Labour induction with prostaglandins: a systematic review and network meta-analysis

Area of Science:

• Obstetrics and Gynecology
• Reproductive Medicine
• Clinical Pharmacology

Background:

• Prostaglandins are commonly used to induce labor and ripen the cervix.
• Evidence on the comparative effectiveness and safety of different prostaglandin regimens is crucial for clinical practice guidelines.

Purpose of the Study:

• To systematically review and meta-analyze the effectiveness and safety of prostaglandins for labor induction.
• To compare various prostaglandin formulations, doses, and administration routes.

Main Methods:

• Systematic review and Bayesian network meta-analysis of 280 randomized clinical trials (48,068 women).
• Included studies compared prostaglandins against placebo, other prostaglandins, or different doses/administration routes.
• Assessed outcomes included rates of Cesarean section, vaginal delivery within 24 hours, and uterine hyperstimulation.

Main Results:

• Low-dose (<50 µg) titrated oral misoprostol solution showed the lowest probability of Cesarean section.
• Vaginal misoprostol (≥50 µg) demonstrated the highest probability of achieving vaginal delivery within 24 hours.
• Maternal and neonatal mortality/morbidity data were limited; hyperstimulation outcomes showed inconsistency.

Conclusions:

• Low-dose oral misoprostol is associated with reduced Cesarean section risk.
• Higher-dose vaginal misoprostol is more effective for achieving timely vaginal delivery.
• Findings inform labor induction guidelines and future research priorities.