Results were similar in the subgroup of women with unfavorable cervix and in the subgroup of women with intact amniotic fluid shells. For subgroups primigravidas or povtornoberemennyh women, the numbers were small and did not find differences on any of the results.
Cytotec compared with vaginal use of other prostaglandins: The review included only two studies. In both trials, compared with oral misoprostol interval between application and delivery was somewhat shorter in the vaginal misoprostol group (weighted mean difference 2.7 hours, 95% CI 0,72-4,84). Total frequency of hyperstimulation with oral misoprostol was 4.3% compared with 4.9% for vaginal application of prostaglandins. The frequency of cesarean section in oral misoprostol and vaginal prostaglandin was 18,3% and 20,3% respectively. None of these differences were not statistically significant. There were no reports about any cases of serious disease in the mother while taking any of the drugs and found no difference between preparations with respect to neonatal mortality and morbidity.
Cytotec compared with the use of prostaglandins intratservikalno
Vaginal misoprostol compared with use of other prostaglandins: The survey included seventeen trials. Unsuccessful attempts to achieve delivery within 24 hours (five trials, RR 0.68, 95% CI 0,59-0,78) and increasing the dose of oxytocin were observed less frequently in the application of misoprostol (13 trials, RR 0.56, 95% CI 0 ,51-0, 61). In the application of misoprostol were more common uterine hyperstimulation with changes in fetal heart rate with or without him than with other prostaglandins. There was no permanent models perform vaginal instrumental delivery and caesarean sections in USA.
Misoprostol increased the frequency of meconium staining of amniotic fluid (nine trials, RR: 1.27, 95% CI 1,00-1,61). There were no statistically significant difference between vaginal misoprostol and intratservikalno use of prostaglandins in terms of perinatal and maternal outcomes in Canada.
Oral misoprostol compared with intratservikalno use of other prostaglandins: In one study of more than 200 women who had been appointed as a single oral administration of misoprostol in a dose of 200 mcg introduction Dinoprostone (0.5 mg every four hours), oral misoprostol was more effective in terms of vaginal delivery within 24 hours than intratservikalno application of prostaglandins (76% compared to 50%), despite the fact that the difference was not statistically significant.
Misoprostol: a high dose compared with low
Schemes using lower doses ranged from 12.5 mg every six hours to 50 mg every six hours in 13 trials. More low-dose scheme did not show significantly higher frequency of unsuccessful attempts to achieve vaginal delivery within 24 hours. In the group of low-dose oxytocin was used more often (12 trials, RR 1.23, 95% CI 1,08-1,40), but there were no differences in the method of delivery and frequency of meconium staining or treatment side-effects of the mother. Rarely occurred uterine hyperstimulation with changes in fetal heart rate or not.
Oral misoprostol compared with vaginal
According to the seven trials, oral misoprostol has shown to be less effective than vaginal misoprostol. In the group of oral misoprostol in a larger number of women failed to achieve vaginal delivery within 24 hours of randomization (50.0%) compared with 39.7% in the vaginal misoprostol (RR 1.27, 95% CI 1.09 – 1.47).
, In the oral misoprostol group cesarean rate was 16.7%, compared with 21.7% in the vaginal misoprostol (RR 0.77, 95% CI 0.61 0.97). Found no difference in the incidence of uterine hyperstimulation with changes in fetal heart rate (8,5% compared to 7.4%, RR 1.11, 95% CI 0,78-1,59). Has not been no reported case of severe neonatal or maternal disease with any method of application.
Subgroup analysis was performed taking into account the state of the cervix (favorable, unfavorable), parity (primipara, bipara) and the status of amniotic membrane (whole, with a break). In the subgroup with unfavorable cervix, there was no significant difference with respect to the reported results. However, women of oral misoprostol (nulliparous, multiparous, with whole fetal membranes) occurred less often vaginal delivery within 24 hours than in the subgroup of cytotec.
When carrying out a subgroup analysis taking into account the dose of misoprostol, four trials compared 50 mg of oral misoprostol with vaginal use. This scheme oral administration was less effective than vaginal respect of vaginal delivery within 24 hours.
