Cochrane · systematic review · CD014484
Low‐dose oral misoprostol for induction of labour
Kerr, RS, Kumar, N, Williams, MJ, et al. · Cochrane Database of Systematic Reviews · 2021 · Cochrane Library
Pregnancy and ChildbirthAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
49
current version
GRADE rated
48
No studies
1
Included studies
NR
No studies 1 · 2%Ungraded 0 · 0%Very low 23 · 46.9%Low 20 · 40.8%Moderate 5 · 10.2%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Oral misoprostol compared to placebo/no treatment for induction of labour
Population: women with ruptured membranes in the third trimester for induction of labour.
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Vaginal birth within 24 hours Oral misoprostol vs placebo/no treatment | no estimate extracted | NR | No studies |
Caesarean section Oral misoprostol vs placebo/no treatment | RR 0.81 [0.59, 1.11] | 4 studies · 594 participants | Low Downgraded: imprecision |
Uterine hyperstimulation with fetal heart rate changes Oral misoprostol vs placebo/no treatment | RR 5.15 [0.25, 105.31] | 3 studies · 495 participants | Very low Downgraded: imprecision |
Oxytocin augmentation Oral misoprostol vs placebo/no treatment | RR 0.46 [0.38, 0.55] | 3 studies · 495 participants | Moderate Downgraded: risk of bias, imprecision |
Uterine hyperstimulation without fetal heart rate changes Oral misoprostol vs placebo/no treatment | RR 2.06 [0.39, 10.87] | 2 studies · 430 participants | Very low Downgraded: imprecision |
Apgar score less than 7 at 5 minutes Oral misoprostol vs placebo/no treatment | RR 1.11 [0.46, 2.66] | 3 studies · 495 participants | Very low Downgraded: imprecision |
Admission to neonatal intensive care unit Oral misoprostol vs placebo/no treatment | no estimate extracted | 1 study · 130 participants | Very low Downgraded: risk of bias, imprecision |
Oral misoprostol compared to vaginal dinoprostone for induction of labour
Population: women in the third trimester for induction of labour.
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Vaginal birth within 24 hours Oral misoprostol vs vaginal dinoprostone | RR 0.93 [0.87, 1] | 10 studies · 8983 participants | Low Downgraded: risk of bias |
Caesarean section Oral misoprostol vs vaginal dinoprostone | RR 0.84 [0.78, 0.9] | 13 studies · 9676 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Uterine hyperstimulation with fetal heart rate changes Oral misoprostol vs vaginal dinoprostone | RR 0.49 [0.4, 0.59] | 11 studies · 9084 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Oxytocin augmentation Oral misoprostol vs vaginal dinoprostone | RR 0.9 [0.75, 1.09] | 12 studies · 9451 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Uterine hyperstimulation without fetal heart rate changes Oral misoprostol vs vaginal dinoprostone | RR 0.83 [0.72, 0.97] | 9 studies · 8171 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Apgar score less than seven at five minutes Oral misoprostol vs vaginal dinoprostone | RR 0.8 [0.52, 1.23] | 12 studies · 9473 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Admission to neonatal intensive care unit Oral misoprostol vs vaginal dinoprostone | RR 0.8 [0.6, 1.07] | 11 studies · 9278 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Oral misoprostol compared to vaginal misoprostol for induction of labour
Population: women in the third trimester for induction of labour.
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Vaginal birth within 24 hours Oral misoprostol vs vaginal misoprostol | RR 0.81 [0.68, 0.95] | 16 studies · 3451 participants | Low Downgraded: risk of bias |
Caesarean section Oral misoprostol vs vaginal misoprostol | RR 1 [0.86, 1.16] | 32 studies · 5914 participants | Low Downgraded: risk of bias |
Uterine hyperstimulation with fetal heart rate changes Oral misoprostol vs vaginal misoprostol | RR 0.69 [0.53, 0.92] | 25 studies · 4857 participants | Low Downgraded: risk of bias |
Oxytocin augmentation Oral misoprostol vs vaginal misoprostol | RR 1.28 [1.15, 1.44] | 28 studies · 5416 participants | Low Downgraded: risk of bias |
Uterine hyperstimulation without fetal heart rate changes Oral misoprostol vs vaginal misoprostol | RR 0.69 [0.49, 0.99] | 16 studies · 3212 participants | Low Downgraded: risk of bias |
Apgar score less than seven at five minutes Oral misoprostol vs vaginal misoprostol | RR 0.68 [0.46, 1.02] | 21 studies · 4438 participants | Low Downgraded: risk of bias |
Admission to neonatal intensive care unit Oral misoprostol vs vaginal misoprostol | RR 1.03 [0.86, 1.23] | 23 studies · 4450 participants | Moderate Downgraded: risk of bias |
Oral misoprostol compared to intravenous oxytocin for induction of labour
Population: women in the third trimester for induction of labour (200 had ruptured membranes, 317 women had intact membranes and in the remainder the membrane status was not reported)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Vaginal birth within 24 hours Oral misoprostol vs intravenous oxytocin | RR 1.12 [0.95, 1.33] | 3 studies · 466 participants | Low Downgraded: risk of bias |
Caesarean section Oral misoprostol vs intravenous oxytocin | RR 0.67 [0.5, 0.9] | 6 studies · 737 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Uterine hyperstimulation with fetal heart rate changes Oral misoprostol vs intravenous oxytocin | RR 0.66 [0.19, 2.26] | 3 studies · 331 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Oxytocin augmentation Oral misoprostol vs intravenous oxytocin | RR 0.12 [0.02, 0.85] | 3 studies · 261 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Uterine hyperstimulation without fetal heart rate changes Oral misoprostol vs intravenous oxytocin | RR 6 [0.76, 47.6] | 2 studies · 220 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Apgar score less than 7 at 5 minutes Oral misoprostol vs intravenous oxytocin | RR 2.05 [0.27, 15.7] | 4 studies · 527 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Admission to neonatal intensive care unit Oral misoprostol vs intravenous oxytocin | RR 0.65 [0.12, 3.45] | 4 studies · 517 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Oral misoprostol compared to mechanical methods for induction of labour
Population: women in the third trimester for induction of labour.
