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Updated: May 14, 2025
Contractility Measurements of Human Uterine Smooth Muscle to Aid Drug Development
Published on: January 26, 2018
Misoprostol Versus Oxytocin for the Prevention of Postpartum Haemorrhage: A Systematic Review and Meta-Analysis
Madeline Flanagan1, Nicole Au1, Malitha Patabendige1,2
1Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash University, Clayton, Victoria, Australia.
Background:
Postpartum haemorrhage (PPH) is the leading cause of maternal mortality. Uterotonics are the mainstay of PPH prevention.
Objectives:
To compare the efficacy of misoprostol and oxytocin for the prevention of PPH and to evaluate the trustworthiness of these randomised controlled trials (RCTs).
Search Strategy And Selection Criteria:
Seven databases were searched for peer-reviewed literature meeting the inclusion criteria of RCTs comparing misoprostol and oxytocin for the prevention of PPH.
Data Collection And Analysis:
Data were collected by two independent reviewers. Individual participant data (IPD) were meta-analysed for outcomes PPH ≥ 500 and ≥ 1000 mL. RCTs that did not share IPD were classified as trustworthy or not, and aggregate data were meta-analysed according to trustworthiness.
Main Results:
Of 79 eligible RCTs, 10 (12.7%) provided IPD, of which 6 were included. Analysis of IPD showed PPH ≥ 500 mL to be significantly higher in the misoprostol than in the oxytocin group (2022 participants, aOR 1.84, 95% CI 1.43-2.34). For PPH ≥ 1000 mL, analysis of IPD showed that misoprostol and oxytocin were comparable (2022 participants, OR 1.14, 95% CI 0.68-1.91). Of the 69 studies that did not provide IPD, 23 (33.3%) were assessed as trustworthy. Analysis of trustworthy data (IPD and 23 aggregate data RCTs) showed no difference between misoprostol and oxytocin for PPH ≥ 500 mL (24 334 participants, OR 1.01, 95% CI 0.69-1.49), while misoprostol was associated with a significantly increased risk of PPH ≥ 1000 mL compared to oxytocin (25 249 participants, OR 1.36, 95% CI 1.16-1.59).
Conclusions:
Of 79 RCTs comparing misoprostol and oxytocin for the prevention of PPH, 36.7% met trustworthiness criteria. Oxytocin is comparable to misoprostol for preventing PPH and may be superior for preventing severe PPH.
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