevant differences for many outcomes. Several studies reported few of our prespecified outcomes and reporting of infant outcomes was especially scarce. The GRADE level for quality of evidence was moderate to very low, due to imprecision and study design limitations.High-quality, adequately-powered RCTs would be the best approach to determine the optimal method for induction of labour in women with a prior caesarean birth. However, such trials are unlikely to be undertaken due to the very large numbers needed to investigate the risk of infrequent but serious adverse outcomes (e.g. uterine rupture). Observational studies (cohort studies), including different methods of cervical ripening, may be the best alternative. Studies could compare methods believed to provide effective induction of labour with low risk of serious harm, and report the outcomes listed in this review.
Topics: Dinoprostone; Early Termination of Clinical Trials; Female; Humans; Labor, Induced; Misoprostol; Oxytocics; Oxytocin; Pregnancy; Randomized Controlled Trials as Topic; Uterine Rupture; Vaginal Birth after Cesarean
PubMed: 28599068
DOI: 10.1002/14651858.CD009792.pub3 -
Annals of Palliative Medicine Sep 2021To date, guidelines on the impact and value of atropine combined with omeprazole in the treatment of acute gastritis have not been well established or well defined. This... (Meta-Analysis)
Meta-Analysis
BACKGROUND
To date, guidelines on the impact and value of atropine combined with omeprazole in the treatment of acute gastritis have not been well established or well defined. This study aimed to clarify the efficacy and safety of combined atropine and omeprazole therapy for the management of patients with acute gastritis.
METHODS
Through searching the electronic database, the related literature of the combination of atropine with omeprazole in the treatment of acute gastritis were reviewed. A meta-analysis was performed after literature selection according to inclusion criteria. The treatment efficiency and the incidence of adverse reactions were used as the main outcome indicators. The odds ratios (ORs), standardized mean differences (SMDs), and 95% confidence intervals (CIs) of the two treatment regimens were analyzed.
RESULTS
This study analyzed 11 articles from the literature with a total of 1,053 subjects. The combination of atropine and omeprazole significantly improved the clinical outcomes of patients with acute gastritis compared to patients treated with combined anisodamine and omeprazole (control group). The effective rate of combined atropine and omeprazole treatment was 1.21 times higher than that observed with the control group, and the incidence of adverse reactions was 0.41 times that of the control group. Atropine combined with omeprazole significantly alleviated the clinical symptoms of the patients. The total treatment time was shortened by 0.57 days, duration of abdominal pain was shortened by 2.82 days, duration of diarrhea was reduced by 1.99 days, and the duration of nausea and vomiting was shortened by 2.68 days compared to the control group.
DISCUSSION
The combination of atropine with omeprazole in the treatment of acute gastritis demonstrated a high effective rate with few adverse reactions than. It was effective at alleviating the clinical symptoms associated with acute gastritis. The results of this study provide support for the clinical implementation of combined atropine and omeprazole in the treatment of patients with acute gastritis.
Topics: Atropine; Gastritis; Humans; Omeprazole; Treatment Outcome
PubMed: 34628879
DOI: 10.21037/apm-21-1868 -
Fertility and Sterility Jan 2016To examine the long-term complications and reproductive outcomes after the management of retained products of conception (RPOC). (Review)
Review
OBJECTIVE
To examine the long-term complications and reproductive outcomes after the management of retained products of conception (RPOC).
DESIGN
Systematic review.
SETTING
Not applicable.
PATIENT(S)
Women suspected of RPOC who were subjected to medical therapy with misoprostol or surgical treatment.
INTERVENTION(S)
An electronic literature search was conducted in June 2015 using MEDLINE, EMBASE, and the Cochrane library. We included clinical trials in which women were consecutively included, independent of their symptoms.
MAIN OUTCOME MEASURE(S)
The prevalence of intrauterine adhesions (IUAs) and reproductive outcomes.
RESULT(S)
No studies reporting on IUAs or reproductive indicators after medical management with misoprostol were found. We included 10 cohort studies with poor to average methodological quality. Five cohort studies (n = 339) reported IUAs in 22.4% (95% confidence interval, 18.3%-27%) of women hysteroscopically evaluated. Significantly more IUAs were encountered after dilation and curettage (D&C) compared with after hysteroscopic resection (HR): 30% vs. 13%. Incomplete evacuation was encountered in, respectively, 29% and 1% of the D&C and HR cases. Similar conception, ongoing pregnancy, live-birth, and miscarriage rates were reported after D&C and HR in six cohort studies (n = 380), and there was a tendency toward earlier conception after HR. The reproductive outcomes were not reported in relation to IUAs.