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Vaginal birth within 24 hours Oral misoprostol vs mechanical methods | RR 1.32 [0.98, 1.79] | 4 studies · 1044 participants | Low Downgraded: imprecision, inconsistency |
Caesarean section Oral misoprostol vs mechanical methods | RR 0.84 [0.75, 0.95] | 6 studies · 2993 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Uterine hyperstimulation with fetal heart rate changes Oral misoprostol vs mechanical methods | RR 1.31 [0.78, 2.21] | 4 studies · 2828 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Oxytocin augmentation Oral misoprostol vs mechanical methods | RR 0.79 [0.65, 0.95] | 4 studies · 2708 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Uterine hyperstimulation without fetal heart rate changes Oral misoprostol vs mechanical methods | RR 0.64 [0.3, 1.38] | 3 studies · 2506 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Apgar score less than 7 at 5 minutes Oral misoprostol vs mechanical methods | RR 1.29 [0.69, 2.39] | 4 studies · 2707 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Admission to neonatal intensive care unit Oral misoprostol vs mechanical methods | RR 1.24 [0.87, 1.76] | 5 studies · 2886 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Oral misoprostol one‐ to two‐hourly compared to oral misoprostol four‐ to six‐hourly for induction of labour
Population: women in the third trimester for induction of labour with intact membranes
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Vaginal birth within 24 hours Oral misoprostol one‐ to two‐hourly vs oral misoprostol four‐ to six‐hourly | RR 0.6 [0.31, 1.17] | 1 study · 64 participants | Very low Downgraded: imprecision |
Caesarean section Oral misoprostol one‐ to two‐hourly vs oral misoprostol four‐ to six‐hourly | RR 1.31 [0.77, 2.22] | 1 study · 64 participants | Very low Downgraded: imprecision |
Uterine hyperstimulation with fetal heart rate changes Oral misoprostol one‐ to two‐hourly vs oral misoprostol four‐ to six‐hourly | no estimate extracted | 1 study · 64 participants | Very low Downgraded: imprecision |
Oxytocin augmentation Oral misoprostol one‐ to two‐hourly vs oral misoprostol four‐ to six‐hourly | RR 1 [0.59, 1.68] | 1 study · 64 participants | Very low Downgraded: imprecision |
Uterine hyperstimulation without fetal heart rate changes Oral misoprostol one‐ to two‐hourly vs oral misoprostol four‐ to six‐hourly | RR 4 [0.92, 17.4] | 1 study · 64 participants | Very low Downgraded: imprecision |
Apgar score less than 7 at 5 minutes Oral misoprostol one‐ to two‐hourly vs oral misoprostol four‐ to six‐hourly | no estimate extracted | 1 study · 64 participants | Very low Downgraded: imprecision |
Admission to neonatal intensive care unit Oral misoprostol one‐ to two‐hourly vs oral misoprostol four‐ to six‐hourly | no estimate extracted | 1 study · 64 participants | Very low Downgraded: imprecision |
Oral misoprostol 20 µg hourly titrated compared to oral misoprostol 25 µg two‐hourly static for induction of labour
Population: induction of labour.
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Vaginal birth within 24 hours Oral misoprostol 20 µg hourly titrated vs oral misoprostol 25 µg two‐hourly static | RR 0.97 [0.8, 1.16] | 2 studies · 296 participants | Low Downgraded: risk of bias |
Caesarean section Oral misoprostol 20 µg hourly titrated vs oral misoprostol 25 µg two‐hourly static | RR 1.66 [0.63, 4.32] | 2 studies · 296 participants | Very low Downgraded: risk of bias |
Uterine hyperstimulation with FHR changes Oral misoprostol 20 µg hourly titrated vs oral misoprostol 25 µg two‐hourly static | RR 3 [0.12, 72.45] | 1 study · 146 participants | Very low Downgraded: risk of bias |
Oxytocin augmentation Oral misoprostol 20 µg hourly titrated vs oral misoprostol 25 µg two‐hourly static | RR 1.04 [0.85, 1.27] | 2 studies · 296 participants | Very low Downgraded: risk of bias |
Uterine hyperstimulation without FHR changes Oral misoprostol 20 µg hourly titrated vs oral misoprostol 25 µg two‐hourly static | RR 4 [0.88, 18.2] | 1 study · 146 participants | Very low Downgraded: risk of bias |
Apgar score less than 7 at 5 minutes Oral misoprostol 20 µg hourly titrated vs oral misoprostol 25 µg two‐hourly static | RR 1 [0.32, 3.16] | 2 studies · 296 participants | Very low Downgraded: risk of bias |
Admission to NICU Oral misoprostol 20 µg hourly titrated vs oral misoprostol 25 µg two‐hourly static | RR 1.38 [0.57, 3.31] | 2 studies · 296 participants | Very low Downgraded: risk of bias |