CONCLUSION(S)
HR may be a preferable surgical treatment in women suspected of RPOC; fewer IUAs and incomplete evacuations are encountered, while similar reproductive outcomes were reported compared with D&C. Confirmation of the observed effects is required, and trials evaluating medical treatment with misoprostol as well as expectant management are urgently needed.
Topics: Abortifacient Agents, Nonsteroidal; Dilatation and Curettage; Female; Fertility; Humans; Hysteroscopy; Misoprostol; Pregnancy; Pregnancy Complications; Prevalence; Risk Factors; Time Factors; Tissue Adhesions; Treatment Outcome; Uterine Diseases
PubMed: 26453977
DOI: 10.1016/j.fertnstert.2015.09.021 -
Contraception Dec 2016Potential barriers to intrauterine device (IUD) use include provider concern about difficult insertion, particularly for nulliparous women. (Review)
Review
BACKGROUND
Potential barriers to intrauterine device (IUD) use include provider concern about difficult insertion, particularly for nulliparous women.
OBJECTIVE
This study aims to evaluate the evidence on the effectiveness of medications to ease IUD insertion on provider outcomes (i.e., ease of insertion, need for adjunctive insertion measures, insertion success).
SEARCH STRATEGY
We searched the PubMed database for peer-reviewed articles published in any language from database inception through February 2016.
SELECTION CRITERIA
We included randomized controlled trials (RCTs) that examined medications to ease interval insertion of levonorgestrel-releasing IUDs and copper T IUDs.
RESULTS
From 1855 articles, we identified 15 RCTs that met our inclusion criteria. Most evidence suggested that misoprostol did not improve provider ease of insertion, reduce the need for adjunctive insertion measures or improve insertion success among general samples of women seeking an IUD (evidence Level I, good to fair). However, one RCT found significantly higher insertion success among women receiving misoprostol prior to a second IUD insertion attempt after failed attempt versus placebo (evidence Level I, good). Two RCTs on 2% intracervical lidocaine as a topical gel or injection suggested no positive effect on provider ease of insertion (evidence Level I, good to poor), and one RCT on diclofenac plus 2% intracervical lidocaine as a topical gel suggested no positive effect on provider ease of insertion (evidence Level I, good). Limited evidence from two RCTs on nitric oxide donors, specifically nitroprusside or nitroglycerin gel, suggested no positive effect on provider ease of insertion or need for adjunctive insertion measures (evidence Level I, fair).
CONCLUSIONS
Overall, most studies found no significant differences between women receiving interventions to ease IUD insertion versus controls. Among women with a recent failed insertion who underwent a second insertion attempt, one RCT found improved insertion success among women using misoprostol versus placebo.
Topics: Equipment Safety; Female; Humans; Intrauterine Devices; Misoprostol; Nitroglycerin; Nitroprusside; Pain; Randomized Controlled Trials as Topic
PubMed: 27373540
DOI: 10.1016/j.contraception.2016.06.014 -
BMC Women's Health Jul 2020A wide range of drugs have been studied for first trimester medical abortion. Studies evaluating different regimens, including combination mifepristone and misoprostol...
BACKGROUND
A wide range of drugs have been studied for first trimester medical abortion. Studies evaluating different regimens, including combination mifepristone and misoprostol and misoprostol alone regimens, show varying results related to safety, efficacy and other outcomes. Thus, the objectives of this systematic review were to compare the safety, effectiveness and acceptability of medical abortion and to compare medical with surgical methods of abortion ≤63 days of gestation.
METHODS
Pubmed and EMBASE were systematically searched from database inception through January 2019 using a combination of MeSH, keywords and text words. Randomized controlled trials on induced abortion at ≤63 days that compared different regimens of medical abortion using mifepristone and/or misoprostol and trials that compared medical with surgical methods of abortion were included. We extracted data into a pre-designed form, calculated effect estimates, and performed meta-analyses where possible. The primary outcomes were ongoing pregnancy and successful abortion.
RESULTS
Thirty-three studies composed of 22,275 participants were included in this review. Combined regimens using mifepristone and misoprostol had lower rates of ongoing pregnancy, higher rates of successful abortion and satisfaction compared to misoprostol only regimens. In combined regimens, misoprostol 800 μg was more effective than 400 μg. There was no significant difference in dosing intervals between mifepristone and misoprostol and routes of misoprostol administration in combination or misoprostol alone regimens. The rate of serious adverse events was generally low.
CONCLUSION
In this systematic review, we find that medical methods of abortion utilizing combination mifepristone and misoprostol or misoprostol alone are effective, safe and acceptable. More robust studies evaluating both the different combination and misoprostol alone regimens are needed to strengthen existing evidence as well as assess patient perspectives towards a particular regimen.
Topics: Abortifacient Agents, Nonsteroidal; Abortifacient Agents, Steroidal; Abortion, Induced; Female; Humans; Mifepristone; Misoprostol; Pregnancy; Pregnancy Trimester, First
PubMed: 32635921
DOI: 10.1186/s12905-020-01003-8 -
BMJ Open Apr 2024To compare the efficacy and safety of seven Chinese patent medicines (CPMs) combined with conventional triple/quadruple therapy (T/Q) for -positive peptic ulcers. (Meta-Analysis)
Meta-Analysis
Efficacy and safety of seven Chinese patent medicines combined with conventional triple/quadruple therapy for -positive peptic ulcers: a systematic review and network meta-analysis.
OBJECTIVES
To compare the efficacy and safety of seven Chinese patent medicines (CPMs) combined with conventional triple/quadruple therapy (T/Q) for -positive peptic ulcers.
DESIGN
A systematic review and network meta-analysis.
DATA SOURCES
China National Knowledge Infrastructure, VIP database, Wanfang database, ScienceDirect, EBSCO, EMBASE, Web of Science, Cochrane Library and PubMed were searched through 1 June 2022.
ELIGIBILITY CRITERIA
Randomised controlled trials (RCTs) testing CPMs combined with T/Q for -positive peptic ulcers were included. The CPMs included Anweiyang capsule, Jianweiyuyang tablets/capsule/granule, Jinghuaweikang capsule, Kangfuxin liquid, Puyuanhewei capsule, Weifuchun tablets/capsule and Weisu granule. At least one of the following outcome indicators was recorded: complete ulcer healing rate (CUHR), effective rate (ER), eradication rate (ER), rate of peptic ulcer recurrence (RPUR) and incidence of adverse reactions (IAR).
DATA EXTRACTION AND SYNTHESIS
Two researchers independently conducted the study selection and extracted data for included studies. The risk of bias was assessed using the Cochrane risk of bias tool. A pairwise meta-analysis was performed using RevMan V.5.3. Network meta-analysis was performed using STATA/MP V.15.0. Confidence in the evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluation.
RESULTS
A total of 36 RCTs involving 3620 patients were included. Compared with T/Q alone, Weisu+T/Q, Weifuchun+T/Q and Puyuanhewei+T/Q had the highest CUHR, ER and ER, respectively. Weisu+T/Q and Jianweiyuyang+T/Q had the lowest RPUR and IAR, respectively. The cluster analysis results showed Jianweiyuyang+T/Q might be the best choice concerning efficacy and safety simultaneously, followed by Kangfuxin+T/Q.
CONCLUSION
Among the combination therapies with the CPMs, Jianweiyuyang+T/Q might be the most favourable option for -positive peptic ulcers, followed by Kangfuxin+T/Q. Considering the limited quantity and quality of the included RCTs, the results should be interpreted with caution.
PROSPERO REGISTRATION NUMBER
CRD42022327687.
Topics: Humans; Helicobacter Infections; Drug Therapy, Combination; Helicobacter pylori; Network Meta-Analysis; Drugs, Chinese Herbal; Peptic Ulcer; Anti-Bacterial Agents; Randomized Controlled Trials as Topic; Proton Pump Inhibitors; Anti-Ulcer Agents; Treatment Outcome; Nonprescription Drugs
PubMed: 38684278
DOI: 10.1136/bmjopen-2023-074188 -
European Journal of Medical Research Jan 2023This study is aimed to compare the effect of oral misoprostol with vaginal misoprostol to induce labor as a systematic review and meta-analysis. (Meta-Analysis)
Meta-Analysis
OBJECTIVES
This study is aimed to compare the effect of oral misoprostol with vaginal misoprostol to induce labor as a systematic review and meta-analysis.
METHODS
Electronic databases including PubMed [Medline], Scopus, Web of science, Embase, Ovid, Cochrane library, and ClinicalTrials.gov were searched using the relevant keywords. All RCTs comparing the effect of oral vs vaginal misoprostol on labor induction were considered. The Cochrane Risk of Bias checklist was used for assessing quality of included RCTs. All statistical analyses were completed using STATA (Version 16) and Revman (Version 5).
RESULTS
Thirty-three RCTs with 5162 patients (1560 in oral and 2602 in vaginal groups) were included in this meta-analysis. Labor induction length did differ significantly between the two routes of misoprostol administration [Standardized Mean Difference: 0.40 h, 95% confidence interval (CI) 0.34, 0.46; I: 66.35%; P = 0.04]. In addition, the risk of neonatal death, tachysystole, uterine hyperstimulation, preeclampsia, non-FHR and abortion was lower in the oral misoprostol group and the risk of hypertonus, PROM, oxytocin need and cesarean fever was higher in this group than the vaginal misoprostol group.
CONCLUSIONS
Based on results of this meta-analysis, it can be inferred that currently, clinical specialists can decide to use this drug orally or vaginally on a case-by-case basis, depending on the condition of the pregnant mother and the baby.
Topics: Pregnancy; Female; Infant, Newborn; Humans; Misoprostol; Oxytocics; Administration, Oral; Administration, Intravaginal; Labor, Induced
PubMed: 36707858
DOI: 10.1186/s40001-023-01007-8 -
International Journal of Environmental... Mar 2020Currently, there is no meta-analysis comparing intravaginal misoprostol plus intracervical Foley catheter versus intravaginal misoprostol alone for term pregnancy... (Meta-Analysis)
Meta-Analysis
Currently, there is no meta-analysis comparing intravaginal misoprostol plus intracervical Foley catheter versus intravaginal misoprostol alone for term pregnancy without identifying risk factors. Therefore, the purpose of this study is to conduct a systematic review and meta-analysis of randomized control trials (RCTs) comparing concurrent intravaginal misoprostol and intracervical Foley catheter versus intravaginal misoprostol alone for cervical ripening. We systematically searched Embase, Pubmed, and Cochrane Collaboration databases for randomized controlled trials (RCTs) comparing intracervical Foley catheter plus intravaginal misoprostol and intravaginal misoprostol alone using the search terms "Foley", "misoprostol", "cervical ripening", and "induction" up to 29 January 2019. Data were extracted and analyzed by two independent reviewers including study characteristics, induction time, cesarean section (C/S), clinical suspicion of chorioamnionitis, uterine tachysystole, meconium stain, and neonatal intensive care unit (NICU) admissions. Data was pooled using random effects modeling and calculated with risk ratio (RR) and 95% confidence interval (CI). Pooled analysis from eight studies, including 1110 women, showed that labor induction using a combination of intracervical Foley catheter and intravaginal misoprostol decreased induction time by 2.71 h (95% CI -4.33 to -1.08, = 0.001), as well as the risk of uterine tachysystole and meconium staining (RR 0.54, 95% CI 0.30-0.99 and RR 0.48, 95% CI 0.32-0.73, respectively) significantly compared to those using intravaginal misoprostol alone. However, there was no difference in C/S rate (RR 0.93, 95% CI 0.78-1.11) or clinical suspicion of chorioamnionitis rate (RR 1.22, CI 0.58-2.57) between the two groups. Labor induction with a combination of intracervical Foley catheter and intravaginal misoprostol may be a better choice based on advantages in shortening induction time and reducing the risk of uterine tachysystole and meconium staining compared to intravaginal misoprostol alone.
Topics: Administration, Intravaginal; Catheterization; Cervical Ripening; Cesarean Section; Female; Humans; Labor, Induced; Misoprostol; Oxytocics; Pregnancy; Randomized Controlled Trials as Topic
PubMed: 32168947
DOI: 10.3390/ijerph17061825 -
Journal of Healthcare Engineering 2022Hypertensive disorders of pregnancy (HDP) can cause serious prenatal and postnatal complications and is a threat to maternal and fetal health. To offer guidance for... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Hypertensive disorders of pregnancy (HDP) can cause serious prenatal and postnatal complications and is a threat to maternal and fetal health. To offer guidance for clinical decisions, we systematically reviewed the effects of misoprostol on induction of labour in HDP patients.
METHODS
PubMed, Web of Science, Embase, CNKI, and Wanfang databases were searched for relevant literature from 2010 to 2020. Subsequently, a meta-analysis was performed to compare the effective rate of induction of labour and reducing postpartum hemorrhage (PPH) between the intervention group ( = 544, misoprostol) and the control group ( = 543, oxytocin).
RESULTS
A total of 10 studies with 1087 patients were included. The 10 studies compared the effective rate of induction of labour between the two groups and confirmed that the effective rate in the intervention group was significantly higher than that in the control group (OR = 4.37; 95% CI: 2.73, 7.00). Seven studies compared PPH between the groups and showed that it was significantly reduced in the intervention group compared to the control group (SMD = -1.32; 95% CI: -2.05, -0.59; < 0.0001).
CONCLUSION
Misoprostol has a high effective rate of induction of labour in HDP patients and is an effective uterotonic agent in reducing PPH. This meta-analysis provides clinicians with meaningful information to help them make evidence-based decisions.
Topics: Female; Humans; Hypertension, Pregnancy-Induced; Labor, Induced; Misoprostol; Oxytocics; Oxytocin; Postpartum Hemorrhage; Pregnancy
PubMed: 35432818
DOI: 10.1155/2022/8448690